Hannah Wallace

The Globalization of Healthcare

As we continue to debate (and debate and debate) health-care reform in this country, many Americans who are either uninsured or under-insured are traveling abroad for health care. And not just for plastic surgery or dental work, as I found out while writing this article for Endless Vacation (RCI's travel magazine).

The savings are enormous, even, unbelievably, when you factor in international airfare and luxury hotels. In India, which has an array of top-end facilities including Wockhard and Apollo Hospitals, the average price for medical care is 80% less than it is here in the U.S., according to Devon Herrick, senior fellow at the National Center for Policy Analysis in Washington D.C.

Adventurous travelers are heading to Costa Rica for dental work, India for high-tech heart and orthopedic surgeries (including hip resurfacing, which is not widely practiced in the U.S.), and Turkey for oncology care. And the total number of "health tourists" is only expected to rise in coming years, according to health economists. 

If you're intrigued, check out these 7 tips which I gleaned from Josef Woodman, author of Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Travel.

A Picnic in Toronto: Celebrating Slow Food and Green Spaces

There are worse ways to get to know a city than through its food.

This past weekend, I was fortunate enough to be in Toronto for both Nuit Blanche and a  fundraiser "picnic" for Slow Food Toronto and Evergreen, a non-profit organization that makes cities more livable by creating and restoring outdoor spaces. The event was held at the spectacular Brick Works facility in the Don River Valley—a former brick quarry and factory that dates back to 1889 and that's used for a weekly farmers' market, chef workshops, sustainability fairs, etc. It will soon be the site for Evergreen's ambitious new environmental community center, slated to open in summer of 2010. (In fact, that's what this fundraiser was for: generating funds to finish the construction.)

First of all, forgive me, because I did not take notes. You try scribbling in a notebook while carrying a wine glass in one hand (you only get one for the entire picnic) and a compostable bamboo plate in the other. So I rely purely on my fickle memory and the memory of my boyfriend and our friends (Torontonians)—and the handful of business cards and menus I swiped from various food stands.

The theme of this year's picnic was "locally global"—a celebration of Toronto's diverse food traditions. Each chef (specializing in Mexican, Indian, Middle Eastern, etc. cuisines) was paired with a leading locavore chef and a local grower to showcase a seasonal ingredient.

Chef Jamie Kennedy Making Pakoras

Anyway, the wait was worth it: crispy heirloom bean pakoras (above) with yogurt raita or a smokey eggplant salsa. After this, things get a little foggy, no doubt helped by a glass of Steam Whistle pilsner and a generous swig of Frogpond Farm's standout organic cabernet-merlot. (Frogpond is one of two certified organic wineries in Ontario.)  I had a plateful of Argentinian goodness from a restaurant called Canoe: steak tartare, lamb empanada, and a salted tongue (a delicacy I saved for my meat-loving boyfriend); a diminutive pulled pork taco; and a lovely spear of butter chicken and stewed apricots. Clearly, this all called for another wine pairing, so I refilled my glass with a touch of organic and biodynamic merlot from Southbrook Vineyard.

As the five of us slowly made our way over to the dessert area, I looked up from my now-empty plate long enough to notice that several eaters were in a similar state of post-prandial bliss: walking around the barn-like room with dazed expressions, licking their fingers and looking for the next delectable morsel. (Mind you, there were over 60 restaurants present so it did get a bit overwhelming. What is it about being human that makes you want to try everything?)

The thing about these Slow Food events, where zillions of top chefs and local producers are vying for your attention, is that they tend to be fairly insular. (Well-heeled foodies hitting a never-ending smorgasbord of the best local food and wine...I must admit, it does sound elitist.) However, this was hardly a navel-gazing event. Proceeds from the tickets supported two worthy causes: in this case, both Slow Food Toronto (which defends biodiversity and supports small-scale, sustainable, local economies) and Evergreen's new facility, which will eventually house a native plant nursery and garden center, a "green job" training program for area youth, food gardens, farmers' markets, hands-on geology exhibits, and so on. (For more on Evergreen Brick Works, see here.)

