Centre for Sustainable Healthcare (CSH)

Since 2008 the Centre for Sustainable Healthcare (CSH) has engaged healthcare professionals, patients, and the wider community to understand the connections between health and the environment and reduce healthcare’s resource footprint.

CSH’s work is guided by the principles of sustainable clinical practice:

  • Prevention
  • Patient empowerment and self care
  • Lean systems
  • Low carbon alternatives

CSH programmes equip healthcare professionals and organisations with methods and metrics for sustainable models of care:

  • Sustainable Specialties Programme
  • Carbon Footprinting and Triple Bottom Line Analysis
  • Education and Training
  • Sustainability in Quality Improvement
  • The Green Team Competition
  • Green Space for Health
  • Sustainable Healthcare Peer Networks

CSH was born in and will always have its heart in Oxford, England, but our expanding team of international experts is situated all over the UK, the EU and beyond. CSH has grown into the world’s foremost institution for sustainable healthcare in research and practice and has had a positive impact on so much of the healthcare system in the UK and beyond.

From measuring and reducing our own carbon footprint to prioritising the health, wellbeing, and work/life balance of those in our team, the CSH team practices what they preach every day. In line with our sustainable ethos, we minimise the daily commute by working online. This provides us with the freedom and efficiency to tap into the best and brightest minds in their fields while making a positive impact on the environment in the way we work.

By building its own research base, best practice recommendations and an ever-growing bank of case studies, it has fulfilled its goal of bringing all of that expert knowledge into action, changing clinical care and influencing policy at the highest level.

As CSH goes from strength to strength, so too does its message that healthcare can be sustainable.

German Nutrition Society (DGE): DGE position statement on a more sustainable diet (2021)

Renner B, Arens-Azevêdo U, Watzl B, Richter M, Virmani K, Linseisen. J for the German Nutrition Society (DGE): DGE position statement on a more sustainable diet. Ernahrungs Umschau 2021; 68(7): 144–54. DOI: 10.4455/eu.2021.030

Summary

Our understanding of the term sustainability has evolved considerably over the last 50 years and is now a key element of social action. An essential part of sustainable development is a more sustainable diet. In this position paper, the German Nutrition Society states that advocating for and promoting a more sustainable diet is an integral part of its activities. Health is a key goal of a more sustainable diet since health, quality of life, and well-being are affected by what people eat and drink. The goal dimensions of environment, animal welfare, and social aspects are explicitly added to the goal dimension of health (in their various definitions).

The food environment is also immensely important for nutritional behaviour. The DGE relies on statements from the report of the Scientific Advisory Board on Agricultural Policy, Food and Consumer Health Protection at the Federal Ministry of Food and Agriculture (WBAE) to present a comprehensive form of the various aspects of a more sustainable diet. The position paper ensures a common basis for developing an understanding of a more sustainable diet, and enables the different fields of nutritional science to pursue a differentiated development from their specific perspectives. This paper should provide the DGE with an orientation and a commitment for its work in the future.

Recipe for a Livable Planet: Achieving Net Zero Emissions in the Agrifood System (2024)

Sutton, William R.; Lotsch, Alexander; Prasann, Ashesh. 2024. Recipe for a Livable Planet: Achieving Net Zero Emissions in the Agrifood System. © Washington, DC: World Bank. http://hdl.handle.net/10986/41468  License: CC BY 3.0 IGO.

Abstract

The global agrifood system has been largely overlooked in the fight against climate change. Yet, greenhouse gas emissions from the agrifood system are so big that they alone could cause the world to miss the goal of keeping global average temperatures from rising above 1.5 centigrade compared to preindustrial levels. Greenhouse gas emissions from agrifood must be cut to net zero by 2050 to achieve this goal.

Recipe for a Livable Planet: Achieving Net Zero Emissions in the Agrifood System offers the first comprehensive global strategic framework to mitigate the agrifood system’s contributions to climate change, detailing affordable and readily available measures that can cut nearly a third of the world’s planet heating emissions while ensuring global food security.

These actions, which are urgently needed, offer three additional benefits: improving food supply reliability, strengthening the global food system’s resilience to climate change, and safeguarding vulnerable populations.

This practical guide outlines global actions and specific steps that countries at all income levels can take starting now, focusing on six key areas: investments, incentives, information, innovation, institutions, and inclusion.

