Europe – Sustainability

The SALSA Questionnaire: creation and validation of a tool to assess people’s self-perceived barriers and facilitators to follow a sustainable and healthy diet (2025 Feb)

Muñoz-Martínez, J., Cañete-Massé, C., Cussó-Parcerisas, I. et al. The SALSA Questionnaire: creation and validation of a tool to assess people’s self-perceived barriers and facilitators to follow a sustainable and healthy diet. Environ Dev Sustain (2025). https://doi.org/10.1007/s10668-024-05954-y (open access)

This work was partially supported by an ICDA SFS Toolkit grant. You can read more under ‘Spain’ on the NDA SFS Grant page.

*From the Article: Table 2 Results from the Exploratory Factor Analysis with sample A (n = 207), including factor loadings, eigenvalues, and percentage of variance*

Abstract:

A transition towards a sustainable and healthy diet (SHD) is crucial for both population and planetary health. However, changing consumer’s behaviour is challenging due to the many factors influencing food choices. Tools that comprehensively assess these factors are paramount, yet none are available in Spain. Hence, we created and validated the SALSA questionnaire to capture self-perceived barriers and facilitators for SHD.

The process involved three phases:
— First, item development combining insights from a scoping review and content validity with experts (n = 9) and the target population (n = 38);
— Second, scale development by pre-testing the questionnaire (n = 4), administering it through an online survey to two samples(Dimensionality-Sample, n = 516; Reliability-Sample, n = 61), and applying exploratory factor analysis for factors extraction and item reduction;
— Third, scale evaluation by testing its dimensionality through confirmatory factor analysis, its reliability through Cronbach’s alpha and McDonald’s omega, and intra-class correlation coefficient, and construct validity through discriminant validity, convergent validity, and correlation analysis.

Results yielded a questionnaire with 27 items grouped into four dimensions: personal factors, sociocultural factors, external factors, and meat and plant-based meat alternatives. The psychometric analysis revealed that the SALSA questionnaire is a reliable instrument to identify behavioural determinants.

FOODPathS

FOODPathS is a project funded by the European Commission (EC) that aims to offer a concrete pathway and necessary tools for establishing an appropriate operational environment for the future European Partnership for Sustainable Food Systems (SFS) for People, Planet & Climate, to be launched in 2024. The SFS Partnership aims for the transformation of national, EU and global food systems, making them safe, sustainable, healthy, resilient and trusted – for everyone and within planetary boundaries. It will bring policymakers, businesses, researchers and civil society to coordinate, align and leverage European and national efforts to future-proof food systems through an integrated and transdisciplinary approach.

Foodtech Living Labs Platform – This serves as a central hub of collaboration and innovation for Europe’s foodtech sector. It comes as a result of the mapping and reviewing of living labs across Europe, identifying successful models that can be scaled and adapted elsewhere. It is designed to connect national and regional Food Systems Living Labs from across Europe, facilitating the exchange of knowledge, insights, and successful practices. Visit the site to use an Interactive Map to explore living labs across Europe.

Network of Universities – This network of university-driven local food ecosystems motivates institutions, staff, and students to foster Food 2030-inspired food system transitions. FOODPathS is: Mapping European universities and research centres that can act as Sustainable Food System actors in this new-to-build network and review food systems education and lifelong learning programs. Contributing to improved Food System education and training programs by helping to fill skills and knowledge gaps. Writing a food systems sustainability charter to foster improved Food System education and training programs across Member States. Organising activities such as demo events, hackathons co-organised with young professional networks, visualisations of success stories of SFS education and Living Labs, food festivals for education, student competitions, and opportunities to link incubators and public school programs.

Map of funders – Their network spans multiple European countries to co-develop and deliver best practices, solutions, and synergies with the greatest potential for impact. They listen to and work with partners across the food system continuum, who share their commitment of achieving a future with a resilient, flexible food system that is safe, affordable, and nutritious.

Partnership Inclusivity – FOODPathS is committed to including all the farm-to-fork voices in building an inclusive and transparent SSFS Partnership.

If you are interested in keeping up to date on progress you can:

Join the Sustainable Food System Network that brings together actors across the food system (around the globe) to break silos and offer opportunities for dialogue.

