Determining Health: Food systems issue brief (2024)

This issue brief explores the connections between food systems and human health and well-being in the Canadian context, as part of the Determining Health series of the National Collaborating Centre for Determinants of Health. It is also available in French. This issue brief is intended for public health practitioners, decision-makers, researchers, and students looking to learn about the public health relevance of (industrial) food systems and the urgent need for their transformation.

The resource is divided into four sections:

  • Section 1 introduces food systems and their major components, defining food systems as the “webs of activities, people, institutions and processes that bring food from the fields, forests and waters to our plates, and beyond”.
  • Section 2 explains why food systems matter for public health policy and practice. It describes their importance for meeting populations’ nutritional needs and highlights key issues with Canada’s industrial food systems, the dominant type of food system in the country.
  • Section 3 draws on peer-reviewed and grey literature from 42 sources to explain five pathways linking industrial food systems to health inequities.
  • Section 4 concludes the document and underscores that all public health practitioners and organizations have a role in helping build healthier, more sustainable and just food systems.  

Use this resource to

  • Build understanding of food systems and their major components
  • Facilitate discussion on how industrial food systems contribute to health inequities in the Canadian context
  • Support food system-related public health interventions

CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis)

CASCADES’ vision is a pan-Canadian health system that supports a healthy planet, is caring and equitable, and serves communities so that they thrive. Their work supports the Canadian healthcare community in making this vision a reality. CASCADES strengthens the capacity of the healthcare community across Canada to transition towards, high-quality, low-carbon, sustainable and climate-resilient care through:

  • Resources to fill the implementation gap. We leverage community expertise to build robust implementation resources.
  • Training to strengthen the capacity for change. We deliver training through a range of courses and events.
  • Collaboration to foster pan-Canadian coordination. We work with interested parties across the country with a view to pan-Canadian exchange and coordination.

Across Canada, teams are testing and refining evidence-informed change ideas. CASCADES work alongside these innovators to equip and empower a broader community of early adopters. CASCADES also work with partners across Canada to embed validated change ideas within health system guidance, policy, regulation, and institutional structures.

They work with and learn from many other organizations and individuals across the country. CASCADES is funded by Environment and Climate Change Canada and is an initiative of four founding partners: the University of Toronto Collaborative Centre for Climate, Health & Sustainable Care, the Healthy Populations Institute at Dalhousie University, the Planetary Healthcare Lab at the University of British Columbia, and the Canadian Coalition for Green Health Care. In Quebec, CASCADES is a partner in the Réseau d’action pour la santé durable du Québec.

Key collaborations:

  • The Canadian College of Health Leaders (CCHL) and CASCADES are partnering to offer health leaders in Canada a new avenue to leverage, build knowledge, skills and networks across Canada’s healthcare community to promote and deliver sustainable health systems.
  • Through the Health Leadership Specialty in Sustainable Health Systems, Canadian health leaders will undertake the FREE Fundamentals of Sustainable Health Systems course and one of the advanced courses. Participants will apply their learning in their workplace and write a paper on the impact and experience of knowledge translation. The paper is reviewed by a panel of three CCHL Fellowship Evaluators, who may award the Health Leadership Specialty in Sustainable Health Systems.
  • HealthcareLCA constitutes the first global living database of healthcare-related environmental impact assessments. The HealthcareLCA database is designed to support the transition to sustainable, low-carbon health systems, providing an open-access, interactive, and up-to-date evidence resource for healthcare workers, sustainability researchers, and policymakers. The collaboration between CASCADES and HealthcareLCA aims at supporting regular updates of the database and its availability as an open access resource.

Collaborative Centre for Climate, Health & Sustainable Care Organization (2023)

The Collaborative Centre for Climate, Health & Sustainable Care is a multi-faculty academic unit at the University of Toronto. Launched in November 2023, the Collaborative Centre is an initiative of four faculties: the Dalla Lana School of Public Health, the Temerty Faculty of Medicine, the Lawrence Bloomberg Faculty of Nursing, and the Leslie Dan Faculty of Pharmacy, with an administrative home for Temerty Medicine in the Department of Family and Community Medicine.