Calling for collaboration among governments, businesses, citizens, and international organizations, it maps a pathway to making agrifood a significant contributor to addressing climate change and healing the planet.

Communicating about healthy & sustainable eating to consumers with low socioeconomic status: Evidence-based recommendations (2024)

European Food Information Council (EUFIC) and Caritas Trieste in Italy conducted joint research and developed evidence-based recommendations for “Facilitating the Healthy and Sustainable Diet Shift through Effective Communication in Communities with Low Socioeconomic Status”.

Consumers with low socioeconomic status (SES) face unique challenges that limit their uptake of healthy & sustainable eating (e.g., reduced affordability, accessibility, and availability of healthy & sustainable foods). The reduced exposure to, seeking of, and trust in health information that has been observed in consumers with low SES further reinforce these challenges.

This toolkit presents evidence-based recommendations on how to tailor your communication to consumers with low SES to empower them to shift towards healthier & more sustainable diets. The recommendations were developed based on a combination of qualitative and quantitative research findings.

Focus groups with social supermarket beneficiaries and professionals of the Caritas Trieste charitable foundation in Italy provided insights into the barriers and communication preferences of consumers with low SES with regard to healthy & sustainable eating. Based on these insights, tailored communication material (i.e., infographics) was developed and tested in a larger pool of consumers with low SES via an online survey.

This toolkit of recommendations is particularly relevant for science communicators, researchers, health professionals, journalists, NGOs, and policymakers who work with communities with low SES.

Sustain: the alliance for better food and farming (website)

Sustain is a powerful alliance of organisations and communities working together for a better system of food, farming and fishing, and cultivating the movement for change. Together, they advocate food and agriculture policies and practices that enhance the health and welfare of people and animals, improve the working and living environment, enrich society and culture, and promote equity.

The Sustain alliance works to influence government, local authorities, businesses, organisations and decision-makers in a position to influence or achieve change. We advocate for transparency, legal responsibilities, good governance and accountability. We work with sister alliances and organisations in the UK Nations and support experts and groups working on specialist issues where we can lend our weight. We also work with leaders, food partnerships and communities in places across the UK – and internationally – to improve health and sustainability through the mobilisation and celebration of local action on food.

The main sister alliances that Sustain works with include:

  • Eating Better, is a movement for change of sixty organisations working to accelerate the transition from producing and eating too much meat and dairy to a fairer, healthier and more sustainable food system that is better for animal welfare and for nature.
  • Food Sense Wales is built on the foundations of Food Cardiff, a multi-award-winning food partnership and founding member of the Sustainable Food Places Network managed in partnership with the Soil Association, Food Matters and Sustain. Food Sense Wales delivers pioneering programmes such as Sustainable Food Places, Peas Please, and Food Power – bringing people together through food.
  • Green Alliance is an independent think tank and charity focused on ambitious leadership for the environment. It works with influential leaders in business, NGOs and politics to accelerate political action and create transformative policy for a green and prosperous UK. Sustain has worked extensively with Green Alliance members, and during the Brexit process with the Greener UK coalition hosted by the Green Alliance, to integrate food and farming into key environmental, fisheries and agriculture policy initiatives.
  • Green Care Coalition, was established in 2016 to promote the commissioning and use of Green Care services, and to give voice to the many organisations in the UK that are committed to delivering or supporting the delivery of high-quality and cost-effective Green Care services. Green Care refers to structured therapy or treatment programmes that take place in natural surroundings and recognise the instinctive connection between nature and health.
  • Nourish Scotland works across Scotland for a fair, healthy and sustainable food system that truly values nature and people. Nourish takes a systems approach to food. This means they work across a wide range of issues and levels: from production to consumption, from practice to policy, and from grassroots to national. They champion integrated approaches to solving the big challenges of the current food system: hunger and malnutrition, diet-related disease, exploitation, loss of biodiversity, and climate change.
  • The Obesity Health Alliance is a coalition of over 40 organisations working together to reduce obesity by influencing government policy. The goal of the Obesity Health Alliance is to prevent obesity-related ill-health by supporting evidence-based population-level policies to help address the wider environmental factors that lead to excess body weight.
  • The Sustainable Soils Alliance is a partnership of farming organisations, businesses, NGOs, applied science and academia working together to restore our soils to health within one generation. The alliance pursues this aim by bringing together the community of stakeholders interested in soil management to debate the scale and nature of the problem, agree on the appropriate indicators and determining factors and identify the relevant policy mechanisms and levers for reform. They engage media and stakeholders, educate the general public and lobby government for a policy framework that will bring about the transformational step change needed to support the development of healthy soil for generations to come.
  • The Trade Justice Movement is a UK coalition of nearly sixty civil society organisations, with millions of individual members, calling for trade rules that work for people and the planet. Trade Justice Movement members include trade unions, aid agencies, environment and human rights campaigns, Fair Trade organisations and consumer groups. 
  • Wildlife and Countryside Link is the largest environment and wildlife coalition in England, bringing together 57 organisations to use their strong joint voice for the protection of nature. Link’s members campaign to conserve, enhance and access our landscapes, animals, plants, habitats, rivers and seas.

