Correcting Food Policy in Washington Prisons, Prison Voice Washington, 2016
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This report describes how the unhealthy food served and sold to people incarcerated in state prisons directly violates the state’s Healthy Nutrition Guidelines and will lead to costly health care expenditures on preventable diseases, in violation of Executive Order 13-06. It offers recommendations for achieving compliance with EO 13-06 by establishing effective oversight to ensure that the Department of Corrections makes healthy nutrition possible for incarcerated people. Correcting Food Policy in Washington Prisons How the DOC Makes Healthy Food Choices Impossible for Incarcerated People & What Can Be Done Contents Contents .............................................................................................................................................................. 1 Executive Summary ........................................................................................................................................... 3 I. Background .............................................................................................................................................. 4 Food in the Department of Corrections (DOC): 1986-present ............................................................. 4 Health Care Costs from Preventable Dietary Diseases in DOC Facilities ............................................ 6 Executive Order 13-06 (October 2013-present)...................................................................................... 7 II. Changes in Food Service under CI Management .................................................................................... 8 III. How DOC Food Services Violate the Healthy Nutrition Guidelines .................................................... 10 The “Lighter Fare” Diet ......................................................................................................................... 17 Religious and Other Special Diets ........................................................................................................ 18 IV. How Food Sold in DOC Facilities Violates the Healthy Nutrition Guidelines ..................................... 19 Commissaries ......................................................................................................................................... 19 Quarterly Packages ................................................................................................................................ 21 Canteens ................................................................................................................................................ 21 Vending Machines ................................................................................................................................. 21 V. Further Considerations: Costs, the Environment, and Rehabilitation ................................................. 21 Cost ........................................................................................................................................................ 21 Environmental Impact ......................................................................................................................... 24 VI. Recommendations ................................................................................................................................. 24 Immediate ............................................................................................................................................. 24 Longer Term (6-12 months) ................................................................................................................. 26 VII. Frequently Asked Questions ................................................................................................................. 27 Appendices ...................................................................................................................................................... 30 CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 1 KEY POINTS The food served and sold to the 18,000 people incarcerated in Washington state prisons is now unhealthier than it has ever been. It also violates Executive Order 13-06 and the DOH Healthy Nutrition Guidelines, which apply to all state agencies and institutions. When the Department of Corrections turned over responsibility for food services to Correctional Industries (CI), the DOC's business arm, it substituted 95% industrialized, plastic-wrapped, sugar-filled “food products” for locally prepared healthy food. This has turned Washington prisons into state-sponsored food deserts, with drastic reductions in fresh produce, lean protein, and whole grains in the diet of incarcerated people. This unhealthy diet encourages disadvantaged populations to eat poorly, disproportionately impacts the health of people of color, and leads to increased healthcare expenditures on preventable diseases such as diabetes, hypertension, and heart disease. The CI system of producing highly processed, packaged food in Spokane and continually trucking it to prisons across the state is expensive and harmful to the environment. Recommendations Responsibility for prison menu planning must be taken away from CI, allowing a return to the healthier and cheaper alternative of cooking fresh, nutritious, locally grown food from scratch at each institution. Expert dietitians, not CI, must oversee the selection of food products for prison commissaries and quarterly packages. The Governor should empower DOH to evaluate and monitor DOC’s compliance with the Healthy Nutrition Guidelines, not only administratively or by survey, but by careful attention to what is actually served. The topics covered in this report are limited to the scope of Executive Order 13-06 and DOH’s Healthy Nutrition Guidelines. DOH is receptive to suggestions for improvement and plans to update its Healthy Nutrition Guidelines in 2017, but additional orders from the Governor may be necessary to bring DOC’s food system up to the standards of Washington’s local farm and food model. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 2 Executive Summary The food served and sold to people incarcerated in state prisons is now unhealthier than it has ever been. DOC policies and practices violate the state’s Healthy Nutrition Guidelines, encourage disadvantaged populations to eat poorly, damage the environment, have a disproportionate adverse health impact on African Americans, and will lead to increased healthcare expenditures on preventable diseases such as diabetes, hypertension, and heart disease. In 2013, under the mandate of Governor Inslee’s Executive Order 13-06, the Department of Health (DOH) promulgated Healthy Nutrition Guidelines for institutions, announcing that “Washington State supports healthy living by ensuring state facilities and agencies offer, purchase, and serve healthy food and beverages. We are making the healthy choice the easy choice.” In reality, the Department of Corrections (DOC), working through a decades-long Correctional Industries (CI) takeover of food services, commissaries, and food package programs, has implemented policies that systematically deny healthy choices to the incarcerated, their families, and the staff who eat institutional food. Unlike others affected by state food policies, the incarcerated can eat only what DOC makes available. The new policies have eliminated the cooking from scratch of locally grown food (“farm-to-table”) to impose an industrial model that damages both health and the environment through the plastic packaging and transporting of highly processed food products How did this happen? The answer is twofold: (1) absence of any real oversight authority given to DOH under Executive Order 13-06, and (2) institutional disregard for the health of the incarcerated1 in an organizational structure that prevents DOC Health Services from enforcing compliance with nutritional standards. The DOH Guidelines fail to address the commissaries and food packages through which incarcerated people buy food. Even where standards have been explicitly set, DOH has been given no means by which to ensure compliance, and institutional food service venues were entirely left out of evaluations conducted by the University of Washington's Center for Public Health Nutrition (CPHN). Instead, DOH has relied on the fact that DOC has “anecdotally reported” that it is “either fully implemented or close to full implementation across their institutional food service venues.” The only action currently proposed by DOH for ongoing monitoring and evaluation of DOC implementation of the Healthy Nutrition Guidelines is “through a survey disseminated to the point-person by September 2016.” These surveys are voluntary and cannot ensure guideline implementation. DOC has a culture of disregard for the wellbeing of the incarcerated2, and the DOC dietician has been able to do nothing to prevent DOC from flouting the Guidelines in its institutional food service venues, vending machines, commissaries, canteens, and food package programs. What can be done? Active and ongoing collaboration between DOH and DOC in menu and food product planning is the key. The governor should empower DOH and the DOC Program Manager of Dietary Services to begin robust evaluation of DOC's institutional food services, commissaries, canteens, and food package programs to ensure compliance with the Guidelines. DOC must make certain that qualified nutritional experts, not CI factory managers, design the menu and monitor its implementation by Food Services. DOH should collaborate with the CPHN to ensure that evaluations include careful analysis of what is actually being served rather than what Food Services claims is served. DOC food venues must cease using industrial food products and instead return to cooking fresh, nutritious food from scratch as outlined 2 DOC disregard for the health and well-being of the incarcerated is well-documented. On November 17, 2015, a classaction lawsuit was filed against DOC in response to widespread