This unit will catalyze research, education, and practice change in clinical care, health system management, health policy, and public health to meet the transformative challenges posed by climate change and the demands of sustainability.

Pillars of Activity

  • Education – explore options for supporting health professions and graduate health sciences education.
  • Research – assess research needs, identify opportunities for catalyzing research and connecting with trainees from across UofT, and develop a network and directory of members.
  • Practice Change – serves as the Secretariat for the Toronto Academic Health Science Network (TAHSN) Sustainable Health System Community of Practice. It will explore opportunities to strengthen the Sustainable Health System Community of Practice and build links to other Communities of Practice.

Position on the Importance of Including Environmental Sustainability in Dietary Guidance (SNEB, 2019)

Rose, D., Heller, M. C., & Roberto, C. A. (2019). Position of the Society for Nutrition Education and Behavior: The Importance of Including Environmental Sustainability in Dietary Guidance. Journal of Nutrition Education and Behavior, 51(1), 3-15.e1. https://doi.org/10.1016/j.jneb.2018.07.006

Abstract:

It is the position of the Society for Nutrition Education and Behavior that environmental sustainability should be inherent in dietary guidance, whether working with individuals or groups about their dietary choices or in setting national dietary guidance. Improving the nutritional health of a population is a long-term goal that requires ensuring the long-term sustainability of the food system.

Current environmental trends, including those related to climate change, biodiversity loss, land degradation, water shortages, and water pollution, threaten long-term food security and are caused in part by current diets and agricultural practices. Addressing these problems while producing more food for a growing population will require changes to current food systems.

Dietary choices have a significant role in contributing to environmental impacts, which could be lessened by consuming fewer overconsumed animal products and more plant-based foods while reducing excess energy intake and the amount of food wasted. Discussion of sustainability within governmental dietary guidance is common in many countries, is consistent with previous US guidelines, and is within the scope of authorizing legislation. Dietary choices are a personal matter, but many American consumers are motivated by a concern for the environment and would welcome sound advice from credentialed nutrition professionals.

More opportunities are needed for developing such interdisciplinary knowledge among nutritionists.

About the Society for Nutrition Education and Behavior (SNEB)

The Society for Nutrition Education and Behavior (SNEB) represents the unique professional interests of nutrition educators worldwide. SNEB is dedicated to promoting effective nutrition education and healthy behavior through research, policy, and practice and has a vision of healthy communities, food systems, and behaviors. SNEB is an international community of professionals actively involved in nutrition education and health promotion. Their work takes place in colleges, universities and schools, government agencies, cooperative extension, communications and public relations firms, the food industry, voluntary and service organizations, and with other reliable places of nutrition and health education information.

  • SNEB Vision: People worldwide empowered by food and nutrition education to change behavior, food systems, and policy.
  • SNEB Mission: The Society for Nutrition Education and Behavior advances food and nutrition education research, practice, and policy that promote equity and support public and planetary health.

SNEB has an External Funding Policy based on its vision and mission there they strive to secure contributions from a variety of donors and provide opportunities for sharing diverse perspectives. In addition, SNEB and SNEBF will actively seek contributions from donors that are aligned with our mission.

SNEB has a Division of Sustainable Food Systems (DSFS) whose mission is to promote food systems that are environmentally sound, socially just, economically viable and produce quality food. The division supports leadership in advocacy, education and research through communications and networking among division members and with individuals and organizations in the public at large. Become a member via SNEB and/or connect with DSFS on Facebook.

SNEB’s Healthy Meeting Guidelines were adopted by members in September 2014. To the extent that funding and staff resources are available and the item is logistically feasible, SNEB incorporates these guidelines into its meetings. SNEB’s goal is to fulfil at least 80% of the guidelines for each meeting. General Recommendations are are follows, for the full guidance use the link.

