“It is possible that some of the best public health tools we have are a sharp chef’s knife, a cutting board, and a salad spinner.” – Dr. Preston Maring
Dr. Preston Maring is nationally known for connecting good food to health through his work at Kaiser Permanente. While his clinical practice was in the field of obstetrics and gynecology, Maring had the opportunity to support other specialties as well. He helped start an innovative pediatric neurosurgery program that has treated children from around the world. But he is most recently known for his passion for connecting local food to institutions.
His creative ideas led to a farmers market at the Kaiser Permanente Oakland Medical Center, an idea that spread to more than 50 Kaiser health facilities in seven states. Since retiring from Kaiser Permanente, Maring has joined UC San Francisco’s Program on Reproductive Health and the Environment as an associate adjunct professor. In this role, he is working with Health Care Without Harm and the Community Alliance with Family Farmers (CAFF) to help create the partnerships that could bring more locally-sourced fruits and vegetables to hospitals, schools and universities. Maring – an enthusiastic cook – wrote a cooking blog for about 10 years that received up to 50,000 hits a month, and believes that providing educational resources to help build cooking skills is critical.
A former W.K. Kellogg Food and Society Policy Fellow, Maring’s work focuses on linking local food systems to institutions, helping to improve community health and economic capacity and promoting “good food” as the fundamental building block for good health.
He makes his home in the Bay Area.
We caught up with Dr. Maring recently for a conversation about the connection between food and health.
Q: You’ve created some models that have been vital in linking local food systems to institutions, and promoting good food as the fundamental building block for good health. Can you tell us a bit about the work you’ve done? What was the biggest obstacle you had to overcome?
A: In 2003 we started one of the nation’s first hospital-based farmers markets at the Kaiser Permanente Medical Center in Oakland in partnership with the Pacific Coast Farmers Market Association. People “go to” most community markets. There we brought a market to where people of all kinds gathered. The market was of benefit to the staff, our patients, hospital visitors, the surrounding neighborhood, and the farmers.
The idea was simple. I thought it might be hard to walk by a bunch of fresh asparagus in the spring or pass up a perfect peach in mid-summer.
The idea caught on. There are now 56 markets at or sponsored by Kaiser Permanente in seven states and Washington, D.C. And there are many other markets at hospitals around the country.
There were no significant obstacles, as facility leaders understood the obvious connection between food and health.
Q: Was there a big “aha” moment for you in terms of your work?
A: Connecting existing institutions and resources in new ways is often easier than creating a system from scratch. Potential shoppers congregate at hospitals, the market association has the management know-how, farmers appreciate the additional marketing opportunity mid-day on a weekday, and health care gets to demonstrate the importance of food to our health.
Q: Can you tell me more about your philosophy of food as Rx?
A: I try to keep this simple and usually don’t think about food as medicine. Prepare fresh whole foods for yourself, family and friends with a focus on vegetables, fruits, whole grains, legumes, nuts, occasional lean animal protein, fish, lower fat dairy or nut milks, a few eggs.
Only about 17 percent of the U.S. population eats even five servings of fruits and vegetables daily so this diet is a good place to start for many.
There are others in our population, however, with serious chronic diseases. For them a more strict plant based diet can serve as “medicine” and reduce their need for some of the multiple drugs they may be taking.
I personally don’t preclude anything from my diet but choose to eat far less meat than the 75 pounds of red meat and 57 pounds of chicken eaten by the average American each year. One can do the math for a family based on the annualized dollars per pound cost of animal protein and just maybe come up with a few hundred extra dollars for really healthy and tasty produce.
Also, I do believe that how food is grown can have not only significant environmental effects on the earth, but also on the consumer and the people who grow it, so I support buying organically produced food whenever possible.
Dr. Brenda Eskenazi’s work out of the UC Berkeley School of Maternal and Child Health on the CHAMACOS study tells the Salinas Valley story about why this matters. About 80 percent of the salad greens eaten in America are grown there and the Salinas River may be the third most polluted river in the country.
Also, the work out of the UCSF Program on Reproductive Health and the Environment, with which I am currently affiliated, also stresses the importance of avoiding environmental toxins, particularly for women and men of reproductive age.
While it may not be possible to state unequivocally that a certain amount of toxic exposure to a particular chemical has this exact detrimental effect on reproduction, we know enough to take action to prevent exposure to toxic chemicals – the American Congress of Obstetricians and Gynecologists endorses the science that makes it clear it would be better for the future health of America if the average pregnant woman did not have 43 measurable toxic chemicals in her body.