Sweet: Ontario Peaches

So then, back to dessert. I tried a prune streusel cake with a dollop of whipped cream from Crush Wine Bar; a tiny piece of Matchbox Garden carrot cake (made with heirloom carrots by Amuse-Bouche chefs Jason Inniss and Bertrand Alépée), topped with a sprig of lavender; a sliver of fresh Ontario peach that blew me away (above); and a Hungarian dumpling with plums from Loïc Gourmet.  Just to prove that I could exercise some restraint, I skipped the homemade honey ice-cream, made with honey from the hives that sit atop the Royal York hotel.

Everyone agreed that the culinary highlight of the day was a pear-pumpkin fritter (made by Brook Kavanagh from La Palette), with a cinnamon-and-maple syrup custard interior. The organic pears were sourced from Ontario's Lincoln Line Orchards and the pumpkins (which were puréed and added to the batter) were from a nearby farm called Psennings.

Earlier in the afternoon, when I was still hungry and sober, I'd spoken to a woman from Farm Start, an Ontario-based non-profit that offers support and training to a new generation of farmers, in some cases linking them up with "mentor farms." Canada's farmers are aging: the number of farmers under the age of 35 has declined from 25% in 1991 to 12% in 2001.

Standing in the Brick Works with my empty plate, I was not worried about the future of small farms. I was surrounded by chefs committed to serving seasonal cuisine, growers ready to supply it, and regular people more than happy to pay for it. Judging by the turnout at this fundraiser, Canada's Slow Food movement, like the U.S.'s, is alive and well.

Where Does Your Beer Come From?

This is the third in a series of articles about polyculture and sustainable farming in Oregon. Read the previous installment, or start at the beginning of the series, which I wrote for The Faster Times.

After sipping wine made from grapes that had not been irrigated (divine!), and then visiting a winery that's practicing polyculture (following the spirit of biodynamics), it was time to visit a farm that produces Oregon's other quintessential beverage: beer.

Even though I've been a beer drinker all my life—my father used to homebrew the stuff and I once thirstily grabbed a Coke bottle from the fridge, only to discover mid-gulp that it was a dusky porter—I'd never, until this summer, seen a hop.

As it happens, the town I grew up in—Salem—is a mere 10 miles from what was once the hop-producing capital of the world: Independence, Oregon. In the 40's, the population of Independence swelled to 50,000 during hop season—with hop-harvesters camping out on the side of the road. Though hop production waned in the 50's, Independence is still the center of much hop activity, including the farm that supplies Oregon's own craft brewer Rogue Ales.

Hops before the harvest at Rogue's farm

As Dustin, a handsome young Rogue employee, showed an assembled group of journalists (and the crew from a new T.V. pilot lamely called "Beer Men") around the farm, he told us some hop history: it was Pliny the Elder who first documented hops, in his Naturalis Historia, but the Germans were the ones to first brew beer, in 732 AD. Of the three species of hop plant, it is Humulus lupulus that is used to flavor and stabilize beer. Dustin then led us into the high-ceilinged hop plant, with its well-worn stairs and rickety cat walks. I was bewildered by the masses of conveyor belts and pulleys going every which way. It all seemed so archaic and intricate. Thankfully, it was the day before harvest, so none of the machines were running. (I hear it's a deafening clatter.)

The intricate machinery at Rogue's hop facility (Photo by Annalou Vincent)

Dustin assured us that the guys who operate the machinery use food-grade quality oil and lubricants. It was at this moment that I realized I'd never once contemplated the origins of my beer—let alone that beer production involves such marvels of engineering, long before it's even brewed or bottled.

From Independence, I drove north with my friend Lisa Donoughe (founder and director of Watershed Communications, who had organized this hop trip) to the town of Mt. Angel. Better known for a Benedictine monastery and its Alvar Aalto-designed library, Mt. Angel is located smack dab in the middle of Oregon farm country.

After a tour of the Annen Brothers' hop collection facility, we met Gayle Goschie, a 3rd generation hop farmer who is turning heads in the beer industry with her commitment to sustainable farming practices. Gayle, along with her brothers Gordon and Glenn, farm 400 acres of hops, and sells them to everyone from Anheuser Busch to craft brewers such as Bridgeport and Deschutes Brewery.