  1. Support healthier choices, provide leadership and role modeling, and help to create a social norm around
    healthier choices and behaviors.
  2. Place healthier foods and beverages in prominent positions, where they are most likely to be seen and more
    likely to be chosen.
  3. Offer nutritious food and beverage options.
  4. Provide reasonable portions of foods and beverages (i.e., avoid large portions).
  5. Ensure healthier options are attractively presented, appealing, and taste good.
  6. If appropriate/possible, post calories at conferences and meetings.
  7. Offer physical activity opportunities that are relevant to the audience and environment to help people achieve
    at least 30 minutes of physical activity each day.
  8. Prioritize sustainable practices when possible, by minimizing waste, encouraging recycling, and sourcing
    products from sustainable producers.
  9. Evaluate efforts to hold healthy meetings and conferences and make adjustments over time to continue to
    improve the acceptability and healthfulness of choices.

Sustainability by the Vegetarian Nutrition Dietetic Practice Group (Website)

The Vegetarian Nutrition Dietetic Practice Group (VN DPG) is the leading authority on evidence-based plant-based nutrition for the public and health professionals who wish to learn more about the benefits of plant-based diets for health and sustainability.

VN DPG professionals are at the forefront of educating the public about vegetarian nutrition and its relationship to disease management and prevention. The VN DPG comprises about 1,400 members. The membership comprises a significant number of Americans, Canadians and overseas members from Europe, Australia, Africa, Asia and the Middle East. VN DPG members work as consultants, clinical dietitians, researchers and in other job settings.

Position of the Academy of Nutrition and Dietetics: Vegetarian Diets: “Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage.”

Partial substitutions of animal with plant protein foods in Canadian diets have synergies and trade-offs among nutrition, health and climate outcomes (2024 Feb)

Auclair, O., Eustachio Colombo, P., Milner, J. et al. Partial substitutions of animal with plant protein foods in Canadian diets have synergies and trade-offs among nutrition, health and climate outcomes. Nat Food (2024). https://doi.org/10.1038/s43016-024-00925-y (Paywall)

The study was published in Nature Food in February 2024 and was conducted by researchers at McGill University and the London School of Hygiene & Tropical Medicine. It analyzed the impacts of partially replacing red and processed meat or dairy with plant protein foods in Canadian diets on nutrition, health and climate outcomes.

Key findings include:

  • Replacing 50% of red and processed meat with plant proteins could reduce diet-related greenhouse gas emissions by 25% and increase life expectancy by up to 8.7 months
  • Replacing 50% of dairy with plant proteins had smaller benefits, reducing emissions by only 5% and increasing life expectancy by 7.6 months
  • Replacing dairy increased calcium inadequacy by up to 14%

Abstract

Dietary guidelines emphasize the consumption of plant protein foods, but the implications of replacing animal with plant sources on a combination of diet sustainability dimensions are unknown.

Using a combination of data from a national nutrition survey, greenhouse gas emissions from dataFIELD and relative risks from the Global Burden of Disease Study 2017, we assess the impact of partially substituting red and processed meat or dairy with plant protein foods in Canadian self-selected diets on nutrition, health and climate outcomes.

The study provides evidence that partially substituting animal with plant proteins, especially red meat, can have synergistic benefits for human and planetary health in Canada.

The substitutions induced minor changes to the percentage of the population below requirements for nutrients of concern, but increased calcium inadequacy by up to 14% when dairy was replaced. Replacing red and processed meat or dairy increased life expectancy by up to 8.7 months or 7.6 months, respectively. Diet-related greenhouse gas emissions decreased by up to 25% for red and processed meat and by up to 5% for dairy replacements.

Co-benefits of partially substituting red and processed meat with plant protein foods among nutrition, health and climate outcomes are relevant for reshaping consumer food choices in addressing human and planetary health.

Teaching nutrition and sustainable food systems: justification and an applied approach (2023 Sep)

Four pillar method of analysis. Prompts to consider when evaluating characteristics of a food product using the sustainable, resilient, healthy food and water system framework.

Campbell, C., & Feldpausch, J. (2023). Teaching nutrition and sustainable food systems: justification and an applied approach. Frontiers in Nutrition. https://www.frontiersin.org/articles/10.3389/fnut.2023.1167180.

