The true cost of food & the game-changing strategy to account for it

Health Care Without Harm
3 min readSep 21, 2021

James Beard Award-winning chef and best-selling author Mark Bittman’s new book, Animal, Vegetable, Junk, is a sweeping view of our food and agriculture systems, which are negatively impacting our health and the environment. Bittman details how hospitals and other institutions can help transform the market to benefit people, communities, and the planet.

Like a recent report from the Rockefeller Foundation, Bittman’s book exposes the hidden costs of unhealthy and unsustainable food. Although the United States spends around $1.1 trillion per year on food, the true cost once these impacts — rising health care costs, climate change, and biodiversity loss — are factored in is much higher: more than $3.2 trillion per year.

As the pandemic continues and rates of food insecurity and diet-related chronic disease rise further, the benefits of sourcing more local, sustainable, and equitably produced food products have never been more clear. These challenges have spurred interest within institutions to shorten their supply chains.

The new standard

Spending more than $130 billion annually on food, institutional food service represents a powerful leverage point for a better food system.

The market is currently governed by a complicated purchasing system, in which each sector requires producers to meet their own definitions of local, sustainable, ethical, and healthy products. A common food purchasing standard, shared by hospitals, universities, and municipalities, promises to solve these problems.

Anchors in Action, a national cross-sector partnership, is currently building this new standard. The partnership represents 1,800 hospitals, 57 public institutions in 23 major cities, 7,800 schools, and 100 colleges across the country and is led by Health Care Without Harm, Practice Greenhealth, the Center for Good Food Purchasing, and Real Food Challenge.

The food purchasing standard will enable institutional collaboration and inspire supply chain shifts, improve public and environmental health, and strengthen the economic vitality of communities.

This institutional food market transformation strategy, which Bittman features in his latest book, could lead to a new era of values-based purchasing for the nation’s largest buyers.

Overcoming historical challenges

While the volume of food community institutions purchase in a given year represents huge contracting opportunities in the marketplace, current institutional pricing structures and limited food and beverage budgets leave small- to mid-scale sustainable food producers and processors out of the equation.

Essentially, they are unable to compete for institutional contracts, expand their infrastructure to take on larger contracts, and make a living wage. These issues are even more pronounced for producers and processors whose racial or ethnic communities have endured decades of systemic racism in our food and agriculture systems.

Current pricing structures and budgets limit institutional food service staffs’ ability to shift their purchasing toward more local, sustainable, and equitable food. Often institutions expect to be able to pay lower prices that do not take into account the “true cost of food.”

Building strong regional food systems

Institutional procurement and investment in strong regional food systems can generate many community benefits and positive impacts. Designed properly, regional food systems can play a major role in climate resilience.

Anchor institutions, such as hospitals, can redirect their procurement dollars to help

  • foster the growth of local food economies and community access to healthy food,
  • afford a living wage to food producers and processors,
  • shorten supply chains, reduce greenhouse gas emissions, and
  • decrease air and water pollution that result from conventional animal agriculture and transportation.

Institutional healthy food purchasing can transform the marketplace and build a healthy food system if the budgets are in place to do so. This will require institutions to focus on internal financial collaboration and to be willing to pay more for the food they serve. When making food purchasing decisions, health, social, economic, and environmental benefits all need to be taken into account.

Health Care Without Harm is calling upon health care and other institutions to inform the development of the new standard. Anchor institutions will need to follow through by mobilizing resources to pay the true cost of food upfront, so our patients, communities, and environments are not paying that cost down the line.



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.