denials of medical care to incarcerated people in Washington. See Haldane v. Hammond, United States District Court for the Western District of Washington, Case No. 2:15 - cv - 01810 - RAJ CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 3 in the Healthy Nutrition Guidelines Implementation Guide. DOH must also issue guidelines to regulate the food made available from commissaries and quarterly food packages so that unprocessed whole foods— whole grains, fruits, vegetables, and lean protein—are available and that healthy choices become, if not easy, at least possible for incarcerated people. I. Background Food in the Department of Corrections (DOC): 1986-present 1. Institutional Food Service Menus Thirty years ago, Washington State’s Department of Corrections could legitimately take pride in its food services menu. While prison food was never gourmet, it was not fundamentally different from ordinary household food. Prisons grew their own food, maintained dairies and bakeries, and the food—real food, not processed food “product”—was cooked locally. Incarcerated people learned to cook and bake professionally. Washington prisons served low-fat milk and whole-grain cereals such as oatmeal and cracked wheat at breakfast, and salad greens and vegetables at dinner. Skillful local food managers could save the state money by making intelligent choices about where to buy their produce, often contracting with local farmers and buying large quantities when prices were low.3 Local facility Consolidated Food Managers were able to save DOC over $20,000 per month by using multiple local contractors.4 Taking pride in their work, they were able to offer incarcerated people a good variety of whole grains, fruits, vegetables and unprocessed meats, including such healthy items as salmon, chicken, spinach, broccoli, blueberries, and yogurt. In 1995, however, DOC Food Services began to deteriorate after the state decided to turn to Correctional Industries (CI), the state-run prison-industrial conglomerate. CI was supposed to save the state money by concentrating all food production at a single DOC Food Factory at the Airway Heights Correctional Center. Local prison facility bakeries, dairies, and farms were shuttered. Problems were noted from the outset. State health department inspectors, responding to a barrage of complaints, cited the food factory for foodhandling violations in 1996. Contracts were cancelled and senior administrators were fired. Yet the industrialization continued. Two decades ago, the environmental costs imposed by this model—which involves shipping food to a central location only to package, process, and ship it back to other facilities— were little appreciated. Policymakers also did not understand the deleterious effect on human health of exclusively consuming processed food containing added sugar, sodium, and soy every single day for many years. Once the first food factory became operational, DOC steadily began demanding that its local food managers buy an ever greater percentage of their food from the CI Food Factory—even when other sources of food were both cheaper and more nutritious. At first it was only 5%, then 15%, and then 51%. Some food managers had concerns that declining food quality posed a security risk by creating unrest in the incarcerated population.5 Many resisted the changes, and some ultimately resigned, but the policy continued. Today, over 95% of the foods served in DOC institutions are from CI, and CI has opened a second food factory at the Coyote Ridge Correctional Center. 3 See “John Holeman: Corrections Champ”, Foodservice Director, February 5, 2009 See “John Holeman: Miracleworker”, Foodservice Director, April 15, 2004 5 Ibid. 4 CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 4 “Paradigm Shift” In a “success story” printed in the Healthy Nutrition Guidelines Implementation Guide about his having reduced sodium from 3,600mg to 3,000mg—a level still 25% over the limit under the Guidelines and double the recommended intake for African Americans6—Brent Carney, DOC’s Health Services Program Manager for Dietary Services, reports that as recently as 2009, “all 15 prisons in the state were preparing and cooking meals in their kitchens.” This would change dramatically in the following years. As Carney reports, “DOC decided to change their paradigm in how they produced meals. DOC decided that our revenue branch— Correctional Industries would start producing the bulk of the meals served instead of letting each prison’s kitchen prepare the menu on site.” Incarcerated people were relegated either to food processing jobs at the factory or to reheating precooked, processed, packaged food items from the factory. As Program Manager for Dietary Services, Carney raised concerns. “I wasn’t happy about this paradigm shift because I was concerned that the quality of the food would not be as nutritious as the foods being prepared fresh in each prison’s kitchen.” This has proven to be an understatement, to say the least. Although Carney touts the benefits of uniformity in the sodium content of meals achieved by central production, each prison’s staff continues to modify the diet with added sodium-heavy seasonings. At the same time, this uniformity has stripped the menu of the nutritious food that institutional kitchens were able to provide in the past—by replacing breakfast with packaged “boats” and freshly cooked meals with processed industrial food products. Meanwhile, DOC takes public officials on tours of a few small gardens at some facilities, presenting a rosy veneer of sustainability and fresh produce to circumvent any real scrutiny of the bleak food reality in Washington prisons. 2. Commissaries and Quarterly Food Packages The other sources of food for incarcerated people—specifically, for those who have jobs or savings, or whose friends and families can afford it—are the prison commissaries, through which those in prison can purchase food bimonthly, and the quarterly food packages that incarcerated people or their families and friends can purchase once every three months. A typical prison commissary list (Appendix A) includes over 175 food items. All items are non-refrigerated, prepackaged food items, since incarcerated people lack refrigerators in which to store perishable items. Commissary lists have not changed much, apart from rising prices7, and have never had a good selection of healthy items. While commissaries have changed relatively little, the food packages have changed drastically in the past ten years. In the 1990s, incarcerated people could obtain a wide variety of food from a number of ordinary and specialty grocery stores, such as Safeway, Albertson’s, and Uwajimaya. However, in the 2000s, DOC severely limited the vendors from which incarcerated people could choose—situation CI as a middleman between families and vendors that benefits from markup profits. Today, CI has complete control of the food packages which are contracted to the private corporation Union Supply Direct three times a year (Appendix B) and to another contractor, Access Securepak, for a “holiday” food package (Appendix C) once per year8. DOC has complete control over what food it makes available, and what it has chosen to provide from these vendors is an enormous selection of debilitating junk food, including dozens of varieties of candy, sugar drink mixes, processed high-fat, high-sodium meats, sugar-coated breakfast cereal, refined 6 See Peters, Rosalind M., and John M. Flack. "Salt sensitivity and hypertension in African Americans." Progress in Cardiovascular Nursing 15.4 (2000): 138-144. 7 For those incarcerated people fortunate enough to be employed under the estimated >80% prison unemployment rate, hourly gratuities (the official term for prison wages) are in most cases less than $1 per hour. Yet commissary prices are similar to those the general public pays for equivalent items. 8 CI is currently in the process of transitioning to Hickory Farms as its holiday package vendor. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 5 flour crackers, and cookies. There are no real healthy choices whatsoever, the best options being some packaged fish and roasted, salted pistachios. (See Appendices B and C). Healthcare Costs from Preventable Dietary Diseases in DOC Facilities Many people are surprised to learn that healthcare costs constitute a far larger portion of the overall cost of incarcerating a person than food does. In 2011, healthcare represented $17.99 of the $94.84 average daily cost, or almost 19% of the total bill.9 According to DOC’s 2012 Annual Report to the Legislature “Health Services Cost Containment,” diabetes and hypertension are among the top five chronic care areas for incarcerated people. Diabetes is second only to mental illness, while hypertension ranked fourth on the list. According to the American Diabetes Association, an estimated additional $25,675 is spent annually on diabetes-related 9 “Are We Paying Too Much for Prisoners?” Everett Herald, April 20, 2011 CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 6 health care per incarcerated person with diabetes.10 While less costly initially, hypertension leads to even more expensive interventions if heart disease results, as it frequently does. Poor nutrition is a primary contributing cause for both these preventable diseases. Given that Washington prisons house a large elderly population, and that 1,383 of the approximately 18,000 people in DOC custody are serving de facto or actual life without parole sentences11, investing in nutrition as preventative care would be a fiscally responsible action. The costs of treating these diseases dwarfs the preventative care cost of providing a healthier diet to incarcerated people, but Health Services personnel play virtually no role in shaping the diet served to incarcerated people. As discussed above, Brent Carney, DOC Health Services Program Manager for Dietary Services and the most senior dietician in the agency, was unable to prevent DOC from adopting an industrial food model that he knew would decrease the nutritional quality of the food. Health Services has thus been relegated to issuing a medical