For my entire life, my doctors, my parents and my government have sent me one clear message about food: Nutrition is a key component of physical and mental health. So I had assumed (and hoped) that if MDs or MPPs were choosing menus for those in their care, the result would be a 3-D version of the Canada's Food Guide chart I coloured in elementary school.
But I have been looking into how we feed two specific groups of people in government care – hospital patients and correctional service prisoners – and the reality is rather unpalatable. Our taxpayer-funded, government-run institutions focus on meeting legal nutritional guidelines for the lowest price, outsourcing their cooking to the same half-dozen companies. But it doesn't have to be that way.
Each Ontario hospital sets its own food budget, since the Ministry of Health and Long Term Care doesn't give hospitals a cost guideline. North York General Hospital in uptown Toronto spends $4.46-million a year on food service: $1.66-million for food, plus $2.8-million for labour. The hospital says it had 144,165 "inpatient days" in 2014-15, which works out to $11.51 for food and $19.42 for labour, each day, per patient.
The hospital uses Steamplicity, a meal program by Compass, a global food service provider with annual sales of $31-billion. It's one of the main providers of large-scale food service in Canada; its competitors include Sysco, Gordon Food Service, Aramark and Sodexo.
Steamplicity meals are made in a production facility in Mississauga: food and water are put in "bespoke packaging" (it appears to be a plastic container) that has a valve designed to pop open when the internal temperature reaches 120 Celsius in a microwave. "The result is hot, delicious food, which retains its essential nutrients, where the flavour and texture of the food are preserved," says Saira Husain, a spokeswoman for Compass.
The company provided sample menus for North York General and Humber River hospitals: There were a variety of choices (Oriental beef stir fry, dhal with rice vegetable medley) and categories (starters, mains, etc). Each hospital assembles its own menus based on the options available: The North York General menu includes a vegan section, while Humber offers baked spaghetti with corn and broccoli.
"It sounds good, but is almost all frozen and quite highly processed," says Joshna Maharaj, a chef and food advocate who has led changes in the kitchens at The Stop Community Food Centre, Ryerson University and the Hospital for Sick Children. "The biggest problem with frozen food is that it ends up quite watery, and everything is soft, one texture. Clinical."
From 2011 to 2012, Maharaj attempted to revolutionize the food at Scarborough General Hospital in east Toronto. Using grants from the province and the Greenbelt Fund, she bought ingredients from local farmers, changed the menu to reflect the community's food culture (congee, jerk chicken) and trained the kitchen staff to cook from scratch.
Sadly, most of the changes were temporary. Scarborough General declined to discuss their budget for food service, but Maharaj says she could produce meals from scratch, using local ingredients, for only 33 additional cents each.
"I've heard a number of doctors say things like, 'If they're well enough to complain about their food, they're well enough to go home,' " Maharaj says. "The pilot projects are great to lay down the framework of how this change could look, but no hospital administrator is going to divert any funds from anything else to support a new food program."
She says she had greater success at Ryerson University, where she was hired to overhaul the food service from 2013 to 2015. "Ryerson was tremendous. We created a beautiful model and the students responded to it," she says.
Under her direction, staff stopped reheating soup from a bag and learned to cook from scratch with raw ingredients. "Soup easily became one of the most popular things on the campus," she says. "Because it was good and made with thoughtfulness and not that much more work."
The big take-away for Maharaj was learning to negotiate with the companies that provide the food. "Working with a third-party operator is the undeniable piece you have to address when you're talking about institutional food," she says. "And these operators are the people we need to start talking to when we want change."
Part of why the Ryerson project was successful is that the school stated its ambition to use local, fresh ingredients and to cook from scratch in its request for proposal when sourcing food providers. The three companies that responded – Aramark, Sodexo and Chartwells, a division of Compass – all submitted proposals listing local farms they would source from and outlining plans to pay those farms quickly (one sticking point for independent farmers is that they often can't afford the 60-to-90-day terms that big clients usually ask for).
In 2012, Paulette Padanyi, a now-retired faculty member of the University of Guelph, co-wrote a research paper called Food Provision in Ontario Hospitals and Long Term Care Facilities. Of the 55 hospitals studied, 19 hospital administrators agreed to discuss their food budgets. All of them outsourced the food production. Most told Padanyi that they took their cue from long-term-care facilities, which have a prescribed Ministry of Health and Long Term Care rate of $8.03 per day per patient to spend on food.
In 2012, the average amount spent per patient in the hospitals Padanyi looked at was $7.91 a day. "They say to the contractors, 'You've got x number of dollars, eight bucks a day per patient or whatever,' effectively downloading the responsibility of meeting that budget," she says.
Often, these contracts are not just for patient meals, but the staffing and operation of food franchises within the hospital, plus housekeeping and custodial. The main conclusion of Padyani's report was that food service is considered unimportant relative to the entire hospital.
Somewhat amusingly, a number of Toronto-area hospitals have ratings on Yelp. The reviews are what you'd expect – "The anesthesiologist was a clown … One star" – although I did find a three-star review of North York General that praised the Starbucks, Tim Hortons and Pizza Pizza in the food court.
