Sourcing meat raised without antibiotics. If A&W can do it, why can’t Canadian hospitals?

Blue skies for cows (Sabine/flickr)

By Jennifer Reynolds, Food Secure Canada, and Stacia Clinton, Health Care Without Harm

Health care facilities are on the front line of dealing with antibiotic resistance, named a global health threat by the World Health Organization. Each year in Canada, more than 18,000 hospitalized patients acquire infections resistant to antimicrobials and the “total medical care costs associated with antimicrobial resistant infections have been estimated at $1 billion” annually. However, health care facilities aren’t flexing one of their biggest muscles that could help address antibiotic resistance: their food purchasing power and influence.

Let’s dig into how leveraging the $4 billion spent on food services by health care could help address antibiotic resistance and what we can learn from Health Care Without Harm’s work with U.S. hospitals.

First of all — what’s antibiotic resistance?

Antibiotic resistance happens when bacteria change and become resistant to the antibiotics used to treat the infections they cause. The overuse and misuse of antibiotics — for example, patients not completing their antibiotic medication regimens and antibiotic overuse in food production — causes this resistance. This resistance is now spreading through the environment, animals and humans. Some microbes now have a combination of multiple types of resistance and have become termed drug-resistant “superbugs.” This all adds up to a frightening near future of a pre-antibiotic era where we are unable to treat ordinary infections.

If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.”

— Chief Medical Officer, UK, Professor Dame Sally Davies

Cartoon inforgraphic explores the connection between food and antibiotic resistance (World Health Organization)

What is the difference between antibiotic and antimicrobial resistance?

Antibiotics are medicines used to prevent and treat bacterial infections. Antimicrobial resistance (AMR) is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV) and fungi (e.g. Candida).)

The good news is that we can still act to reduce the pressure of resistance developing by reducing and managing antibiotic use. In Canada, roughly 30 percent of antimicrobials are used by humans in comparison to 70 percent in food production. Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Strategy for Action (2017) outlines a number of actions underway in both health and food sectors. For example, hospitals are implementing stewardship programs, campaigns like “Do Bugs Need Drugs?” are raising awareness about wise antibiotic use by Canadians, and more monitoring is in place to track the development and spread of resistance.

Food purchasing: An overlooked strategy

However, a significant strategy has been overlooked. What if we put our money where our mouth is, literally?

A&W announced they would be sourcing chicken raised without antibiotics back in 2014, developing a supplier program to meet their demand. Other fast food chains are now jumping onto the antibiotic-free bandwagon. We could similarly leverage the purchasing power of health care food services to incentivize fish and animal producers to reduce antibiotic use. Strategically directing health dollars in this way can create a virtuous circle where health care providers are helping to mitigate this health crisis and its costs. Increasing demand from purchasers will be instrumental in the transition for food producers towards a market for meat raised without antibiotics, particularly for early adopters.

“Each purchase made to support reduction of antibiotic use in agriculture can help make a difference by promoting change in both policy and practice”

— Tertro, J. (2014, Nov 14) Agriculture industry must kick dangerous antibiotic habit. Globe and Mail.

Do I need to be concerned I am consuming antibiotics in my food?

The primary concern is not that we are exposed to antibiotic residues in our food. Levels of antibiotic residues are regulated by the Canadian Food Inspection Agency. Rather it is the overuse in general that is generating resistant superbugs that the public is exposed by various routes that are the public health threat.

Making the business case to invest upstream in antibiotic stewardship

So how does this play out at the facility budget level for Canadian institutions? The University of Vermont Medical Center (formerly known as Fletcher Allen Health Care) offers a case study. The cost to switch to a line of chicken products raised with the routine use of antibiotics was $75,000. The cost of treating just one patient with a resistant bacterial infection like MRSA (Methicillin-resistant Staphylococcus Aureus) in their facility is almost the same amount. By taking a whole-hospital cost accounting approach, the upstream investment in purchasing meat raised without antibiotics to help address this huge challenge seems pretty reasonable.

Unfortunately, many food service directors do not have the ability to access large food budget increases. Instead, they are learning how to intervene through changes to menus so they can purchase the typically higher-priced meats raised without antibiotics using “less meat, better meat” strategies.

Less meat, better meat: Getting to the early majority

Canada can look to the successes of Health Care Without Harm through their Healthy Food in Health Care program in the United States, where they are harnessing the purchasing power, expertise, and voice of the healthcare sector toward the development of a sustainable food system. One of the core initiatives of this program addresses is antibiotics in animal agriculture.

Chef-physician duo at Virginia Mason Memorial, Washington show off their entry to the Health Care Culinary Contest (Veggie Fit Kids)

To elevate the respected voice of health professionals, Health Care Without Harm joined forces with the Pediatric Infectious Diseases Society, U.S. Public Interest Research Group and the Sharing Antimicrobial Reports for Pediatric Stewardship group to form Clinician Champions in Comprehensive Antibiotic Stewardship. This collaborative works to increase knowledge within the clinical community of the link between antibiotic resistance and antibiotic use in agriculture and to promote policy action. Since it started in 2014, the collaborative has led education for health professionals with opportunities centered around health and agriculture policy and started the annual Antibiotic Awareness Week to orient the health care community to the urgency to act.

Pressure from health care facilities and professionals has had an impact. Sales of antibiotics used in food-producing animals decreased by 10 percent between 2015 and 2016, according to the U.S. Food and Drug Administration. This is the first time sales of antibiotics have declined since the FDA started tracking these numbers in 2009.

To date, most of the progress has been made in poultry production. Health Care Without Harm will be turning its attention to beef and pork sectors, seeking to synergize efforts with educational institutions and grocery retailers to use education, purchasing and international alliances to affect change.

Next steps in Canada

The World Health Organization and the Canadian government stress the importance of taking a One Health approach to address antibiotic resistance as humans, animals and the environment are inextricably linked with each other. It makes sense to leverage all of Canada’s health care’s resources, including its food purchasing power, to address this significant health issue.

Canadian health care facilities and health professionals can start to integrate food purchasing as part of their antimicrobial stewardship initiatives using a toolkit provided by Clinician Champions in Comprehensive Antibiotic Stewardship collaborative. More supports are needed to encourage whole-hospital efforts that engage many stakeholders including patients, food services, clinical teams and the C-suite. One way to help scaling out to all facilities could be to incorporate health care facility food purchasing into Accreditation Canada’s Required Organizational Practices (ROPs) for Antimicrobial Stewardship.

Health care’s responsibility for antibiotic stewardship should include reducing use of antibiotics by food producers as part of the bigger picture of reconnecting food and health. We can address our many challenges and turn them into opportunities by serving fresher, healthier and more sustainable food in care that better supports patient, staff and community well-being.

This is a repost of an article published by Nourish Canada.



Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.

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Health Care Without Harm

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.