In this sense, good food is not medicine but is fundamental to good health.
Q: I once heard you say that your ZIP code was perhaps more important than your genetic code. Can you explain what you mean by this to UC Food Observer readers?
A: The rates of obesity, diabetes, and other chronic diseases are often higher in census tracts where poverty rates are the highest. We hear about food deserts. Another term is food swamps. There may be five times as many fast food outlets in low-income neighborhoods as in wealthier parts of a city. It is really difficult to walk away from tasty fat, salt, and sugar. If I had ready access to chocolate chip cookies in my home, I would probably eat more than one most days.
Q: What changes are individuals going to have to make in terms of their food and lifestyle choices to keep a national health care system solvent?
A: It is possible that some of the best public health tools we have are a sharp chef’s knife, a cutting board, and a salad spinner. I am not trying to be trite here. I really believe this. We can take back control of our lives and our health from the mega-giant processed food producers by using these tools.
It is easy for me to do this because I have the skills and the time. While not easy for working families with kids, there are some ways to cook more fresh food. Make triple the recipe of black bean soup with cumin, jalapeno, and cilantro starting with inexpensive dried black beans. The extras freeze well for another night.
Question whether or not it is really cheaper to go out for fast food. Add up the actual bills a few times for a family of four. It may be $30 or more.
Maybe roast a whole chicken and baking potatoes at the same time. That plus a big salad, a simple lemon vinaigrette, and some milk can be made for far less than $30.
Q: Do you think access to good food really can reduce health care costs?
A: Many health care providers believe that easy access to good food in the critical few weeks after a hospitalization for an acute illness could help speed recovery and prevent readmissions. Kaiser Permanente on the West Coast has partnered with Mom’s Meals to make these meals available. They can deliver reasonably priced, disease specific, ready to heat and eat prepared food to anyone in the lower 48 states.
If this could be studied and the cost savings quantified, it would be big news in health care. I can see the headlines now: “Good Food Works As Well As Medicine.” Hospitals everywhere should be asking a simple question of every patient being discharged to home, “Will you be able to get healthy food at home when you leave the hospital?” Many will answer “No.” An elderly person is immobile for a month after a joint replacement. A heart failure patient may not feel well enough to shop and figure out how to cook a low salt diet. We need to provide workable options.
Q: What is your take on the proposed 2015 Dietary Guidelines?
A: Marion Nestle says it best, as she often does.
Q: Consumers are confused about conflicting dietary advice, labels, etc. If you could suggest a few resources that would help people navigate the food system, what would they be?
A: I get confused just like everyone else and don’t focus on micronutrients. A balanced diet of fresh whole foods will cover most nutritional needs. I rely on my favorite cookbooks and online recipe sites for recipes. For about 10 years before I retired, I posted my favorite recipes including some minimal nutrition advice online. The blog continues with great recipes from a new generation of doctors who cook.
Q: Will food politics play a significant role in the 2016 election cycle? What food platform would you like to see?
A: I think an excellent article addressing this was co-written by Michael Pollan, Mark Bittman, Ricardo Salvador, and Olivier De Schutter.
Q: What currently keeps you up at night?
A: Almost nothing most nights unless it rains really hard and I hear it on the roof.
Q: What is inspiring you?
A: I love seeing people doing what they do best with respect for themselves and being passionate about it.
Q: I’m giving you a super power. You can change one thing about the food system with that super power. What change would you make?
A: How about changing the educational system? Make real home economics a required course throughout grade school for boys and girls weaving in math, economics, science, nutrition, genetics, environmental studies, gardening, and food preparation skills.
Q: You’ve had a storied career as a physician and innovator. What’s next for you?
A: In addition to the incredible blessing of being a grandfather to my granddaughter who lives close by, there are two new projects in the works.
I am working with Health Care Without Harm and with the Community Alliance with Family Farmers to identify the collective demand for sustainably produced fruits and vegetables from multiple hospital systems, K-12 school systems, and, hopefully, universities in California. As of 2012 there were about 1,200 acres of organic strawberries in production in California. If all these institutions demanded organic strawberries instead of those treated with methyl bromide, just maybe we could affect the marketplace and help move it toward food that is good for all concerned and double that acreage. And maybe do the same for the other top ten crops used by institutions as well.
“Question whether or not it is really cheaper to go out for fast food. Add up the actual bills a few times for a family of four. It may be $30 or more.
Maybe roast a whole chicken and baking potatoes at the same time. That plus a big salad, a simple lemon vinaigrette, and some milk can be made for far less than $30.”