Systems thinking is an essential skill for solving real-world problems, supporting lasting, impactful change, and creating desired futures. Transdisciplinary teaching and learning should be integrated into higher education to ensure students have the knowledge and skills to prosper in an ever-changing world. Education that addresses the interconnectedness of food systems is fundamental in cultivating future generations equipped to mitigate complex problems, such as hunger, nutrition-related chronic disease, and the climate crisis.

Connecting the food, agriculture, and nutrition sectors is vitally important for improving human and planetary health and well-being. While we continue to acknowledge that it is critically important to teach systems thinking in the context of sustainable food systems limited resources are available to facilitate this type of learning. Historically, a “triple-bottom-line” approach focusing on economic, environmental, and social perspectives has been used to define sustainability. In contrast, including nutrition and health may provide a more robust view and even greater consideration for the system in its entirety.

The sustainable, resilient, healthy food and water system framework, addressing all four pillars, can be used in higher education to help evaluate the sustainability of food and compare methods of production, place, and dietary patterns. This paper justifies the need for addressing sustainability issues in the context of nutrition and provides an educational approach to support student understanding and application of a systems thinking approach.

In addition to the resources cited in the descriptions of the four pillars; the Food Systems Dashboard, Our World in Data, and the Center for Science in the Public Interest may be beneficial references to consider for multiple pillars.

Note: Even though the article is written from the perspective of and with examples from the USA, the teaching approach could easily use other examples from any region of the world.

Healthy, Sustainable Eating 101 (Clif bar website)

Clif Bar has a Nutrition Education Hub is filled with a variety of resources to help you discover easy ways to eat with nutrition and sustainability in mind. With actionable guidance, tips and tricks, and answers to your tough questions by their team of dietitians and expert advisors. Thoughtful choices about the foods we eat can support our health, the health of the planet, and the health of generations to follow.

Some Examples on their website include:

  • Webinar – Dietitians Driving Change: Navigating Healthy, Sustainable Diets (1 CEU) – Join registered dietitians Sharon Palmer and Clancy Cash Harrison to learn why sustainability should be a core part of every dietitian’s toolkit. Learn how to evaluate the environmental and socioeconomic impacts of food choices, and what you can do to lead the charge in making healthy, sustainable diets more accessible.
  • Webinar – Behind the Label: Sustainability Seals and Certification (1 CEU) – Third-party sustainability seals and certifications provide verified guidance allowing consumers to identify sustainable options more easily. This webinar provides an overview of commonly used seals and certifications and the criteria they represent. Dietitians can learn key strategies to help their clients make informed choices that can positively impact their health, the planet and the lives of the people who grow and make our food.
  • Article – Everything You Need To Know About Healthy, Sustainable Eating. By Kate Geagan, MS, RD, Clif Nutrition Advisory Council member. Clif Bar & Company recently brought together 20 leading voices in health and wellness (including registered dietitians) to talk about sustainable nutrition. And while each shared their unique perspective based on personal experiences and passions, common themes emerged when it came down to what constitutes a healthy, sustainable diet (and, just as importantly, how to put it into practice). One key takeaway? Good food has the power to nourish so much more than our bodies. Read on to learn more about what these influential voices had to say, including the “what”, “why” and “how” of healthy, sustainable eating made easy.
  • Article – How to Eat Well for People and the Planet – Food has the power to do more than fuel us. Thoughtful choices about the foods we choose can positively impact our health, the health of the planet, and the health of generations to follow. Clif Bar & Company asked 20 leading voices in health and wellness, including registered dietitians what it means to eat a healthy, sustainable diet. Here’s what they said.
  • Article – Packaging with Purpose – Our Commitment to Sustainable Packaging – Clif Bar has proudly signed the Ellen MacArthur Foundation Global Commitment to help create a world where plastic never becomes waste or pollution.That means, by 2025, 100% of their packaging will be reusable, recyclable, or compostable. See the link for more of the commitments that you can promote and encourage as well.
  • Article – Making it Better with Organic – At Clif Bar, our journey to use organic ingredients started in 2003. Since then, we’ve maintained our commitment to organic and use a majority of organic ingredients in our products. We’ve learned along the journey that organic can be a catalyst for good. It’s key to creating a healthier, more just, and sustainable food system for all of us, and organic food connects people to a healthy planet.

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.