(not) healing with hospital foods
the limitations of food as medicine in industrial spaces
“Just put some frozen cabbage on your boobs, it will help with the pain of drying out your milk supply!” said the public health nurse, cold calling me for a postpartum check-in on a late Tuesday morning.
This cabbage advice was one of many food-related tricks gifted to me from those with infinitely more wisdom about parenting, pregnancy, and postpartum than myself. There were whispers through the mother-vine in my phone: try dates for ripening your cervix ahead of labour, try pineapples for healing, try avocado and bananas for postpartum digestive relief.
Each of these piqued a curiosity — that food could play a healing role in the isolation of postpartum (though much healing is isolating). When you have a baby, there is ample monitoring and expectations communicated around your newborn’s health, but a postpartum body is usually left to their own recovery devices, and contradictory advice abounds. Given that everything and nothing is situated in a range of “normal” for postpartum health, turning to food and vitamins as medicinal feels reasonable, as though a semblance of control can be maintained in the chaos of new life.
But food isn’t always medicine — in a hospital setting, food can also just be bad. The juxtaposition of food as medicine and food as insult was made clear to me during my labour and delivery: cold, pre-packaged egg salad sandwiches and sludge-soups, dry and tangy potato wedges that would make my ancestors roll in their graves, and thick syrupy grape juice out of a hard-to-open peel cup. These meals (a generous description) ran counter to the thoughtful care I received from the nurses and doctors in the family birthing unit. Instead, hospital staff reluctantly and quietly rolled the dishes in. They knew, with full exasperation, that these plates wouldn’t be touched by most patients, only adding to the meal discards growing like scaffolding in the hallway.
Why is bad food served in a place meant for recovery? This made me question how we situate health in a hospital, particularly in an time of social service budget cuts and a booming industry of alternative healthcare practices. Looking at hospital foods can provide a lens to understand the values eschewed from hospitals around care and medicine. How do hospital foods speak to our understandings of health, healing, and care? Is food able to be medicine in institutional spaces?
“death by a thousand budget cuts”
Medically, health can take a rigid definition: the absence of illness, or the successful treatment of an isolated part of a body. How do we understand care, then, in medical settings — and does this change based on where we are, particularly within a hospital?
Both biomedical and holistic healthcare are needed, necessary, and important. There are many of us who would not be alive today were it not for antibiotics — and there are many of us who do not feel seen, heard, or believed in medical settings. These tensions understandably lead many to pursue alternatives for health. Sometimes this is through diet, sometimes this is through practices (exercises, conversations, belief systems), and sometimes there are dangerous or radical streams that go too far (e.g., the silver colloidal poisoning in the Love is Won cult).
To understand the role and value of food in hospital spaces, it is necessary to understand the value of a dollar — particularly how much that dollar will be stretched politically. Joshna Maharaj, a chef and food activist in Toronto, has spent many years looking at the roles of food in institutional settings. In her book Take Back the Tray: Revolutionizing Food in Hospitals, Schools, and Other Institutions, she explicitly identifies why institutional food quality has declined:
“The responsibility for these problems lies within an institutional culture that holds food at a very low priority. This culture is partly the result of a slow death by a thousand budget cuts over the last couple of decades and the tone set by government.”
Maharaj looks at the priorities of the provincial government in Ontario, Canada, but points out similar trends across Canada, and parallels throughout the United States. In Ontario, 1990s conservative governments substantially slashed budgets across healthcare, education, and social services to balance deficits. As Maharaj points out, “the health care sector was not told specifically where the cuts should happen, and because food in hospitals is considered little more than an irritating necessity, food and nutrition services budgets took some of the biggest hits.”
What we see now in 2020s Ontario is the exacerbation of these earlier cuts. What was once stripped is now seen as profitable opportunity. Ontario premier Doug Ford has led a years-long ouroboros campaign: slashing hospital budgets, creating a healthcare “crisis,” and proposing legislation to allow for private clinic treatments to “take the burden off hospitals.”
Ford’s privatization goals extend further – closing popular public park spaces (such as Ontario Place) to (illegally) build internationally-owned luxury spas is as transparent as it gets. While green spaces may be good for the body and soul, Ford wants to remind you that paying for health is the only option in his economy, and a luxurious one at that.
When a governing body sees food as irritation and health as luxury, it devalues any social, cultural, or spiritual meanings that food holds and disintegrates its connection to healthcare. In these for-profit times, gutted healthcare means that dignity during illness is thrown out the hospital window. Because of this, our contemporary hospital foods are a visual (and arguably visceral) reminder of what is prioritized: industry.
Industrial foods are an advent of the post-WWII scene, reducing the labour and resources needed so that eating could become mechanized and fall within governmental budgets. The emphasis on convenient and pre-packaged industry foods within Canadian hospitals demonstrates a universalist approach to food’s role in health, where food contractors like Sysco and Aramark are king. This has meant that food as therapy or medicine is not considered as integral to health. How do we reconcile the people and movements within these institutions advocating for better quality of food and care, as Maharaj does, while also recognizing that our governments have long deprioritized comprehensive health care that values staff, patients, and community?
hospitals as landscapes, kitchens as sites of care
Anthropologist Alice Street makes the case for hospitals as a place of social projects, particularly in countries that have been subjected to years of colonial and postcolonial exploits from the Western world. To be a social project, a hospital space becomes associated with efforts to maintain some form of improvement, usually linked to either a national health metric, or a way of contributing to strengthening nation-state infrastructures.