Follow on LinkedIn for news on food & health EU-research projects funded by Horizon Europe Research & Innovation Programmes. Managed by EUFIC.

Austrian Dietary Guidelines (2024)

The 2024 Austrian Dietary guidelines were developed by the Competence Center for Climate and Health of Austria GmbH (GÖG) together with the Austrian Agency for Health and Food Safety (AGES) and the Austrian Society for Nutrition (ÖGE). Both health and climate aspects were taken into account.

Visit the link to also download the brochure “Healthy eating, good for the climate” (in German) or it can be accessed or ordered via the brochure service of the Ministry of Social Affairs. The brochure contains healthy and climate-friendly recipes based on the plate model. It was developed by three universities of applied sciences for dietology on behalf of the Ministry of Health.

Exploring the barriers and facilitators for following a sustainable diet: A holistic and contextual scoping review (Barcelona, 2024)

Muñoz-Martínez, J., Cussó-Parcerisas, I., Carrillo-Álvarez, E. Exploring the barriers and facilitators for following a sustainable diet: A holistic and contextual scoping review. Sustainable Production and Consumption (2024). 46, 476-490. https://doi.org/10.1016/j.spc.2024.03.002 (pay wall)

Relevant to:

Dietitians, nutritionists, and public health professionals aiming to promote a shift towards sustainable and healthy diets.

Question:

Identifying the barriers and facilitators people experience when following a sustainable and healthy diet.

Bottom line for nutrition practice:

This research recognises the intricate net of factors that influence individuals to adopt a sustainable and healthy diet. Such influences vary significantly in magnitude and direction among different individuals. The complexity surrounding food decisions demands that interventions and actions targeting food behaviour are tailored to the characteristics and needs of the target population.

Abstract:

Changing current dietary patterns to more sustainable ones is paramount to decrease the pressure food systems are putting onto the planet and people’s health and wellbeing. However, modifying consumers’ behaviour is extremely challenging since multiple factors of variable nature (i.e., personal, socioeconomic, cultural, external…) influence food choices.
For this reason, we aim to identify consumers’ barriers and facilitators for following a sustainable and healthy diet, and explore how these are perceived among people from different socioeconomic backgrounds.
To do so, we conducted a scoping review of the literature with a consultation phase with citizens from Barcelona with different socioeconomic backgrounds.
Results revealed one hundred intricate factors that influence people’s food behaviour, which were grouped into internal, and external factors. Although the literature generally agreed on the direction of influence from the identified factors, the consultation phase generated substantial disagreements given the participants’ diverse perspectives and motivations. However, some limiting factors were commonly mentioned across groups which corresponded to feelings of distrust towards the food industry, lack of time, disgust towards specific foods, and the high cost of foods. Differences across socioeconomic groups were not observed except for the latter. All participants agreed that cost acted as a barrier, although participants from higher socioeconomic backgrounds were more capable to find arguments to overcome the price barrier.
Results are necessary to acknowledge the particularities embedded in each person and the need to design context-based interventions to effectively overcome people’s barriers and enhance their facilitators.

Details of results:

The scoping review revealed 100 intricate factors influencing consumers in following a sustainable and healthy diet.
The consultation phase allowed to identify the nuances surrounding the findings from the literature review.
Significant differences across socioeconomic groups were not observed except for how cost was considered as a barrier. For individuals from low socioeconomic backgrounds, the high cost of food is a decisive factor for not purchasing sustainable food, whereas for those from high socioeconomic backgrounds, the cost barrier can be dissipated by factors linked with knowledge and consciousness.
Additional commonly identified decisive limiting factors were the distrust towards the food industry, lack of time, and disgust towards specific foods.
Newly recognised determining factors included knowledge of ethical aspects of food production, trust in small producers and food sellers, emotional involvement with producers, food addiction, lack of interest, selfishness, the belief that legumes put on weight, being a time-oriented individual, access to culture, food safety, social media, and perceived lack of time.

Of additional interest:

The results from the literature review barely covered the socioeconomic and cultural dimensions of sustainable diets. Although efforts were made to address this limitation by purposely covering this dimension during the consultation phase, future research should take these aspects into account to address sustainable diets in their broadest understanding.