But there are no Starbucks in prison. Not even a Second Cup. And if you don't like hospital food, think of eating nothing else for years.
Compass employs half a million people around the world (including 30,000 in Canada), and supplies food to schools, offices, stadiums, museums, mining camps and offshore drilling platforms, as well as hospitals and correctional centres. Of the company's many customers, patients and inmates have two things in common: First, they are unable to go buy themselves something more healthy, or at least more tasty; and second, we, the taxpayer, are responsible for feeding them.
Last November, Compass took over food services at the Regina Correctional Centre, a move that saved the Saskatchewan government $2.4-million a year. Lacking a Yelp page, inmates went on a hunger strike in January to protest against the quality of the food. "If you don't like the prison food, don't go to prison," Premier Brad Wall responded. In March, inmates refused food again, in part because Compass had raised prices at the canteen.
Ontario spends $14.54 a day per inmate to feed about 8,000 prisoners in 26 correctional facilities, for a total of $41.3-million a year, including labour and transportation. The food cost is $9.17 for three meals. Perhaps inmates should not, per our punitive view of criminal justice, be dining on lamb racks and truffles. But it's hard to imagine eating healthy on $9.17 a day.
There are two types of food services within Ontario's correctional facilities: cook-chill and conventional kitchens. Compass runs the Cook Chill Production Centre, which is located in the Maplehurst Correctional Complex in Milton that holds a 1,066-prisoner jail for men as well as the 247-prisoner Vanier Centre for Women. There, employees prepare food that is distributed to the nine largest institutions across the province, where it's reheated, sometimes with the assistance of inmates. (The province's other 17 institutions prepare meals in conventional kitchens.)
In sample menus provided by the Correctional Services Ministry, every serving is carefully measured – "whole wheat toast/bread 2, margarine 7 g, chicken balogna 90 g, baked beef steakette 140 g, mashed potatoes 175 ml, canned pears 125 ml, enriched fruit drink crystals 1 each." There are options listed for various diets, including gluten-free and diabetic.
"The ministry is committed to providing the best possible services for the inmates in our care," says spokesman Brent Ross, who describes the meals as nutritionally balanced and attractive, including fresh fruit and vegetables. "Each inmate receives a balanced diet of roughly 3,000 calories per day. … Inmates who have specific health or religious dietary requirements are also accommodated."
Tom, a former prisoner introduced to me through the John Howard Society (which asked that I not use his last name), has served time at various correctional facilities around Ontario and suffers from diabetes and Crohn's disease. He challenges Ross's statement. "They don't follow diets," says Tom, who is in his 30s, was first locked up at the age of 12 and has spent more than 10 years behind bars. "Any jail food, you're going to be on the toilet six times a day because what they're giving you is running though you."
The last serious stretch for Tom was five years ago, when he spent time in Toronto's East and West Detention Centres. He has fond memories of the now-shuttered Don Jail, where the guards were nicer and the food was tastier. Last fall, he also served a short bit (a lenient judge let him serve a 30-day sentence spread over weekends) in Ontario's new South Detention Centre – he says the portions are a little larger than in the past, but the food has not changed.
"The vegetables are almost non-existent. They'll throw a couple on the plate. You'll have a spoonful of some nasty peas. And they're not even green no more. They're grey," says Tom, who also says powdered mashed potatoes are served multiple times a week ("Both dehydrated and fresh potatoes are used in both the cook-chill and institutional kitchens," Ross says.)
Tom avoided eating chicken entirely when he was in jail. Another woman I spoke with, who spent a year at Vanier from 2010 to 2011, says the poultry was routinely served undercooked and pink. She says she relied on food purchased at the canteen, mostly ramen noodles. When dinner was "fish slop" – a dish she describes as "garbage with fish parts in it" – inmates would run to their stashes, softening the noodles with hot water from the sink over the toilet.
Canadian prisons no longer serve Nutraloaf or "prison loaf," a baked substance that meets dietary requirements, but has no flavour (and is still served to inmates in solitary confinement in the United States).
The use of prison loaf as psychological punishment ended in Canada 20 years ago, but Tom says food is still used as a form of discipline. "You cannot question a guard on the food. That's a big no-no," he says. "If you get a bad guard, he won't give you no warning. He'll just … slap you in the hole. Then you won't eat for a couple days."
When someone is admitted to hospital or incarcerated, society assumes responsibility for housing and feeding them. They are our charges, and any parent knows that proper eating means some form of real food, ideally fresh vegetables, every day, but instead we serve them the lowest common denominator in food.
Many people facing illness or incarceration are without options or a voice. They are reduced to eating the most processed, least nutritious food available, entirely because it's cheapest for the rest of us.
Editor's note: Due to an editing error, an earlier version of this story stated that all of the changes Joshna Maharaj implemented at Scarborough General Hospital were temporary, and that the hospital no longer cooks onsite. Some of the changed Maharaj implemented are still in place, and some food is still cooked on site.