Though most hop farmers say it's "impossible" to grow organic hops (particularly in Oregon, where powdery and downy mildew, mites, and aphids thrive), Gayle has started an experimental 6-acre organic plot. Instead of artificial chemicals or fertilizers, she plants companion plants like garlic and sprays wintergreen and spearmint oils to attract beneficial insects such as ladybugs. Last year, this organic plot thrived, but this past spring was extremely wet, which meant that aphids and downy mildew were out in full force. Nonetheless, Goschie recently told me that Deschutes enthusiastically purchased the majority of her organic crop this year, and is working hard to produce a 100% organic beer.  (Interestingly, most beers that are USDA-certified organic are not necessarily made with organic hops, since they are still fairly hard to source—and cost twice as much as conventional hops. A product needs to be comprised of 95% organic ingredients to get the USDA organic label and organic beers do that by sourcing organic malted barely and wheat. Both Wolaver's and Peak are trying to source 100% of their hops organically, but haven't gotten there yet.) The Goschies are growing many varieties of organic hops including Willamette, Fuggle, Cascade, Teamaker, and Centennial. They're also testing 24 S.S. Steiner experimental varieties, as well as Summit and First Gold hops grown on low-trellises.

Gayle's eyes lit up as she told us about all she was learning from growing and nurturing organic hops. "I'm curious to know what's the difference in the hop cone between organic and conventional," she said. She's already noticed that organic hops are not as uniform as conventional hops. She's learned to discourage spider mites by allowing the foliage cover to stay put (instead of weeding it as conventional hop growers do). "Spider mites winter in the soil," she said. "They don't build if it's not hot—they won't come up the vine."

But as with wine, organic is just one certification for hop farmers to strive for. Goschie Farms is one of the few hop farms in the U.S. to be certified Salmon Safe.

Gayle Goschie, innovative hop farmer

(Photo by Annalou Vincent)

When I first heard about this eco-label, I did a double-take. What on earth could inland hop production have to do with salmon?

It turns out that many conventional farming practices in the Northwest hurt the salmon population: pesticide runoff, erosion, and damage to animal habitats to name a few. Salmon-Safe certifies everything from Willamette Valley hazelnuts to Walla Walla wines; recently, Real Simple magazine rated Salmon-Safe as one of 8 eco-safe labels you can trust.  Hops are a new addition to the nonprofit Salmon-Safe's repertoire.

To qualify for Salmon-Safe certification, hop growers need to meet rigorous conservation requirements, including finding natural methods to control weeds and pests, protecting streams and wetlands, planting cover crops to prevent erosion and runoff, and reducing irrigation.

"A lot of this, including integrated pest management techniques, we were already doing," Goschie told us with obvious pride. Thanks to her grandfather, who started farming the Silverton land in 1905, she and her brothers know the benefits of composting, pest management, and polyculture. (They also grow specialty seeds, grass, and even some wine grapes.) Before seeking the Salmon- Safe certification, the Goschies had already converted to drip irrigation (as opposed to pipes, which waste a lot of water) and had installed moisture monitors in the field. Compost goes on all fields and they plant native grasses between their farm and the highways to prevent sediment runoff. (This is important so sediments don't ultimately cover nearby fish breeding areas.)

Goschie Farms and Sod Busters (another Oregon hop farm) are the only two to be certified Salmon-Safe in the country—and Deschutes is (as far as I know) the only brewery to promote lines of salmon-safe beer: Green Lakes Organic and Hop Trip (a fresh hop beer). Green Lakes, which had a clever ad campaign ("How to Drink Like a Fish...") deconstructing the Salmon-Safe label, is a limited release beer that's only available in the western states—oh, and Texas.

Skippy's, Froot Loops, Fudgsicles: "Smart Choices"?

A few weeks ago, I read this article in the Times about a new labeling program ironically called "Smart Choices," that is clearly a desperate attempt by various food conglomerates to counter the sustainable food revolution. Nutritionally bereft foods such as Cocoa Krispies, Froot Loops, Fudgsicles and Hellman's Mayo have made the list and get a cheery green check mark and the "Smart Choices" imprimatur. (The official-looking logo says, "Smart Choices Program: Guiding Food Choices.) Companies such as Kellogg’s, Kraft Foods, ConAgra Foods, Unilever, General Mills, PepsiCo and Tyson Foods have all signed up and the entire program is chaired by a nutritionist (!!) named Eileen T. Kennedy, who is the dean of the Friedman School of Nutrition Science and Policy at Tufts.