Conflict of interest/ Funding:

None

Corresponding author:

Irene Cussó-Parcerisas, PhD
irenecp2@blanquerna.url.edu

Recipes for success: Working together for healthy and sustainable diets in Europe (2022)

Excerpts from the introduction to the guide by Marinke van Riet, Chief Weaver, Healthy Food Healthy Planet:

In September 2022, 25 change-makers from across eight European countries convened for three days on a farm outside of Berlin. The reason? To brew on where Healthy Food Healthy Planet as an emerging Pan-European movement needs to go next.
It was our first in-person event, having worked online for over two years, co-creating a strategy reflecting the voices and perspectives of over 120 different organisations. In our midst in Berlin were dietitians, doctors, policy-makers, climate change campaigners, animal welfare and food equity activists, funders, farmers, and artivists, united by a single demand: healthy, just and sustainable food environments, starting with rebalancing animal-sourced foods.
This guide, championed by Eating Better, showcases national and local level examples – where the ingredients for a successful recipe starts. Because together our impact is more powerful and inevitable is part of our newly found purpose. We can only address this enormous challenge together, civil society and funders alike – locally, nationally, regionally and globally.

From the Executive Summary:

Our food system is unsustainable. It’s pushing our warming planet way beyond its limits and driving obesity, preventable disease and food scarcity. Thankfully, adopting healthier, sustainable diets on a wide scale is a main priority for civil society. There’s no clear solution; complicated problems require a vast range of groups and people sharing their knowledge.
Many organisations across Europe have realised it’s more effective to tackle complex problems together to pool resources and expertise and make sustainable dietary change. We’ve spoken to a diverse range of organisations and individuals working on healthy and sustainable diets, across Europe about collaborations. In the spirit of collaboration, we want to share with you what we’ve found. We hope those involved and interested in collaborating for dietary change will find it useful and inspiring.

‘We started this project to bring together our learning from the past 9 years of Eating Better. But in doing so, we found that there is much to learn from collaborations elsewhere in Europe. It proved again to us that working across silos and within national food cultures is critical for making progress towards more healthy and sustainable eating.’
– Simon Billing Executive Director Eating Better

The food marketing environment: A force for or against human and planetary health? (2023)

Haffner, T. and Culliford, A. (2023) The food marketing environment: A force for or against human and planetary health?. Food Research Collaboration Policy Insight. ISBN: 978-1-903957-80-6

This Policy Insight by Tanya Haffner and Amy Culliford examines how the food marketing environment (traditional advertising, online marketing, marketing strategies) contributes to diet-related ill health. The authors analyse how the considerable power of food companies could be leveraged to drive change towards healthier and more sustainable diets. They recommend alternative policies that would ban or restrict advertising of unhealthy foods and instead would increase marketing and promotion of healthy foods that can help enable a shift towards more healthy and sustainable diets.

The Food Research Collaboration is an initiative of the Centre for Food Policy. It facilitates joint working between academics, civil society organisations and others to improve the sustainability of the UK food system, and to make academic knowledge available wherever it may be useful.
Esmée Fairbairn Foundation funded the work.

Amy Culliford started her career as a process engineer in the food industry, then spent three years working as a regulatory officer at the Environment Agency, where she audited industrial sites to ensure compliance with environmental legislation, including many UK-based food manufacturers. She went on to study public health nutrition, specializing in environmentally sustainable diets. She works as a consultant, collaborating on a variety of research projects.

Tanya Haffner is a dietitian and is the CEO & strategic lead on nutrition and sustainability at MyNutriWeb and Nutrilicious. MyNutriWeb is a learning hub on nutrition for professionals and change agents in food, awarded the best nutrition resource of the year 2021 and 2022 by CN publications and Nutrition Graduates. Nutrilicious is a specialised consultancy and marketing agency supporting organisations and brands in building their credentials and communications on nutrition and sustainability. Tanya received the Caroline Walker Trust Award for best Freelance Nutritionist of the Year 2021 and the Outstanding Achiever Award from the British Dietetic Association in 2022 for founding MyNutriWeb & Nutrilicious.