diet when a disease finally results from the poor “mainline” diet.12 For the most part, this is a “lighter fare” diet that increases some of the vegetables, while decreasing the amount of main course entrées and eliminating potatoes and wheat rolls. In recent years, DOC abolished the facility dietician staff position. These facility dieticians had helped provide guidance to Food Services in the preparation of healthier food. Now, Health Services plays no role in Food Services, nor in determining the content of the commissaries or food package programs. Executive Order 13-06 (October 2013-present) In October 2013, Washington Governor Jay Inslee signed Executive Order 13-06 (EO 13-06), “Improving the Health and Productivity of State Employees and Access to Healthy Foods in State Facilities.” Noting that “chronic conditions such as heart disease, stroke, obesity, and diabetes are largely preventable,” and with the intention of improving health and thereby reducing state health care costs, EO 13-06 directed all state agencies, including the Department of Corrections, to adopt and implement food and beverage service policies that meet the Washington State Healthy Nutrition Guidelines (“Guidelines”), which were created concurrently with EO 13-06 and are based on the Dietary Guidelines for Americans, 2010 (DGA). EO 13-06 states that the policies and guidelines shall ensure for the provision of healthful food and beverages in all food venues, including vending machines, cafeterias, on-site retail establishments, and, importantly, in institutional food service sites, specifically including those serving “students, custodial populations, and residents.” EO 13-06 encompasses all food and beverages served or sold by any state agency, and it also promotes Washington-grown products whenever practical. Policies should be fully implemented by December 31, 2016, with the Department of Health named as the lead agency in promoting the guidelines and providing technical assistance on development and implementation of food and beverage service policies. In January 2014, the Food Procurement Workgroup, which was led by Colleen Arceneaux, the Healthy Eating Coordinator in the Department of Health’s Office of Healthy Communities, and which included Brent Carney, DOC Health Services Division Program Manager for Dietary Services, issued Healthy Nutrition Guidelines separately addressing the standards for Vending Machines, Cafeterias, Meetings and Events, and Institutions. The three-page Healthy Nutrition Guidelines for Institutions document 10 Firth, Caislin Leah, et al. "Female Inmates with Diabetes: Results from Changes in a Prison Food Environment." Women's Health Issues 25.6 (2015): 732-738. 11 See the University of Washington’s Law, Societies, and Justice report: “Life Without Parole Sentences in Washington State”. 12 The term “mainline” denotes the regular food served to the majority of incarcerated people, as distinct from diets ordered for religious or medical reasons, such as the kosher, halal, and vegan diets and diabetic snack-supplemented diets. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 7 announces in bold at the top that “Washington State supports healthy living by ensuring state facilities and agencies offer, purchase and serve healthy food and beverages. We are making the healthy choice the easy choice.” The Guidelines specifically encompass food and beverages provided in institutions to clients, incarcerated people, and patients by DOC and Department of Social and Health Services (DSHS). The Guidelines for Institutions comprise five major sections: Section A addresses Food and Beverage Standards for Meals, Section B covers Scheduled Snacks, Section C addresses Standard Principles, Section D outlines Exceptions for Specific Population Groups, and Section E sets out guidelines for Celebratory and Special Occasions. In addition, the DOH issued an Implementation Guide for Agencies, Sites and Vendors that specifically addresses what DOC would need to do to comply with the Guidelines. However, the March 2016 report prepared by the Washington State Department of Health on “Implementation of Food and Beverage Service Policies in State Agencies” reveals that institutions were excluded from the baseline and mid-implementation evaluations conducted by the Center for Public Health Nutrition (CPHN), due to insufficient funding from the Center for Disease Control (CDC). Instead, DOH relied on a “designated wellness coordinator” within DOC “to supply information on policy adoption and implementation,” and DOC “anecdotally reported” that it is “either fully implemented or close to full implementation across their institutional food service venues” (See “Executive Order 13-06: Implementation of Food and Beverage Service Policies in State Agencies,” March 2016, pgs. 5, 8). Clearly, DOC’s anecdotal “self-reporting” is insufficient and unacceptable. The only action currently proposed by DOH for ongoing monitoring and evaluation of DOC institutions is “through a survey disseminated to the point-person by September 2016.” II. Changes in Food Service under CI Management Perhaps the most striking change implemented in recent years is the replacement of freshly cooked breakfast with a factory-packaged breakfast “boat” that is mostly sugar and starch. CI replaced what had been one of the healthier meals served in prisons, usually including fresh fruit, lowfat milk, oatmeal, and eggs, with a plastic-wrapped “boat” (so-called for the shape of the cardboard container holding the items) that incarcerated people collect at their evening meals. These boats contain a single serving of nonfat milk, an aspartame-sweetened, fortified drink mix (intended to compensate for DOC’s failure to provide all nutrients from real food), a serving of processed, usually sugar-coated, breakfast cereal, a breakfast bar that contains large quantities of sugar and chemical preservatives, a sugary muffin, and a peanut-butter and jelly sandwich. Like the CI diet generally, these items are almost entirely sugar, starch, and fat. In fact, apart from the single serving of nonfat milk (no Vitamin D added), every item in the boats contains added sugar. The peanut butter is not all natural peanut butter but rather is a mixture of peanuts, hydrogenated vegetable oil, and sugars. The breakfast bars are supposed to contain replacement for fruit, but one of the bars (the chocolate) contains no fruit at all, and the jelly is flavored sugar. These boats constitute the sole breakfast option that CI Food Services serves to incarcerated people, without any variation except in the flavor of the breakfast bar and the kind of cereal. Of the five varieties of cereal served, all contain added sugar except for corn flakes and Toasty Os (toasted oats cereal). Nearly a third of calories come from sugar with only 10% from protein. The most important change in all the food served to the incarcerated is that all of it is processed. This is not an exaggeration. As CI took over food services around the state, it gradually eliminated all freshly prepared, natural food. Without exception, every single main course is now a reheated, highly processed CI product with high amounts of sodium. Apart from the occasional serving of beans, lean, natural proteins are never served at any meal. Unprocessed meat is never served. Among the meals CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 8 eliminated in the last decade are all that involved unprocessed food: chicken, tuna, salmon, beef, eggs, oatmeal, and milk are no longer served. The last remaining meals prepared from fresh food were the chicken salad and tuna salad sandwiches, which were made from scratch using unprocessed chicken and canned tuna with fresh onions and celery. Repeated requests to add these meals back to the menu have all been rejected. Instead of a variety of fresh vegetables, CI almost exclusively serves celery and carrots for vegetables. Spinach, squash, radishes, and other nutritious vegetables are wholly absent from the CI menu. All 100% whole-grain products have been eliminated. Oatmeal and cracked wheat, along with whole-wheat bread, have been completely eliminated from the institutional menu. What remains are partial wholegrain and refined white flour products. The most important change for workers in Food Services is that, while CI claims that it is training incarcerated people for the jobs of the future, cooking job positions have been eliminated. Except for workers at the Food Factory, Food Services workers now simply reheat processed food, package processed food, or bundle packages of processed foods. Others pick up the garbage, which is considerable, given the amount of plastic packaging. Instead of learning marketable culinary skills that might lead to a career, they are universally engaged in performing entry-level low-skill assembly-line work that cannot sustain a living wage. Figure 1: Nutritional label for Correctional Industries peanut butter packets CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 9 Figure 2: Correctional Industries processed Breakfast "Boats" have replaced freshly cooked breakfasts in Washington Prisons III. How DOC Food Services Violate the Healthy Nutrition Guidelines The DOH Implementation Guide (issued over two years ago in February 2014) provides both an in-text (page O-5) and online template for the complete text of model policy language Executive Order 13-06 requires DOC to adopt, yet DOC’s current policy on food served to incarcerated people has yet to reflect any awareness of the Healthy Nutrition Guidelines. DOC Policy 240.100 sets out its own Guidelines for Mainline Meals (GMM), which establish specific caloric guidelines (2,700-3,000 calories for men, 2,0002,100 for women) and individual nutrient recommendations (protein, fiber, calcium, Vitamin C, and others) as well as limits for sodium (2400 mg), saturated fat (< 10% of calories) and cholesterol (<300 mg). CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 10 Figure 3: Pg. O-5 of the Healthy Nutrition Guidelines Implementation Guide provides model policy language for state agencies to design food policy for custodial