Planting a seed for sustainable hospital menus

Unhealthy food consumption linked to unsustainable food systems is the major determinant of human and planetary health, accounting for nearly 12 million premature deaths each year and a third of greenhouse gas (GHG) emissions. Dominant food choices and demand are driving biodiversity loss, water scarcity, overuse of pesticides, nutrient pollution, climate change, and excessive use of antibiotics. Injustices and inequities embedded within an increasingly fragile food system have multiplied all around the world, reaffirming the critical need for a ‘Great Food Transformation’, the epithet coined by the EAT–Lancet Commission in 2019, which unfortunately remains unrealized.1 In 2019, the American Medical Association (AMA) called on US health care facilities to improve the health of its patients by providing more plant-based meals. Importantly, the AMA requested that hospitals eliminate all processed meats and foods high in saturated and trans-fats from daily menus.2 The American College of Cardiology made comparable recommendations and emphasized the importance of plant-based main dishes and a minimum of three fruit and/or vegetable options offered at each meal.3 The World Health Organization European Office for the Prevention and Control of Noncommunicable Disease published a statement supporting healthful plant-based diets that reduce or eliminate intake of animal products and maximize favourable ‘One Health’ impacts on human, animal, and environmental health.4 Yet despite these declarations, hospital cafeterias and kitchens providing foods for its patients and personnel tend to be less than optimal places for healthy sustainable diets.5 An in-patient hospital stay is a ‘teachable moment’ representing an unparalleled opportunity to get patients to recognize the connection between their diet, lifestyle, and chronic illness that brought them into the hospital. Ironically, hospitals are often hostile environments for facilitating enduring dietary changes, with many lacking the facilities or the personnel to educate and to help patients experience and incorporate healthy sustainable plant-based diets into their dietary repertoire. In-patient menus in the USA often lack healthy plant-based options and even if available are nutritionally not well-balanced, alienating even the most motivated patients from eating healthy. Senate Bills S1471A and SB-1138 introduced in New York and California, respectively, are the first steps taken towards facilitating the availability of plant-based meals at no additional costs to the patient.6,7 These legislative steps provide a firm legal mechanism to help align the mission of health care organizations (HCOs) to help prevent chronic non-communicable diseases (NCDs), with concrete actions to prevent NCDs. Enabling this shift across the USA may represent a great example of pro-active corporate social responsibility (CSR) shown by HCOs.8 Corporate social responsibility is generally understood as a way through which a company achieves a balance of economic, environmental, and social imperatives (‘triple bottom line approach’). There could hardly be any CSR measure with more upfront positive impact than widespread adoption of plant-based foods legislatively or otherwise in HCOs. By promoting plant-based menus, a hospital can help immediately improve its ESG metrics (environmental, social, and governance performance indicators). Given the singular importance of foods in GHGs, expanding the range of plant-based menus, especially those that are locally sourced, can reduce Scope 3 emissions immediately and boost the credibility of a hospital in its community as this will help further drive down toxic anthropogenic emissions.9 Moreover, widespread adoption of limited yet flavourful plant-based foods may simultaneously jettison nutritional inventories that are antithetical to healthy nutrition and sustainability. Limiting inventories could further reduce food wastage and lower costs. However, given that the menu in many cafeterias in the USA is controlled by large for-profit corporations such as Sodexo, Aramark, and Healthcare Solutions, whose goals are profit oriented, these may not be aligned with those of HCOs. Health care organization may need to re-assert their true raison d’etre, which is to improve the health of their constituents. The introduction of healthy plant-based menus in conjunction with other patient- and employee-facing wellness and engagement measures may help boost the public image of the hospital. In a competitive and consumer-driven industry, it is as important to respond to consumer and image mega-trends as it is to address the changing individual needs of patients. There is extensive evidence that a therapeutic choice made in the hospital and personal lifestyle of hospital staff (exercising regularly, eating healthy, etc.) are among the strongest predictors of how patients incorporate this guidance into their lives.10 Training health care personnel in hospitals to not only demonstrate competencies in nutrition but also an understanding of sustainable foods and the health and carbon impact of dietary decisions, including how to incorporate these decisions into daily eating, may help create a transformative and conscious workforce. Plant-based foods may also effectively improve the health of staff members, who are often exposed to less-than-optimal work environments including shift work and overtime that takes a toll on their health. Future hospital food environments may incorporate teaching kitchens not only as classrooms but also as learning laboratories, as research centres that generate cash flow, and as showrooms of planetary foods that are sustainable, delicious, and healthy.11 Incorporating indoor vertical farming with HCO living kitchens may help further align hospital sustainability initiatives towards net-zero targets, whereby many of the produce and herbs, grown year-round in an organic environment, can be utilized for HCO needs. Undoubtedly, major questions, around the health and true environmental impact of many plant-based foods, are being asked. And, these are not necessarily a bad thing. However, while this evidence is being gathered, this should not distract from meaningful progress in minimizing the gaps between health, sustainability, and equity and the repair of a broken food system. All authors declare no conflict of interest for this contribution.