 Good afternoon. I'm a public health physician brought on board by the Humane Society of the US a few years ago to address the human health consequences of some of the ways we treat animals. And industrialized farm animal production is a good example from both an infectious disease standpoint, a chronic disease standpoint, and an environmental health angle as well, all of which I'd like to briefly touch on. By the end of this year, the lifelong confinement of pregnant sows in these so-called gestation crates pictured here will be banned throughout the European Union. And at the beginning of this year, these barren battery cages for egg-glaying hens were banned by law in all 27 nations of the EU. So in the last five years, with both major changes in farm animal production practices on the horizon, millions of euros were spent intensely studying the food safety implications of transitioning away from cages and crates. What impact was this going to have on human health? Well, the greatest food safety burden in our country is Salmonella. According to the FDA, 142,000 Americans are sickened every year by eggs contaminated with Salmonella. That's an egg-borne epidemic every year. The leading cause of food poisoning related to hospitalization and the number one cause of food related death. So what can be done by producers at the farm level to reduce Salmonella risk? Well, that's what the European Food Safety Authority was interested in finding out. The EFSA is the kind of European equivalent of the US Food and Drug Administration. They compared 30,000 samples, taking from more than 5,000 major egg operations across two dozen countries, 5,000 different farms, and this is what they found. So for the most common type of Salmonella in eggs, compared to cages, there's 43% lower odds of Salmonella contamination in cage-free egg operation, 98% lower odds of finding Salmonella on free-range farms, and 95% lower odds on organic egg farms. And this is what it looks like kind of graphically in terms of Salmonella risk. Since that study was published five years ago or completed five years ago, there have been 14 subsequent studies published comparing Salmonella rates in cage versus cage-free egg operations, and they all found lower rates of Salmonella in cage-free. But why? Why this remarkably consistent finding of cage operations being so much riskier? Well, the FCN analysis suggests three factors. The higher prevalence in cage flocks may be explained by the fact that these intensive systems have higher risk of being infected due to, number one, the sheer number and packing density of these animals. Number two, cages can be difficult to disinfect, and so Salmonella has been shown to be more persistent in these cage flocks, where the infection is less easily cleaned out. And number three, batter cage operations breed more rodents, flies, and other disease vectors. And this increased flock risk among the birds appears to translate out into increased human risk. In a prospective case control study published in the American Journal of Epidemiology, among those eating eggs, those eating battery cage eggs, twice the odd suffering Salmonella poisoning, white or brown, eggs from hens and cages, significantly tied to illness compared to eating cage-free or organic, this is why it matters where hospitals source their eggs. And this is why it matters where hospitals get their poultry and pork. We feed antibiotics by the truckload to farm animals. Here's a total amount of antibiotics typically sold for all of human medicine. Every year contrast that to how much it goes to farm animals, mostly just to promote growth and prevent disease in such a stressful, crowded, unhygienic environment. Millions of pounds a year, and now we as physicians are faced with multi-drug resistant bacteria and running out of good antibiotic options. As Britain's chief medical officer put it, every inappropriate use of antibiotics in agriculture is potentially signing a death warrant for a future patient. Now such use has its opponents and its advocates, the feeding of clinically important human antibiotics to pigs and chickens, just to fatten them faster, is condemned by the American Medical Association, but approved by the American Meat Institute. The American Academy of Pediatrics opposed versus the National Turkey Federation. The American Public Health Association is against it, but the American Sheep Industry Association is for it. The National Academy of Sciences Institute of Medicine opposed National Chicken Council in favor, World Health Organization on one side, the National Pork Producers Council on the other. Now to be fair, the National Cattlemen's Beef Association also in favor, along with the United Egg Producers. On the other hand, this practice has been condemned by nearly every medical organization in the United States, yet industrial animal agriculture continues this dangerous practice. This pharmacological crutch is one of the reasons industrialized animal agriculture has been blamed for emerging zoonotic animal-to-human diseases, including swine flu, whose primary ancestor was the triple hybrid mutant that spread