This makes my blood boil.

I was raised to be skeptical of food labels, to examine the "Ingredients" lists on packaging and steer clear of foods that had sugar as one of the first three ingredients. My folks only allowed us to have Golden Grahams and other specious excuses for cereal (which at the time, of course, my sister and I adored!) for dessert. And guess what?  I didn't have my first cavity until I was a senior in high school.

But I well know that my family was not typical. And when a parent who is shopping for cereal sees a label that seemingly tells them the food is healthy, they may believe or want to believe that it's true. I wish that most people knew better, but the fact is—they don't.

So where is our government on this?  How can we stop the madness?

William Neuman, in his article, said that the FDA and and Department of Agriculture had sent a letter to the Smart Choices organizers, saying they "intended to monitor its effect on the food choices of consumers." That's a start, but it's not exactly going to stop the program in its tracks.

Then I read on Marion Nestle's site that Mike Smith of Change.org has organized a letter-writing campaign asking the nutritionists on the board of Smart Choices to resign. If you, too are outraged by this insidious labeling initiative and believe that Teddy Graham's and Froot Loops (41% sugar) are— if not evil—better reserved for the rare snacking indulgence, please take a moment to write a letter to the Smart Choices folks.

Nearly 4,000 people have already done so and—get this—Tufts University, the American Diabetes Association, AND the American Dietetic Association have all asked that their names be removed from the Smart Choices site.

The Politics of "Green Wine"—and Added Sulfites

This post originally appeared on the Faster Times, generating dozens of comments. Clearly the subject of what does, indeed, cause a red wine headache is still controversial—and it's still up for debate.

A few weeks ago, I posted an article about natural wines—just one of the many "green" wines that are getting more attention (and accolades) these days. There's also certified organic wine. Wine made from organic grapes. Biodynamic wine. And—murkiest of all—"sustainable" wine.

A friend recently posted on Facebook that she'd finally come to the conclusion that she can't drink red wine anymore—she wakes up in the middle of the night with raging headaches. Several people (including me) posted that she's probably sensitive to sulfites and that she should give sulfite-free wines a try. (Another friend posited that it was the histamines in red wine that give people headaches—this actually seems more plausible to me since white wines typically contain more sulfites than red. Reds have more natural preservatives in the form of tannins.) 

A discussion ensued about which wines do and do not contain sulfites. Here's the scoop: all wines contain some naturally-occurring sulfites—they are produced by yeast during the fermentation process. In the U.S. any wine that is "USDA Certified Organic" cannot contain any added sulfites. Those organic wines that do contain small amounts of added sulfites are labeled "made from organic grapes." Winemakers with this label add no more than 100 ppm (parts per million) total sulfites—in the form of sulfur dioxide (known as SO2).

QUEST on KQED Public Media.

This recent radio program from KQED in California tries to clear up some of the confusion about all these different eco-wine categories, including this controversial issue of "added sulfites." Reporter Andrea Kissack talks to so-called biodynamic winemaker Tim Thornhill from Parducci Winery and also interviews skeptics who gripe that natural wines have an "organic funk." Towards the end of the segment, she quizzes Luc Erotran from San Francisco's Terroir Natural Wine Merchant who shuns winemakers who are trying to "surf the green wave" and gives his own definition of natural wines.

According to the Organic Wine Journal, the use of added sulfites is a subject of much debate in the organic winemaking community. "Many vintners favor their use, in extremely small quantities, to help stabilize wines, while others frown on them completely," reads the copy on the Organic Wine Journal's site.

While there's nothing inherently wrong with sulfites—they help wines with any kind of shelf life avoid premature oxidation or possible spoilage—they are a chemical and according to the USDA, 1% of the  population is sensitive to them. For more on the still-mysterious subject of Red Wine Headaches, check out this article by Marian Burros.