Can agroecology improve food security and nutrition? A review (2021)

Bezner Kerr, R., Madsen, S., Stüber, M., Liebert, J., Mazibuko, H., Funnel, K., … & Wezel, A. (2021). Can agroecology improve food security and nutrition? A review. Global Food Security, 29, 100540. (paid access)

Highlights

  • 56 agroecology studies had evidence for food security & nutrition (FSN) outcomes.
  • 78% of studies showed positive FSN outcomes from agroecological practices.
  • Key agroecological practices are crop diversity, organic soil amendments, and agroforestry.
  • Farmer networks and attention to social equity dimensions were important.
  • Increased complexity of agroecological system more positively associated with FSN.

Abstract

Agroecology increasingly has gained scientific and policy recognition as having potential to address environmental and social issues within food production, but concerns have been raised about its implications for food security and nutrition, particularly in low-income countries.

This review paper examines recent evidence (1998–2019) for whether agroecological practices can improve human food security and nutrition. A total of 11,771 articles were screened by abstract and title, 275 articles included for full review, with 56 articles (55 cases) selected.

A majority of studies (78%) found evidence of positive outcomes in the use of agroecological practices on food security and nutrition of households in low and middle-income countries. Agroecological practices included crop diversification, intercropping, agroforestry, integrating crop and livestock, and soil management measures.

More complex agroecological systems, that included multiple components (e.g., crop diversification, mixed crop-livestock systems and farmer-to-farmer networks) were more likely to have positive food security and nutrition outcomes.

Food as Medicine Global

Vision – A collaborative global community of farmers, health care providers, healers, hospitals, clinics, educators, schools, academic centers, students, cooks and consumers united in a vision for a healthy world.

Mission – To facilitate educational conversations and collaborative engagement for unifying agriculture and medicine to promote health and healing for all. Food as Medicine Global (FAMG) is about community. We facilitate conversations leading to increased collaborations and individual actions to promote health and healing for all. We host events for continued cooperative engagement, brainstorming, and learning from each other to advance the Food as Medicine movement.

Why? Many of our current world challenges have a common root: the way food is grown and consumed. Farming practices impact the health of people, animals, and the environment. Healthier soil leads to healthier food, healthier people, a healthier ecosystem, and healthier climate. There is already a great deal of work happening globally in these areas; however, much of it is in isolation. Our intent is to gather information, build bridges, advance conversations, strengthen engagement, highlight success stories, and amplify efforts to energize a global movement. 

Food systems-based dietary guidelines (FSBDGs, 2024)

This document is a brief introduction to the new food systems-based dietary guidelines (FSBDGs) methodology developed by FAO, which not only aims to address health and nutritional priorities but takes a food system approach to promote healthy diets, by considering socio-cultural, economic, and environmental sustainability.

Why is a food systems-based methodology necessary?

Most countries have developed dietary guidelines with a focus on improving consumers’ nutrition and overall health. Such guidelines have been mainly used for nutrition education. Only a few countries have extended their use to inform policies and interventions in other sectors, such as in public procurement and social protection.

To leverage their potential for doing more in other sectors, some countries have included sustainability considerations in new or revised dietary guidelines. However, the methodologies and approaches used by these countries differ significantly from one another and are seldom made public.