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’s Sustainability in Quality Improvement (or SusQI) recognises that there are finite environmental, social and financial resources available to deliver a high standard of patient care. The overall goal of incorporating sustainability into quality improvement is to maximise sustainable value. This means to deliver the best possible health outcomes with minimum financial and environmental costs, while adding positive social value at every opportunity.

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.

Manifesto for One Health in Europe (2023)

From the Manifesto:

The Coalition of Health Professionals for Regenerative Agriculture is a growing movement of health professionals and a multidisciplinary set of people and organisations connecting the dots between soil health and human health. This manifesto aims to give voice to a European Regenerative Healthcare movement and incentivise actions across the food, agriculture, and healthcare systems. This piece aims to align the voices of different stakeholders to achieve One Health in Europe.

The One Health concept highlights that the health and well-being of humans are inseparably linked to the health of other ecosystem components such as soil, plants, and animals. As health professionals, we recognise our unique role in mitigating the climate, food, and health crisis by promoting One Health.

Regenerative Healthcare is one of the practical solutions of One Health, where soil health connects to human health. The cycle starts with the farmer, who grows nutrient-dense food through agroecological practices. The food is then provided to hospitals and other public institutions as a tool to treat and prevent disease.

This chain demands that health professionals and all the different stakeholders involved have a holistic understanding of agriculture, nutrition, food systems, and also prevention-based measures to tackle human and environmental health crises. Training healthcare providers in regenerative healthcare promote soil, plant, animal, and human health, and it can scale regenerative agriculture and agroecology.

Call for sustainable food systems including (medical) nutrition for hospitalised children and their families (2024)

Verbruggen SCAT, Cochius den Otter S, Bakker J, et al. Call for sustainable food systems including (medical) nutrition for hospitalised children and their families. Frontline Gastroenterology Published Online First: 20 March 2024. doi: 10.1136/flgastro-2023-102478 (open access)

Key messages
- The climate emergency is a pressing global issue that poses significant threats to human health and the environment.
- A call to collective action from industry, legislators, and non-governmental organisations to develop standardised processes to reduce the amount of plastic in medical nutrition and associated waste.
- To develop scalable circular economy for medical nutrition there needs to be standardisation of process and methodology, as a current lack of transparency and large-scale action hinders progress towards effecting change.
- Research is required around behaviour change models to support the transition from animal-based to plant-based diets, including medical nutrition, for hospital patients, visitors, and staff.
- Collective action is required for all of us, although small acts can save our planet – we need large scale action.
- How can you get involved in advocating for your hospital to reduce the amount of medical nutrition waste?

Abstract
- The climate emergency presents a profound threat to global health, adversely affecting the health and well-being of children who are projected to bear a substantial disease burden, as well as impacting children’s right to food, water, healthcare and education. The healthcare sector strives to prioritise preventative healthcare policies improving the health of individuals across the life course. However, current healthcare practices significantly contribute to greenhouse gas (GHG) emissions and waste generation, in which (medical) nutrition plays an important role.
- Plant-based proteins offer sustainability benefits, and potential health advantages, and have a lower climate footprint, although there may also be unintended consequences of land-use change and deforestation for certain crops. However, to develop suitable plant-based alternatives to medical nutrition, it will be necessary to address regulatory obstacles as well as ensure nutritional profiles are suitable, particularly protein (amino acid) and micronutrient composition. Additionally, the development of heat-tolerant and water-efficient plant genotypes could bolster adaptation to changing climatic conditions.
- Effective waste management, including wasted food and medical nutrition, emerges as a key strategy in mitigating the climate impact of medical nutrition. While research on food waste in healthcare settings is limited, minimising waste spillage in medical nutrition is a crucial area to explore. Healthcare professionals must acknowledge their roles in curbing the climate footprint of medical nutrition as well as recommendations for food-based approaches.
- This review aims to investigate the sustainability of medical nutrition for paediatric care, focusing on factors contributing to GHG emissions, plant-based alternatives, waste management and plastic packaging. Such an exploration is vital for healthcare professionals to fulfil their responsibilities in addressing the climate crisis while advocating for change.

https://doi.org/10.1136/flgastro-2023-102478