throughout factory farms in the U.S. a decade before a further reassessment went on to kill 12,000 Americans. I don't have time to get into swine flu, but I do have a whole presentation on DVD, free to anyone on the webinar today. Just email me at mhg1 at cornell.edu. That's mhg just the numeral one at cornel.edu. In terms of chronic disease, our number one killer is heart disease, which can be prevented, treated, and even reversed. Arteries opened up without drugs, without surgery, with a plant-based diet. But one can obtain many of the health benefits from a low-meat diet, not just a no-meat diet. Adventus II is the largest-ever study of so-called flexitarians. You can see a significant risk reduction, just moderating one's intake of meat. In this study, a semi-vegetarian was defined as someone who eats meat on a weekly, rather than kind of a daily basis. Not vegetarian, yet associated with significantly lower BMI, lower obesity risk, significantly less diabetes, and significantly less high blood pressure, allowed it to top killers in the US. You can tell this is an American study, because even the vegetarians, on average, were overweight. As you can see, there seems to be a stepwise reduction in risk, though, as one gets more and more plant-based across the board. But I wanted to emphasize that one doesn't have to go all the way to derive benefits from cutting back on meat. The second largest study on flexitarians released data on cataract risk last year are leading cause of vision loss. You can tell this is a European study, because the heavy meat-eating category is defined as basically just a single serving, a meat a day or more. Those are the heavy meat-eaters. But compared to one or more, those eating less than half a serving a day significantly lower cataract risk. Though, again, you do see this kind of progressive drop in risk, as one takes plant-based eating to more kind of an extreme. But on a population scale, even a 15% risk reduction is huge. Let me share a quick public health success story after World War II, Finland, joined us in packing on the meat eggs and dairy. By the mid-1970s, the mortality rate from heart disease and Finnish men was the highest in the world, even putting us to shame, bumping us down to number 2. They didn't want to die, so they got serious. Heart disease caused by high cholesterol, high cholesterol caused by high saturated fat intake. So the main focus of the strategy was to reduce the high saturated fat intake in the country. So in this country, that would mean cheese and chicken, cake and pork, primarily. So a berry project was launched to help dairy farmers make a switch to berry farming, whatever it took. And indeed, many farmers did switch from dairies to berries. They pitted villages against one another in these friendly cholesterol-lowering competitions to see who could do best. Well, so how'd they do? An 80% drop in cardiac mortality across the entire country. With greatly reduced cardiovascular and cancer mortality, the all-cause mortality was cut nearly in half. And look, Finland is no land of vegetarians. This was just from them cutting down on saturated animal fat. I've got a whole presentation on DVD free again to anyone on this webinar today on the role plant-based diet that can play in preventing, treating, even reversing our 15 leading causes of death. Again, just email me your mailing address, and all of my nutrition work is available free on my website nutritionfacts.org. In terms of environmental health, from the proceedings of the National Academy of Sciences, using a meat thermometer graphic to basically show that when it comes to three environmental catastrophes in the making, climate change, biomass appropriation, and nitrogen mobilization, by 2050, if we rely on livestock, we're basically screwed, screwed, and screwed. But if we instead rely on plant protein, we'd be in the green across the board. So, not surprisingly, some of the world's largest environmental organizations, like Sierra Club, advocate eating less meat, suggesting that 20% drop in consumption would be like our entire nation switching to hybrid cars. And indeed, Dr. Pichari, the head of the UN Climate Change Panel, is quoted as advocating eating meat-free at least a day a week. And that's where hospitals can join in by promoting Meatless Mondays, for example. SEDEXA launched a Meatless Mondays initiative last year, promoting vegetarian options 900 hospital cafeterias, three-quarters of which found it easy to implement, for signage available, big, pink, pig-post costumes, you name it. Or even better, option, take the balance menus challenge to reduce meat purchases, you know, 20%, right? We drop meat consumption 20%. Again, we get that Sierra Club benefit of all switching to Priuses. In terms of our team at HSU-S, we've personally worked with hospitals coast-to-coast, large and small, in the Midwest, deep south, you name it. Please feel free to contact us. We'd be happy to help email me, call me, anything we can do to support hospitals to provide healthier and safer options for the public and the planet. Thank you, and I'll meet you back on the webinar.