For these social health projects to be successful, the hospital space is recognized as a formal institution that is deeply situated in a localized time, place, and viewpoint. That way, “personal transformations can take place within them” while abiding by broader nationalistic transformation visions. Street acknowledges that engineering hospital landscapes as place of social improvement becomes complicated when colonial administrations are reimagined:
“The perpetual orientation to the future has created a landscape scarred with the physical remnants of successful interventions… the hospital landscape makes both anticipated futures and past interventions present to those who inhabit it.”
If a hospital’s physical presence through time contributes to an individual transformation so much as it plays into the visions of a national project, that does not bode well for the privatized Canadian hospital. Food’s role in maintaining a nationalist landscape and social project play out clearly here. As Maharaj describes in her book, it looks like sloppy plates stained from being jostled through hallways, after frozen and mega-packaged freeze-dried shipments are re-thermed in a hospital basement. These are hardly aspirational for strong, healthy citizens.
Street argues that hospitals elicit emotions that are attached to nation-state ideologies and boundaries. Theoretical emotions aside, hospitals elicit a lot of very real emotions, too: the transformation of person to parent, of wife to widow, of person to illness. While it may not be in the government’s budgetary best interest, these personal emotions and transformations interact with the foods being provided. After a long night waiting for a family member to get out of emergency surgery, a strong cup of coffee can be a reprieve. A chocolate popsicle can act as a hug for a kid who’s spent the day having their brain tested in loud and nerve-wracking CT scans (I speak from experience).
Food’s power to provide care is framed as an unspoken practice by anthropologists Emily Yates-Doerr and Megan Carney. They argue that referring to health solely through a focus on spoken word is unsatisfying, as the work done in kitchens to cook, eat, and maintain understandings of health does not always “proceed in words.” Their work challenges the idea that healthy eating is exclusively an individual person or location — health can be dispersed across collectives, and kitchens can be de-medicalized spaces from where health is explored more robustly. They invoke the importance of caring through food, and setting intentions for health that are “encompassed by practices, responsibilities, and rituals intersecting in the kitchen.”
The hospital kitchen still plays an important role in the care that patients experience. While the foods being prepared there (or reheated) may not be in an entirely edible form, the consequences for healing are still informed by their existence and perception by staff and patients alike.
consequences for healing
Chefs and dieticians tend to position the pathway of patient recovery through “good, wholesome” food in hospital care. But people are simply not eating hospital foods. The ramifications are that patients are not being appropriately nourished, and much food is being wasted.
As Maharaj points out throughout her book, what constitutes wholesome food may vary by perspective — she observes dieticians struggling with her desire to add butter to Red Fife biscuits for a hospital menu, or negotiating the joy that a diet Coke might bring for a cancer patient losing taste during chemo. Maharaj acknowledges the tremendous challenge of creating meals when team members are diametrically opposed in practice, theory, and expertise fields, and doesn’t ignore that these will continue to shape how a hospital kitchen functions.
While nutrients are important for health, culturally appropriate foods matter too. Abiding to a patient’s dietary restrictions can provide mood boosts that are supportive of strong recoveries. During my recent stay, my lactose intolerance was surprisingly cared for, through the provisions of soy milk for cereal, and a vegan banana loaf as a snack. It’s not nothing! It was respect, which is an important, if forgotten, component of care that can build trust. If patient limitations or abilities are respected, then wellbeing is being accounted for.
For those with religious dietary requirements, or for those whose cultural foods play a strong role in health experiences, these matter tenfold. How would someone who requires halal foods feel if they were stuck in a hospital bed for not afforded this decency? How can you get better if you are not able to eat anything?
Other important considerations around physical abilities are challenged by industrial foods. Anecdotally, my hands became so swollen that I had difficulty opening my water bottle, so tightly shrink-wrapped lunch foods was too much of an effort to bother with. While mine was a temporary condition, for those who are battling chronic illnesses and lengthy hospital stays, each day where food is inaccessible is another day where food is inedible, and energy devoted to healing suffers from it.
When these aren’t valued, food quality deteriorates, and food waste becomes a significant challenge for hospitals in countries like Canada, the U.K., and the U.S. It seems that it would be more cost effective to cook meals patients would actually eat, to reduce risks of malnutrition and food waste costs. Yet the values exuded from the hospital as institution make it abundantly clear that it is better to make and waste shitty, pre-packaged hospital foods than to show care through good food (in whatever form that takes).
food as care and compromise
I do not trust that the in-hospital Tim Hortons bagel with a thiccccc layer of cream cheese my dad purchased for me has much in the way of nutritional value or complexity – but it was good for my soul. After 24 hours of not eating, this is important in its own way, outside of nutritional or biological requirements. While it’s not great that this food was outsourced to a third-party provider, I know the Tim Hortons bagel will always taste the same: plain, digestible, warm. The sludge-soup, though? It only evoked disgust and frustration in me.
If food plays a role in hospital care, advocating for more compromise in how it’s made is a needed step to combat privatization. There may not be a swift return to fresh cooking in hospital kitchens, but at least some negotiations around food that matters to people, or food that isn’t destined for the bin. Maybe that means serving a banana with a note about its benefits for a postpartum person, or working with local farmers to determine which foods could be stored, frozen, and built into a smaller budget.
How can we create more space for regional dependence, community, and care in hospitals? I’m not totally sure, but I do have a suspicion it would mean holding government a bit more accountable, too.
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