populations. Since it affects the large majority of incarcerated people, this report focuses on the 28-day 2800-calorieper-day CI Statewide Mainline Menu for incarcerated men (Appendix D). (The diet for incarcerated CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 11 women, it should be noted, suffers from many of the same defects.) As will be discussed further on, the CI menu nutritional information often significantly misstates the nutritional value of the foods actually served to incarcerated people, but for the purposes of this analysis the claims of the menu will be taken at face value. The core of DOH Healthy Nutrition Guidelines for Institutions comprises two sections: the Food and Beverage Standards for Meals (Section A) and the Standard Principles (Section C). These sections govern the meals provided to people incarcerated in DOC institutions. Section A: Minimum Standards for Meals Section A lists minimum required amounts of fruit, vegetables, grains, protein, milk products, and beverages to be provided daily. The Guidelines state explicitly that “if these standards are met, individual nutrient needs should be met as well”—that is, there will be no need for nutritional supplementation. This would be true if the DOH Guidelines were based, as the Guidelines claim, on the appropriate recommendation in the U.S. Department of Agriculture's Dietary Guidelines for America, 2010 (DGA). Unfortunately, the Section A guideline requirements are based on the recommendations appropriate for a 2000-calorie diet. As such, they dramatically undershoot the actual DGA requirements for the 2800-calorieper-day menu for incarcerated men. Nevertheless, even taking the claims made by CI at face value and using the lower guideline requirements, the CI statewide mainline menu directly violates the DOH Guidelines on nearly every count. Specifically: Fruits: The actual DGA requirement for a 2800-calorie diet is 2½ cups of fruit daily. DOH Guidelines, however, only require “a minimum of 2 cups of fruit daily.” A small baseballsized piece of fruit (such as the ordinary apple, orange, or banana predominantly served to incarcerated people) is considered a half-cup serving of fruit (DGA, pg. 80). Food Services would therefore need to serve 4 such pieces of fruit to meet the requirement. Before the introduction of breakfast boats, incarcerated people received 3 pieces of fruit, which was still too low, but since the boats are not served with a piece of fruit, incarcerated people now receive only 2 pieces of fruit, for a total of one cup of fruit daily. Incarcerated people now receive half of the minimum quantity of fruit required by the Guidelines. It should be noted that when previously frozen apples, bananas, and oranges are served they are mostly left uneaten and trashed. Vegetables: DOH Guidelines require “a minimum of 2½ cups of vegetables daily” and “a variety of vegetables, especially dark-green, red and orange, and beans and peas. See DGA 2010 for details.” Remarkably, the Statewide Menu is most flagrantly deficient in the specific nutritionally important varieties of vegetables that the Guidelines single out for mention. As noted above, the DOH Guidelines minimum of 2½ cups is too low for a 2800-calorie diet: the DGA 2010 detailed distribution for a 2800-calorie diet is based on a higher recommended minimum of 3½ cups of vegetables daily. Table 1 (below) therefore shows both the real DGA requirement and the adjusted lower minimum amount of vegetables required by the DOH Guidelines (an amount which would really only be appropriate for a 2000-calorie diet), with the Food Service provision in red if it does not meet even that reduced minimum. As Table 1 illustrates, Food Services does not meet DGA vegetable requirements in any category. Incarcerated people do not receive even the lower minimum in any category other than starchy vegetables: CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 12 Table 1. Detailed Vegetable Distribution Requirement (measured in cups per 28-day period) Vegetables by DGA Category DGA minimum Adjusted DOH Guideline Minimum† Food Services Menu Provision Detailed Breakdown Dark Green Vegetables 10 6 2½ all broccoli Red & Orange Vegetables 28 22 9¾ carrots: 7¼ tomato salsa: 1½ carrots in “mixed”: 1* Beans & Peas 10 6 5½ all beans potato: 19 corn: 1½ green peas: 2½ peas & corn in “mixed”: 2* Starchy Vegetables 28 20 25 Other Vegetables 22 16 18½ All Vegetables 98 70 61¼ Vegetables per day 3½ 2½ 2.19 celery: 8½ lettuce‡: 7¼ onions: ¼ green beans: 2½ * Since “mixed” vegetables are a relatively equal mixture of corn, green peas, and carrots, for the purposes of this table the 3 cups of mixed vegetables served every 28 days have been allocated into the appropriate categories (1 cup red & orange, 2 cups starchy). † DOH will need to update the Healthy Nutrition Guidelines to reflect a 2,800-calorie diet. DOC cannot be counted on to make the calculations by extrapolation. ‡A cup of lettuce counts as a half cup of vegetables (DGA 2010, pg. 79) Note that green beans are considered “other vegetables” and green peas are considered starchy vegetables (DGA 2010, pg. 35). Again, the breakfast boats contain no vegetables. At lunch, incarcerated people receive a half-cup portion of carrots or celery every day without variation. At dinner, a half-cup portion of nutritionally empty iceberg lettuce laden with “dressing” (misleadingly described in the menu as “Vegetable Salad”) is served together with a half-cup portion of one of the following cooked vegetables: peas, carrots, corn, a combination of the first three called “mixed vegetables,” green beans, and only five times every 28 days, broccoli. In the past, incarcerated people were served good portions of a variety of vegetables, including fresh broccoli, steamed spinach, squash, etc. That has all but ceased. Today, incarcerated people receive a quarter of the DGA minimum for dark green vegetables and less than 40% of the minimum under the Guidelines; a third of the DGA minimum of red and orange vegetables and less than half of what is required under the Guidelines. Despite receiving excess amounts of starchy vegetables and nutritionally marginal vegetables such as lettuce and celery, they never meet the minimum weekly quantities for any of the critical varieties specified by the DOH Guidelines (dark green, red and orange, beans and peas). CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 13 Figure 4: Correctional Industries iceberg lettuce salads are served to incarcerated people coated in sugary, oily dressings Grains: The actual DGA requirement for a 2800-calorie diet is 10 oz. of grains daily, with 50% being whole grains. DOH Guidelines require approximately 6 oz. grains daily with “at least 50% whole grains in each serving.” To be sure, the CI menu does not skimp on grain-based products, serving much more than 6 oz. daily, but the grain products served are almost exclusively refined starches. CI never serves any 100% whole-grain products. The only rice and pasta served are white rice and white flour pasta. During each 28-day menu rotation, CI serves 100% refined grain products 27 times. CI claims that its rolls and bread meet the technical requirements for being 50% whole grain because whole grains are the first ingredient, but these products often contain less than 50% whole grain flour. In addition, all CI products use white wheat, rather than the more familiar red wheat, and white wheat lacks the beneficial dark phytochemicals found in red wheat.13 Ultimately, incarcerated people are mostly served either 100% refined grain products or receive grain products that do not meet, or barely meet, the Guidelines requirements at every meal. The result is that incarcerated people never receive the minimum 50% whole grains required by the Guidelines. Protein: This is perhaps the most serious deficiency in the diet. The actual DGA requirement for a 2800-calorie diet is 7 oz. of a variety of lean protein foods daily. DOH Guidelines require approximately 5½ oz. of protein with “a variety of lean proteins including meat, poultry, eggs, fish, seafood, beans, peas, nuts, seeds, and soy products.” However, the DGA specifies that “Beans and peas are considered part of this group as well as the vegetable group, but should be counted in one group only.” Since the CI Statewide Menu never provides enough 13 See Sizer, Frances Sienkiewicz, et al. Nutrition: concepts and controversies. Cengage Learning, 2013. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 14 beans and peas to fulfill the vegetable requirement, none of those beans and peas should be counted toward the lean protein requirement. Table 2. Protein Distribution Recommendation (measured in ounces per 28-day period) Lean Protein DGA minimum Adjusted DOH Guideline Minimum Food Services Menu Provision Detailed Breakdown Seafood 44 32 0 None Meat, Poultry, Eggs 136 104 ?† ?† Nuts, Seeds, Soy Products 20 16 28* all peanut butter All Protein Foods 200 152 ?† Protein Foods Per Day 7 5½ ?† *Soy products are present in nearly all the processed CI food products, so it is difficult to estimate the total amount being served. This quantity is a minimum. † Because CI recipes instruct factory workers to mix beans, crumbled TVP, and finely chopped processed meat protein into sauces, white pasta, or wraps, there is no accurate way to assess protein content of individual servings. Remarkably, CI almost never serves lean protein, and it never serves fish, seafood, or seeds.14 The word “turkey” in the menu does not denote actual turkey meat, but rather an artificially processed and formed product that contains some turkey material. The only unprocessed lean protein offered is simmered beans, and that is offered only five times every 28 days. All meat is processed with textured vegetable protein (TVP) and other adulterants in high-sodium, highly processed food products such as “hamburger,” “Salisbury steak,” or “meatloaf” patties that contain far more fat than protein, in “wraps,” or in processed CI turkey “sauces” of various kinds. The consequences of never serving simple, lean meat or eggs are severe for incarcerated people because they can never meet their protein requirements without eating unhealthy amounts of fat and starch. According to DOC GMM, prisoners should receive between 70 and 110 grams of protein daily. DOC counts protein of no biological value (the indigestible proteins in celery, for example) in meeting this value. Even so, the requirement is seldom if ever met, and it can never be met by incarcerated people without consuming the unhealthy sauces and condiments in which protein is buried by CI, with excessive calories, sodium, fat, sugar, and refined flour. 