The international community has recognized the potential and need for dietary guidelines to catalyze food systems transformation towards sustainability and to influence policies beyond the scope of consumer education. However, at present, there is a lack of global guidance and tools to facilitate this.

To fill in this gap, the Food and Agriculture Organization (FAO) has developed the new food systems-based dietary guidelines (FSBDGs) methodology through a collaborative process involving multiple global, regional, and country-level experts.

Next-generation solutions to address adaptive challenges in dietetics practice: the I+PSE conceptual framework for action (2022)

Tagtow A, Herman D, Cunningham-Sabo L. Next-generation solutions to address adaptive challenges in dietetics practice: the I+PSE conceptual framework for action. J Acad Nutr Diet. 2022; 122(1): 15-24.

This article focuses on Applications for Professional Practice. The following is taken from the introduction to the article:

“It describes the Individual plus Policy, System, and Environmental (I+PSE) Conceptual Framework for Action (known as the “Framework”) as a roadmap for RDNs across all areas of practice (eg, research, education, clinical, community, and management) to better address adaptive challenges and to formulate multidimensional strategies for optimal impact. The Framework has cross-cutting practice implications for all areas of dietetics practice and can lead to the next generation of solutions to tackle adaptive challenges that better support nutrition and health.

The I+PSE Conceptual Framework for Action (see Figure) is a blueprint for RDNs and their partners to develop and implement multidimensional strategies using a systems orientation to achieve greater responsiveness to adaptive challenges and realize greater impacts.

  • Phase 1 –
    • Once an adaptive challenge is identified, RDNs can apply a determinants of health lens (Figure, phase 1) to closely examine nutrition and health problems and better identify why problems are worsening despite best efforts to solve them. The result of this focused assessment is a stronger diagnosis of the root causes that supports strategic decision-making in phase 2.
  • Phase 2 –
    • Is the formation of coordinated multidimensional strategies that produce a sustainable and synergistic effect.
  • Phase 3 –
    • Is the evaluation of outcomes and impacts of the suite of strategies and the degree to which change has occurred at the individual, practice, program, organizational, policy, and population levels. Encircling the Framework is systems thinking and reflection to support an iterative cycle of robust assessment, planning, implementation, and impact evaluation. The Framework is versatile and can be adapted to a wide range of nutrition issues, areas of dietetics practice, and diverse partnerships.”

Sustainability Practices in School Feeding Programs (2023 Sep)

This paper provides an overview of research on environmental considerations in school feeding programmes and a synopsis of evaluations of two school feeding programs (U.S. National School Lunch Program and Portugal) with emphasis on their environmental impacts.

The paper concludes that estimates of the environmental impacts of school feeding programs are needed to design menus and make policy recommendations, which, in turn, can reduce their environmental impacts and help students develop food preferences aligned with sustainable dietary patterns. Studies can be performed to better inform implementation of different components of new standards.

The following were strategies found to assist:
💰 Financial incentives, including local food procurement, could encourage school districts to offer beef less frequently, and provide plant-based meals on school menus.
📝 School-based curriculum that emphasizes food literacy (e.g., cooking, gardening) and marketing campaigns could ensure that menu changes are well-received by students.
🫛 Sourcing plant-based school meals seasonally and locally that use eco-friendly production practices such as organic food production and agroecology can provide environmental, economic, and social
sustainability benefits.
🧑‍🍳 Finally, introducing plant-based school meals gradually, giving careful consideration of the seasoning, naming, and aesthetics of plant-based meals, and training kitchen staff in the preparation of plant-based meals are all strategies that can be used to overcome potential implementation barriers.

This article appeared in a member-only newsletter of the Vegetarian Nutrition Dietetics Practice Group of the Academy of Nutrition and Dietetics and is shared with permission. The author, Christine McCullum-Gomez, PhD, RDN, is a food and nutrition consultant based in Bogotá, Colombia. She has a PhD in Nutritional Sciences from Cornell University with minors in Program Evaluation and Public Policy. Her research and work experience lie in food security and sustainable food systems. Dr. McCullum-Gomez is a Column Editor and serves on the Editorial Board for the Journal of Hunger & Environmental Nutrition. She is also Chair-Elect of the Global Member Interest Group (GMIG) of the Academy of Nutrition and Dietetics.