Public hospitals, in addition to treating patients and injuries, are also workplaces that can have a positive or negative impact on the health and well-being of their staff. To promote a healthier workplace, it is important to ensure that workers and visitors have easy access to healthy foods and to limit the availability of junk food.
In 2011-12 public hospitals employed nearly 271,000 full-time equivalent staff. Around 45% are nurses who have a greater rate of obesity in their communities.
Healthy lifestyle programs in the workplace are a great way to change this. However, they require time and a multifaceted strategy. Their most important characteristic is that they provide an environment that supports healthy food choices.
A dire state
Public hospitals are notorious for their unhealthy food environments. You don’t need to go far to find vending machines, despite what you may or may not find in the hospital food outlets.
These machines offer food and drinks that are high in sugar or salt but low in nutrients. Water and sugar-free drinks are often available, but they may not be prominently displayed.
We know that healthy vending machine options encourage people to make better nutritional decisions without compromising revenue volume. The Australian National Preventive Health Agency produced guidelines for healthy Vending Machines based on this evidence.
Most state health departments, including Queensland, South Australia, New South Wales, Western Australia, and Victoria, released their policies on healthy eating and drinking choices for hospital staff and visitors long before the ANPHA guidelines.
All of these policies use a traffic light system, where healthy foods are labeled green, and junk food is marked red.
Red-labeled foods cannot be sold in super-sized portions, advertised, or offered at points of sale. They also can’t make up more than 20% of the food and beverages displayed, even in vending machines. Yellow-labeled food is somewhere between the best choices and the worst.
This approach is proven to work by research. In the large cafeteria of the Massachusetts General Hospital, Boston, for example, traffic-light labeling of food and beverages was associated with an improvement in the sales of healthier foods and a reduction in the sales of less healthy ones.
The trend continued for the entire two-year period of the Evaluation. How are Australian policies performing?
Public hospitals are dotted with vending machines. Emil Jeyaratnam/The Conversation
South Australia’s Example
South Australian Department of Health published its first policy document on October 8, 2008. A March 17, 2011 update by SA Health has been marked as “Directive,” for which “Compliance Is Mandatory.”
The directive explains in great detail what is meant by “healthy food and drink.” The directive aims to make sure that healthy food and drinks are available everywhere food and beverages are offered or sold in SA health facilities.
There are no benchmarks or specifics for this. Healthy choices should be prominently advertised and displayed.
There should be less junk food available, and it should be displayed discreetly rather than tempting customers when they pay for their food at the register. After hours, it must be easy to find healthy food and drinks, and there should be plenty of water available. The policy includes vending machines.
The initiative’s directive nature and the principle that underlies it is commendable. As far as I am aware, the initiative’s effectiveness has not been audited.
On a recent stroll around the South Australian Hospital where I work, I noticed that vending machines displayed water more prominently than sweetened drinks.
The snack options were neither healthy nor labeled. The main hospital cafeteria offered a limited selection of salads but otherwise did not comply with the policy.
Public health policies that are well-intentioned and courageous require stakeholders to be educated, committed, and buy-in. They also need procedures for evaluating and dealing with noncompliance.
It can be incorporated into the tendering process for vending machine and food outlet contracts, or it can take the form of informal feedback and monitoring, encouragement, and education. It is also necessary to conduct regular formal audits.
Public hospitals are responsible for promoting the health and wellbeing of their employees and demonstrating public health initiatives. The people who visit hospitals deserve to have better choices in food.
The state health department’s and ANPHA’s initiatives could be very beneficial if they were properly implemented. State health departments have now formulated directives for public hospitals to follow.