14 The absence of fish, nuts, and seeds in CI menu items deprives incarcerated people of the omega-3 fatty acids crucial to brain function, mental health, and nonviolent behavior. See “Omega-3, junk food and the link between violence and what we eat”, The Guardian, October 17, 2006. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 15 Figure 5: Correctional Industries does not serve unadulterated lean protein to incarcerated people. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 16 Dairy: The DOH Guidelines specify low-fat or nonfat milk, and note that “the DGA 2010 recommendation is that adults consume 3 cups daily.” DOC used to offer unlimited milk at breakfast. This was reduced to two cups and then one cup. Now incarcerated people receive a single cup of nonfat powdered milk in their boats. Incarcerated people never receive the 3 cups of milk recommended by the DGA per DOH Guidelines. Section C: Standard Guiding Principles The CI Statewide Menu not only fails to meet the basic minimum requirements enunciated in Section A, but also flouts the standard guiding principles designed to ensure healthy nutrition. Three of the five key principles are: Emphasize fruits, vegetables, and whole grains. Use less processed foods that do not contain added sugar and sodium. Use healthy cooking techniques such as baking, roasting, broiling, grilling, poaching, steaming, and stir frying. As the Implementation Guide created by the Department of Health makes clear, using “less processed foods that do not contain added sugar and sodium” means cooking from scratch as much as possible (Healthy Nutrition Guidelines Implementation Guide, I-5). Remarkably, DOC food policies adopted in the past few years have actually eliminated cooking from scratch and instead introduced a menu that relies completely on processed food containing added sugar and sodium. Much of this food, not to mention the taxpayer money that purchases it, ends up dumped into the prison garbage cans. At a Sustainability in Prisons Project site that composts food at one Washington prison, difficulties were encountered when even compost worms would not eat certain types of highly processed CI food. The DOH has provided state agencies with an online template for model vendor contract language to ensure vendors provide state agencies with food products that meet the standards of the Healthy Nutrition Guidelines. However, DOC and CI seem to have ignored this template, and have not required vendors to provide products that meet the standards of the Healthy Nutrition Guidelines. Because the processed food products served on the CI Statewide Menu are so unpalatable, they are usually not reheated according to the specifications for use assumed by the dietician when calculating the nutritional values. Instead, CI Food Service workers attempt to fry the ingredients in oil or margarine. As a result, items like Salisbury steak and meatloaf patties, which already contain more fat than protein, are served to incarcerated people literally soaked in oil and margarine. Supplementation DOC is well aware its diet does not provide sufficient micronutrients. The CI diet is supplemented with aspartame-sweetened, fortified drink powder packets at meals. Many incarcerated people do not consume these mixes. Dietary guidelines are meant to meet nutritional requirements without supplementation. It is contrary to the spirit of the Healthy Nutrition Guidelines for such supplementation to be required to meet individual nutrient needs. The Healthy Nutrition Guidelines emphasize deriving nutrients from fresh fruits, vegetables, and whole grains, while the CI diet emphasizes refined flour and sugar. Figure 6: CI's Bernard Food Industries fortified drink mix ingredients CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 17 Figure 7: Cost of fortified drink powder mix for one DOC facility's April 2015 order Disparate Impact on African Americans, Older People, and the Medically Vulnerable African Americans and the elderly are particularly vulnerable to the elevated levels of sodium that cannot be avoided in a diet based on processed food. One of the key recommendations of the DGA 2010 is to “Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among person who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults” (DGA pg. 21). Considering that DOC incarcerates a disproportionate number of African Americans and a large aging population of lifesentenced incarcerated people, it is irresponsible to adopt food practices that do especial harm to the health of these populations. The “Lighter Fare” Diet The CI Statewide Mainline Menu has a column listing adjustments for a so-called “Lighter Fare” diet. This diet represents an improvement in some respects on the mainline diet because it doubles the amount of good vegetables provided at a given meal (e.g., broccoli and carrots), provides an additional piece of fruit daily, eliminates the cookies, cupcakes, and wheat rolls, and halves the amount of potatoes and white rice served. Unfortunately, the “lighter fare” diet reduces the already unacceptably low amount of protein in the diet, offering only two-thirds of the usual serving of the main course. As a result, this is not a viable way for prisoners to meet nutritional goals, even when such a diet is ordered by Health Services. Religious and Other Special Diets While this report focuses on the mainline diet, many of the nutritional deficiencies noted are exacerbated in the religious and other special diets. In particular, the prepackaged kosher meals rely excessively on artificially derived soy protein. Excess soy protein has been shown to cause serious medical problems such as hyperthyroidism.15 15 See Sathyapalan et al. "The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism." The Journal of Clinical Endocrinology & Metabolism 96.5 (2011): 1442-1449. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 18 IV. How Food Sold in DOC Facilities Violates the Healthy Nutrition Guidelines As the Healthy Nutrition Guidelines recognize, Governor Inslee’s EO 13-06 encompasses all the food served and sold by any state agency: the Guidelines aim to “ensure that state agencies offer, purchase, and serve healthy food and beverages.” Unfortunately, the Healthy Nutrition Guidelines for Institutions fails to specifically address commissaries, food packages, canteens, or vending machines in DOC institutions. Commissaries Commissaries are the stores through which incarcerated people purchase items from their prison trust accounts. DOC Policy 200.210 governs the operation of the commissaries and at present it reflects no awareness of the Healthy Nutrition Guidelines. More than 90% of the items—such as chocolate bars, jelly beans, doughnuts, cookies, syrup, potato chips, refined white flour crackers, cake frosting, and marshmallows—are very unhealthy, and are categorized as “Avoid” in the Healthy Nutrition Guidelines for Vending Machines: chocolate bars, jelly beans, doughnuts, cookies, syrup, potato chips, refined white flour crackers, cake frosting, marshmallows, etc. CI enjoys an extremely high markup value on many of these items, and does not take nutritional standards into consideration. Only a handful of items among the nearly two hundred items offered meet the criteria established by the Guidelines for foods designated “Healthiest,” among them nonfat dry milk, jack mackerel, and chicken. Even the oatmeal sold is the kind of instant oatmeal that is on the “Not Recommended” list in the Healthy Nutrition Guidelines Implementation Guide (R-7). There are many healthy, inexpensive, nonperishable foods that could be sold in commissarries: dry beans and lentils, which incarcerated people could soak overnight and cook in the microwaves; unroasted, unsalted nuts such as walnuts, pistachios, and almonds; unsweetened and unsalted 100% whole grain foods such as rye crackers (Ryvita®) and whole-grain wheat cereals (Quaker® 3-Minute Steel Cut Oats) and crackers (Triscuit®); 100% fruit spreads; low-sodium fish and low-sodium meat jerky; dehydrated fruit (Peeled Snacks® and Just Fruit®, for example); and dehydrated vegetables, including kale, seaweed (kelp), and spinach. Healthy choices are, for the most part, not being increased. Although CI was persuaded to add a few new small vegetable products to the October 1, 2016 commissary order form, other commissary products have become unhealthier. Recently, the V8 Fusion juice (which, as 100% fruit and vegetable juice, would qualify as “Healthiest”) was inexplicably replaced with V8 Splash, which is 10% fruit juice and 90% sugar and highfructose corn syrup flavored water. Thus, incarcerated people have no way to purchase the recommended foods and beverages promoted by the Healthy Nutrition Guidelines. They are forced to rely on supplements because DOC has completely eliminated omega-3 rich fish and other healthy foods. While DOC makes supplements such as fish oil, calcium, multivitamins, glucosamine, and the like available in commissaries, many of these supplements have no certification to guarantee that they contain what their packages claim. The supplement industry is notoriously unregulated.16 Consumers rely on USP certification, but DOC Health Services has no authority to ensure that supplement products offered on the commissary have been appropriately certified. Given that, for example, as many as 40% of fish oil supplements are rancid17, there is a high likelihood that incarcerated people are being forced to purchase products that will harm their health in their efforts to compensate for their lack of access to healthy foods. It is therefore crucial that nutrients be derived from the food sold to incarcerated people, and not from supplements. 16 See “The problems with the unregulated dietary supplements industry”. American Council on Science and Health. June 26, 2014. 17 See Supplements and Safety. PBS Frontline. January 19, 2016. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 19 DOH Healthy Nutrition Guidelines Recommended Foods and Beverages Beverages Recommended Not Recommended Coffee Served with non-fat (skim) or low-fat (1%) milk Served with half and half Juice drinks 100% fruit or vegetable juice Fruit or vegetable drinks (including full-sodium tomato juice) and “ades” Milk Non-fat or low-fat (1%) milk, enriched low-fat soy Reduced-fat (2%) or whole milk Soft drinks Diet soft drinks or reduced calorie sports drinks Full calorie soda, sports drinks Tea Unsweetened iced tea with lemon slices or hot tea Sweetened iced tea Water Provide as an option at every meal Flavored waters with more than 5g of sugar per serving Foods Recommended Not Recommended Bagel 2 ½” – 3 ½” size or cut in half; whole wheat, whole grain, rye or pumpernickel Greater than 3 ½”; “salt” bagels Baked goods Small slices of quick bread (pumpkin, oatmeal, banana); lower fat, lower sugar granola bars or small muffins; whole grain pancakes less than 4” made from scratch; no trans-fats or partially hydrogenated oils Doughnuts, sweet rolls, pastries, large muffins Bread Whole wheat, good source of fiber, whole grain, rye or pumpernickel; 200mg or less of sodium per slice White, “wheat” Cereal Whole grain, good source of fiber, lightly sweetened or unsweetened cereal (low-fat granola, oatmeal), non-instant oatmeal; less than 200mg sodium per serving Highly sweetened, low fiber, instant oatmeal Cheese Low- or reduced-fat cheeses (part skim mozzarella, skim ricotta, reduced calorie Cheddar); low-sodium cheeses (American, Colby, Cheddar, Swiss, other products labeled “low-sodium”) Large slices or cubes, processed cheese unless labeled “low-sodium,” higher sodium cheeses such as bleu, Roquefort, Edam, feta, Gorgonzola, Romano, Parmesan, Provolone Chips Baked chips, pretzels, whole grain chips Full-fat chips Condiments Ketchup, mustard or low-fat mayonnaise, low-sodium soy sauce in 1 tsp portions, lemon juice, vinegar, homemade salsa, guacamole, no or low-sodium seasoned salts Regular soy sauce, tartar sauce, teriyaki sauce, steak sauce, full-sodium seasoned salts, barbeque sauce Crackers Low- or reduced-fat, whole grain, brown rice, whole wheat; sodium below 150mg per serving Full-fat, not labeled “whole grain;” sodium above 150mg per serving Desserts Lower fat, lower calorie desserts (fresh fruit, low-fat ice cream, low-fat frozen yogurt, sherbet, sorbet, yogurt parfait with fruit and low-fat granola); small slices (2”) lowfat cake (angel food cake with fruit and light whipped cream) High-fat, high-calorie desserts (ice cream, cheese cake, pie, cream puffs, large slices of cake) Dips Salsa, low-fat cottage cheese, hummus, reduced- or lowfat salad dressing, dips from low-fat mayonnaise, low-fat sour cream, reduced-fat cream cheese Dips made from mayonnaise, full-fat sour cream, cream cheese, cream sauce English muffin Whole wheat English muffin White English muffin Fruit Fresh, dried, canned in juice, frozen Sweetened, canned in syrup CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 20 Quarterly Packages The quarterly package program offers no variety, and no healthy choices whatsoever apart from fish—and even the fish options are high-sodium, flavored varieties. Indeed, had the items been chosen with the specific design of fostering unhealthy eating habits, they could hardly be unhealthier than they are: Ding Dongs, three varieties of Twinkies, ten varieties of candy, ten varieties of cookies, etc. Again, none of the healthy food items mentioned above are available. The fish sold in the packages are the kinds that are “Not Recommended” by DOH because they are packed in oil; no fish packed in water with 290 mg or less of sodium, as recommended by DOH, is sold. Canteens Prison canteens are over-the-counter or vending machine-based operations. DOC has a specific policy governing prison canteens that flagrantly violates the Healthy Nutrition Guidelines, mandating that only unhealthy food be sold: DOC 200.210, Section VI, subsection B states that “Items sold in the canteen will be limited to popcorn, soda pop, chips, ice cream bars, and individual candy bars.” Subsection C states “Canteen operations may sell to offenders, offender friends/family employers, contract staff, and volunteers,” ensuring that state employees, volunteers, and the public18, as well as incarcerated people, are completely denied healthy food choices at these canteens. Vending Machines Visitors are not allowed to bring food to DOC visiting rooms. Instead, DOC Visiting Rooms have private contractor vending machines, from which the families of incarcerated people must purchase all food and beverages. Many travel from across the state to spend the whole day inside the prison with their incarcerated family member and have to eat lunch and dinner regularly in the visiting room. Despite repeated requests from individual family members and Family Councils for a healthier product selection, these vending machines do not comply with the Healthy Nutrition Guidelines for Vending Machines. Although efforts have been made to improve the food in visiting room since the issuance of the Guidelines, they remain an area with room for significant improvement. V. Further Considerations: Costs and the Environment This report focuses on the violations of the DOH Healthy Nutritional Guidelines because of the clear contravention of EO 13-06 involved. However, the industrial food model imposed by CI on incarcerated people has additional problems. Expense and waste is endemic to the CI Food Services model. It is not only unhealthy but also costly and environmentally destructive.19 Cooking from scratch with fresh, locally grown produce, whole grains, and unprocessed lean sources of protein avoids the unnecessary additional commercial costs of chemical processing, packaging, and shipping. It is also environmentally sustainable, since it eliminates the need for plastic packaging and the carbon emissions from fuel used to transport food products to and from distant factories. Costs DOC continually justifies the CI takeover of food production as a cost-saving measure. It takes the stance that a state agency cannot meet budget constraints and still maintain the practice of cooking from scratch 18 Prison staff, volunteer, and visitor food purchases are restricted to items available inside of DOC security checkpoints. 19 DOC may tout the success of its recycling programs, but there would be far less waste to recycle if excessive CI plastic packaging were eliminated. Moreover, much of the packaging is of a type that cannot be recycled, such as that used for the aspartame-sweetened supplement drink powder mix packets. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 21 at local facilities. However, a 2014 study on the cost of cooking from scratch in ten school districts found that there is no statistically significant relationship between total agency food costs and the level of local kitchen scratch cooking.20 It will cost the DOC nothing to offer a good selection of healthy food in its commissaries, quarterly packages, and canteens, since it is incarcerated people and their families who pay for the food, not the DOC. The DOC does pay for the meals provided by Food Services, but if the decision to use CI (DOC’s “revenue branch”) to produce meals has been driven by the hope of increased revenue, it has been a failure.21 The most glaring example is seen in the CI breakfast boats. Instead of buying foods such as eggs, oatmeal and other whole grains, natural peanut butter, and fruit in bulk and cooking them—using the inexpensive labor of incarcerated people—Food Services now annually purchases a minimum of 5,840,000 (one breakfast boat per prisoner per day for a year) individual plastic bowls of commercial Malt-O-Meal cereal, individual peanut butter packets, and so forth. Figure 8: Cost of peanut butter and jelly packets for one DOC facility’s April 2015 purchases. Costs are a moving target in the Department of Corrections, but the Department has reported spending an average of $2.22 per meal per person in its institutions, of which just $1.32 goes to food, the remainder being spent on labor ($0.81) and paper, cleaning supplies, etc. ($0.09). By comparison, during the same period DSHS was spending $5.45 per meal—two and a half times as much. Put another way, DOC spends 25% less per day on food for incarcerated people than DSHS spends on a single meal. Considering that the applicable Nutritional Guidelines (and the actual nutritional needs) for each population is the same, the fact that DOC is feeding people in its institutions at 40% of the cost at which DSHS is doing so suggests that food is not being adequately resourced. Indeed, the food budget could be vastly increased without significant effect on the overall budget: given that the average daily cost (as of 2011) of incarcerating a prisoner was $94.84, actual food costs constitute less than about 4% of the bill. Healthcare costs represented $17.99 of the total cost, or roughly 19% of the bill. Doubling the expenditure on food for incarcerated people would result in a 4% difference in the overall costs of incarcerating a person in Washington State. A healthy diet can be achieved with far less expenditure than that. Purchasing more produce from local Washington farms and small-scale whole food producers will also benefit Washington State commerce. 20 See Woodward-Lopez et al. "Is scratch-cooking a cost-effective way to prepare healthy school meals with US Department of Agriculture foods?." Journal of the Academy of Nutrition and Dietetics 114.9 (2014): 1349-1358. 21 Correctional Industries management has had notable public failures in other areas as well. See the 2014 Seattle Times series covering the track record of CI operations. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 22 Figure 9: Invoice excerpts for some weekly purchases of cookies, cupcakes, and brownies at two DOC facilities. Remarkably, while Food Services denies incarcerated people basic nutritional requirements, it wastes money on dessert treats. Food Services fails to provide the minimum amounts of fruits, vegetables, whole grains, and protein required by the Healthy Nutrition Guidelines, but it spends taxpayer dollars on a variety of debilitating packaged sweet dessert items. Yellow cupcakes, chocolate cupcakes, chocolate-chip cookies, orange crackle cookies, lemon sugar cookies, and oatmeal cookies, as well as prepackaged sweetened commercial Malt-O-Meal breakfast cereals in individual plastic bowls are instead offered. Indeed, although Food Services never comes close to meeting Healthy Nutrition Guidelines requirements to serve a minimum of 6 cups of dark green vegetables in every 4-week period, funds are found to provide 35 muffins, cookies, and cupcakes in every 28-day menu rotation (Appendix D). In fact, when DOC spends 20 to 30 cents for each CI cookie, it is spending nearly 13-23% of the total amount allotted for the meal on a dessert treat that harms those who eat it. In the short term, healthy food does cost more than unhealthy food, but the difference is less significant than most people assume, and that difference is more than made up by the savings from decreased health care expenditures. Any additional costs are also offset by mitigating the social cost to society. Tim Thielman, president of the Association of Correctional Food Service Affiliates, told The Guardian that “spending a little more money on food can have a huge impact in improving prisoners’ mental and physical CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 23 health and bringing down reoffending rates… A lot of people don’t understand the importance of taking care of inmates and giving them proper nutrition.”22 Environmental Impact The most glaring example of waste is the breakfast boat. Each boat consists of a plastic bag that contains a cardboard box that contains a packet of nonfat dry milk, a plastic bowl containing a tiny serving of cereal, a plastic packet of peanut butter, two plastic packets of jelly, plastic-wrapped bread, plastic-wrapped muffin, and a plastic-wrapped breakfast bar. The breakfast boat packaging is thus at odds with the Environmental Protection Agency (EPA) recommendations for reducing food packaging waste and human health risks from repeated exposure to certain types of plastic packaging.23 The EPA strives to motivate behavioral change in private and public sector food packaging practices, as food packaging accounts for almost two-thirds of total American packaging waste by volume. Yet rather than use local facility food preparation methods that reduce waste, DOC has actively exacerbated detrimental environmental impacts with its industrial CI food production and packaging model. Security Access to quality, healthy food in prisons is an important security issue. In 2000, incarcerated people at one Washington prison organized a work strike, partially in response to declining quality of food.24 According to Tim Thielman, president of the Association of Correctional Food Service Affiliates, “years of penny-pinching on food can be wiped out in minutes if a riot erupts over the quality of food.”25 During the famous 1971 Attica prison riots, incarcerated people listed access to “a healthy diet” and “fresh fruit daily” as one of their fifteen proposals to prison administrators.26 Washington’s DOC continually cites security concerns and correctional officer safety as top priorities for their agency. CI’s increasingly processed food production model is a potential threat to the goals. VI. Recommendations Immediate 1. The Governor should order that DOC end Correctional Industries control over the prison food system and give the DOC Health Services Program Manager of Dietary Services final authority over menus, commissary stock, and quarterly food packages. DOH should assist the Health Services Program Manager of Dietary Services in ensuring that menus, commissary, and food packages comply with the Healthy Nutrition Guidelines. This is the only way to ensure that DOC will achieve compliance with the Healthy Nutrition Guidelines in its food services, commissaries, and food package programs. Correctional Industries revenue priorities are at odds with nutritional goals, and have eroded the authority of DOC’s dietician to plan nutritious menus and food product options for incarcerated people. This has led to a detrimental system in which nutritional needs of incarcerated people are not a consideration in menu, commissary, and package program planning. Incarcerated people are residents in Washington State’s institutions, and it is the State of Washington’s responsibility 22 See “Prison food politics: the economics of an industry feeding 2.2 million”. The Guardian. September 30, 2016. See Marsh, Kenneth, and Betty Bugusu. "Food packaging—roles, materials, and environmental issues." Journal of Food Science 72.3 (2007): R39-R55. 24 See “John Holeman: Miracleworker”, Foodservice Director, April 15, 2004 25 See “Prison food politics: the economics of an industry feeding 2.2 million”. The Guardian. September 30, 2016. 26 See “The Fifteen Practical Proposals”. September, 1971. 23 CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 24 to care for them appropriately. This is impossible if the DOC’s head dietician and DOH have insufficient oversight power in menu and food product planning. Ultimately, the DOC Program Manager of Dietary Services should have authority to give final approval to all foods sold or served to incarcerated people. 2. The Governor should order that DOC make immediate changes to the Statewide Menu necessary to move toward compliance with the Healthy Nutrition Guidelines by increasing the quantity and variety of fruits and vegetables, increasing the quantity of nonfat milk provided, and increasing the quantity and quality of lean protein offered. a. Provide 3 cups of nonfat dry milk at breakfast rather than 1 as currently provided. The Guidelines state: “Institutions should offer low-fat (1%) or non-fat milk and milk products daily” and “the DGA 2010 recommendation is that adults consume 3 cups daily.” b. Provide 4 pieces of fruit daily (equivalent to two cups) rather than 2 pieces of fruit. Two pieces of fruit could easily be provided with the breakfast boats to meet this requirement. The Guidelines state: “A minimum of 2 cups of a variety of fruits daily.” A baseball-sized piece of fruit comparable to the apples27 and oranges served in DOC institutions is considered a half-cup serving of fruit. Four such fruits are required to meet the Guidelines. c. Provide 2½ cups of a variety of vegetables daily, in particular the critical categories of dark green, red and orange, and beans and peas, which are underprovided. Spinach and kale, for example, are wholly absent from the diet at present. The Guidelines state: “A minimum of 2½ cups of vegetables daily” and “A variety of vegetables, especially dark-green, red and orange, and beans and peas. See DGA 2010 for details.” d. Provide the required 5½ oz. of lean protein in accordance with the DGA 2010 recommendations, using unprocessed meat. Reinstate healthy lean protein meals previously served in DOC institutions, including items such as chicken salad sandwiches, chicken hindquarters, and baked salmon. The Guidelines require approximately 5½ oz. of protein with “a variety of lean proteins including meat, poultry, eggs, fish, seafood, beans, peas, nuts, seeds, and soy products.” e. Forbid individually wrapped food products in meals. This is perhaps the simplest way to eliminate the highly processed food products every CI meal contains. f. Restore local correctional facility kitchens. Returning to freshly cooked foods at each local facility is crucial to ensuring access to healthy food for incarcerated people. 27 Note that apples served to incarcerated people are of markedly smaller sizes than apples the public sees in grocery stores. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 25 3. The Governor should order that DOC ensure that its commissaries and food package programs begin offering foods described as the “Healthiest” in the Healthy Nutrition Guidelines for Vending Machines Foods described as “Healthiest” in the Healthy Nutrition Guidelines for Vending Machines are “mostly whole foods that contain low or no added sugar and sodium”: 100% whole-grain products with no added sugars or sodium, unroasted and unsalted nuts, dehydrated vegetables and fruit, low-sodium packaged fish, low-sodium dried meat (jerky). See page V-2 and Table 3 on page V-4 of Healthy Nutrition Guidelines for Vending Machines. Longer Term (6-12 months) 1. The Governor should empower DOH to more actively assist DOC in developing and monitoring the implementation of new menus for institutions that genuinely reflect the Standard Principles enunciated in the Guidelines, in particular the first three: Emphasize fruits, vegetables, and whole grains. Use less processed foods that do not contain added sugar and sodium. Use healthy cooking techniques such as baking, roasting, broiling, grilling, poaching, steaming, and stir frying. The Healthy Nutrition Guidelines Implementation Guide provides excellent guidance in the form of suggested recipes, suggested food products, and suggested food preparation methods. However, DOC and its CI food managers cannot be entrusted with the development of the menus. Instead, for this unique state agency, DOH should help create the menus and monitor their implementation to ensure that the Healthy Nutrition Guidelines are being met. However, executive Order 13-06 only gives DOH the ability to provide DOC with technical support in implementing the Healthy Nutrition Guidelines. A follow-up order may be necessary to ensure a stronger DOH role in implementation. 2. DOH should either amend the next iteration of its Healthy Nutrition Guidelines for Vending Machines to make it clear those guidelines apply to all DOC commissary and food package offerings OR add a section of guidelines to the Healthy Nutrition Guidelines for Institutions that directly addresses food and beverages that are sold through the commissaries and food package programs The Guidelines for Vending Machines states, “Ideally, 100% of items in vending machines should meet the Healthy Nutrition Guidelines for foods and beverages.” It goes on to set a target of 50% meeting “Healthiest” or “Healthier” standards. DOH should require that at least 50% of the offerings of commissaries and food packages be the kinds of natural, whole foods described as “Healthiest” in the Healthy Nutrition Guidelines for Vending Machines (“mostly whole foods that contain low or no added sugar and sodium”): 100% whole-grain products with no added sugars or sodium, unroasted and unsalted nuts, dehydrated vegetables and fruit, low-sodium packaged fish, low-sodium dried meat (jerky). See page V2 and Table 3 on V-4 of the Guidelines. 3. DOH and DOC should collaborate with non-profit organizations and nutrition graduate students to develop effective annual nutrition education workshops for incarcerated people. DOC has expressed some interest in working with organizations that could provide nutrition education in Washington prisons. Education workshops for incarcerated people CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 26 must reflect awareness of both the Healthy Nutrition Guidelines and the food products that are actually available to those living in Washington prisons. Past attempts, such as DOC’s offensively titled “Slender Offender” program28, were insufficient. Conclusion For over two and a half years, the DOC has ignored the mandate of Executive Order 13-06 to provide access to healthy food in its facilities. Despite extensive support and technical assistance from the Department of Health, which published a comprehensive Implementation Guide with model policy language specifically for custodial populations, lists of recommended foods and beverages, sample meals, and additional resources for implementing the guidelines, the DOC has yet to take even the first step required toward implementing the guidelines, which were ordered to have been fully implemented by December 31, 2016. At present, DOC seems unlikely even to acknowledge its duty to attempt to implement the guidelines by the end of the year. Instead, the agency has steadily been reducing access to healthy food in Washington prisons. The result: Nearly 20,000 Washingtonians live in state-sponsored food deserts, where they are literally coerced by the state into eating unhealthy food. Not only are they denied access to healthy food in the institutional meals they are served, but also in their commissaries and food package programs, which sell all but exclusively unhealthy food to them. Only strong executive action can ensure access to healthy food in state facilities. Incarcerated people, their families, and their friends are counting on the governor to correct the egregious food policies in Washington prisons and enable all Washingtonians to lead the healthy lifestyle that leads to improved productivity, quality of life, and life expectancy, as well as to reduce healthcare costs for the state of Washington. Departments of Corrections in a few other states have started to move away from the processed prison food model. For example, Minnesota’s Commissioner of Corrections, Tom Roy, has made a conscious effort to reintroduce freshly cooked, nutritious meals in Minnesota prisons.29 There is no reason that Washington, as one of the most food and health conscious states in the nation, cannot do the same. VII. Frequently Asked Questions Isn't Correctional Industries a good thing because it trains workers? CI claims to trains incarcerated workers. The reality is quite different. CI Food Service employees are all but universally relegated to menial low-skill reheating and packaging tasks for which little or no training is required. The CI takeover of Food Services has resulted in the elimination of skilled cooking positions throughout Washington State prisons. Now, CI workers merely reheat processed food. In a world increasingly shifting to locally grown and freshly prepared food, there are no careers in reheating. Reheating food certainly does not constitute a viable path to a real career or a living wage.30 28 The June 2010 report "Opportunities for Increasing Access to Healthy Foods in Washington", prepared for the Access to Healthy Foods Coalition, lists the “Slender Offender” program in its chart of potential helpful programs. 29 See “Prison food politics: the economics of an industry feeding 2.2 million”. The Guardian. September 30, 2016. 30 On May 28, 2015, the Washington State Supreme Court Minority and Justice Commission held a symposium to address the many ways in which Washington State fails at ensuring employment readiness and other reentry skills for incarcerated people. CI Food Services will need to drastically change its model if it wishes to tout any supposed contribution it makes to the reentry goals discussed at the Supreme Court Symposium. See "Reentry: Do We Really Care About People Succeeding After Prison?” CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 27 If Food Services returned to preparing healthy meals from scratch, there would be significant opportunities to train incarcerated people in valuable culinary skills that could lead to genuine career opportunities. In Denmark, for example, renowned restaurateur Claus Meyer of Noma, consistently ranked the best restaurant in the world, started a foundation called Melting Pot, which teaches incarcerated people how to cook. In Seattle, Fair Start trains low-income and at-risk populations to cook professionally, and their activity could easily be modeled in Washington prisons. Cooking fresh food in healthy ways is a laborintensive activity, and the demand for employees with the relevant culinary skills is increasing. Won't healthy food cost the state more? Investing in healthy food is an intelligent way for Washington State to save money. As noted above, making it possible for incarcerated people to purchase healthy food will cost the state nothing. With regard to the institutional food services, incarcerated people have no choice but to eat what the state provides them, and the state has an obligation to ensure that they receive healthy food. In the short run, healthy food does cost a little more—but unhealthy people cost a great deal more, and the savings from lowered health care costs more than make up for any difference. Food costs are less than about 4% of the cost of incarcerating a person; health care costs constitute about 19% of the total bill. Moreover, the benefits of health are worth the cost: if the cost of feeding people a cheap, unhealthy diet and treating their preventable diseases through health care were the same as the cost of feeding people a more expensive but healthier diet and avoiding disease altogether, it is clear that the latter is vastly preferable. Don't incarcerated people prefer to eat junk food? Like many economically and educationally disadvantaged people, many incarcerated people were not raised on healthy food, and as a result often have poor eating habits. To support rehabilitation and fiscal goals, the Department of Corrections has a duty to reform incarcerated people’s palates and help them learn about nutrition so that they can raise healthy families and reduce prison healthcare cost burdens on taxpayers. In any event, the taste preferences of incarcerated people are irrelevant: state agencies have no duty to provide food that some consider tasty, but they do have a duty to provide nutritious food. About This Report Prison Voice Washington exists to help redesign and update Washington’s broken prison system by introducing common sense, humanity, and the latest scientific research into policy discussions. Our goal is to improve both the safety of our communities and the lives of prisoners by expanding opportunities for rehabilitation. We also seek to update our laws and policies to reflect what works, based on the last 30 years of social science research. Prison Voice bases its nutritional analysis exclusively on the authoritative statements in Dietary Guidelines for America, 7th ed., as provided for in the Food and Drug Administration Modernization Act, which upholds the “significant scientific agreement” standard for authorized health claims. By law, this standard is based on the totality of publicly available scientific evidence, and excludes statements based on moderate, limited, inconsistent, emerging, or growing evidence. Prison Voice grounds its implementation analysis on Department of Corrections official reporting, public Correctional Industries records, and firsthand, corroborated reporting from people living and working inside DOC institutions. Prison Voice Washington may be contacted at PrisonVoiceWA@gmail.com, or at P.O. Box 463, Mountlake Terrace, WA, 98043. CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 28 Works Referenced 1. Executive Order 13-06: Improving the Health and Productivity of State Employees and Access to Healthy Foods in State Facilities 2. Healthy Nutrition Guidelines for Vending Machines, Meetings and Events, Cafeterias, and Institutions 3. Healthy Nutrition Guidelines Implementation Guide for Agencies, Sites and Vendors 4. Healthy Nutrition Guidelines Implementation Guide for Institutions 5. Dietary Guidelines for Americans, 2010 6. (Report) Executive Order 13-06: Implementation of Food and Beverage Service Policies in State Agencies, March 2016 7. DOC Guidelines for Mainline Meals (DOC Policy 240.100 Attachment 1) Revised 4/15 CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 29 Appendices Appendix A Commissary Order Form Appendix B Quarterly Package Order Form Appendix C Holiday Package Order Form Appendix D Correctional Industries Statewide Mainline Menus CORRECTING FOOD POLICY IN WASHINGTON PRISONS – PRISON VOICE WASHINGTON October 25, 2016 30 APPENDIX A – COMMISSARY ORDER FORM APPENDIX B – QUARTERLY PACKAGE ORDER FORM APPENDIX C – HOLIDAY PACKAGE ORDER FORM APPENDIX D – CORRECTIONAL INDUSTRIES STATEWIDE MAINLINE MENU APPENDIX E – YALE’S ONQI FOOD SCORE RATINGS