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.

Planetary Health by Rx Brick Exchange (updated regularly)

One of the free collections by Rx Brix Exchange is about Planetary Health, which covers the relationship between human health and the environment to empower future health professionals to prepare for and tackle challenges that a changing climate and environmental pollution present to our health and livelihoods. 14 bricks are in the collection and it will take about 3 hours to read or listen to if you choose the audio.

About Rx Brick Exchange

Rx Brick Exchange is a place to share and build on ideas and curriculum, learn from leading experts, and use their expertise in your classroom. Their mission is to create sustainable and accessible medical education for students and educators around the world. It is the first global health sciences curriculum exchange that empowers educators to create and share health science Bricks with faculty and students worldwide.

The Medical Student Alliance for Global Education (MeSAGE) is a student-driven consortium of the world’s leading medical student organizations, representing over 1.3 million learners. Founded in 2019, MeSAGE empowers and supports student organizations with the tools they need to work toward closing educational gaps in areas like health equity, diversity, inclusion, or social justice.

Content development processes are constantly evolving, as they embark on new projects and redefine roles. Their commitment to working with students never wavers. They have a directory of student authors and reviewers to acknowledge people who contribute to the development of the global, shared curriculum vision.

Rx Essentials Collections is a comprehensive library of digital learning modules, designed to help build your foundation of medical knowledge, brick by brick. There are 23 free collections. A 5-day free trial lets you access all of them to see if you are interested in paying to access them as a member.

“A ruined planet cannot sustain human lives in good health. A healthy planet and healthy people are two sides of the same coin.”

Dr. Margaret Chan, Former Director General of the World Health Organization.

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.

Communicating on climate change and health: Toolkit for health professionals (2024)

While climate change is a big threat to health, implementing solutions to address climate change presents a huge opportunity to promote better health and protect people from climate-sensitive diseases. Communicating the health risks of climate change and the health benefits of climate solutions is both necessary and helpful.

Health professionals are well-placed to play a unique role in helping their communities understand climate change, protect themselves, and realize the health benefits of climate solutions. This toolkit aims to help health professionals effectively communicate about climate change and health.

Note: Food and nutrition are mentioned in the toolkit but are not a large part of the toolkit. Agriculture is not mentioned. There is general guidance on preparing communication which can be helpful when used with a resource like our ICDA SFS Toolkit.

Communicating on climate change and health: toolkit for health professionals. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.

A pathway to personal, population and planetary health for dietitians and nutrition professionals (2023 Nov)

MacKenzie-Shalders, K. L., Barbour, L., Charlton, K., Cox, G. R., Lawrence, M., Murray, S., Newberry, K., Senior, N. M., Stanton, R., & Tagtow, A. M. (2023). A pathway to personal, population and planetary health for dietitians and nutrition professionals. Public Health Nutrition, Advance online publication. https://doi.org/10.1002/puh2.137



Earth and all its inhabitants are threatened by a planetary crisis; including climate change, deforestation, biodiversity loss and pollution. Dietitians and nutrition professionals have a responsibility to lead transformational change in contemporary food and health systems to help mitigate this crisis. The study aims to develop a conceptual framework to support dietitians towards personal, population and planetary health.


Non-empirical methods were used by the co-researchers to explore and explain the application of an international framework ‘Next-Generation Solutions to Address Adaptive Challenges in Dietetics Practice: The I + PSE Conceptual Framework for Action’. (I+PSE = Individual plus Policy, System, and Environmental)


A non-sequential pathway guide to personal, population and planetary health for nutrition professionals was developed including several key guiding principles of Agency, Action, Ascension, Alignment, Alliance and Allyship, and Advocacy and Activism. Each guiding principle features descriptors and descriptions to enhance dietitian and nutrition professional

  • Agency (i.e. vision, self-belief, confidence, strength and responsibility),
  • Action (i.e. start, shift, translate, achieve and commit),
  • Ascension (i.e. build, overcome, manage, challenge and progress),
  • Alignment (i.e. leadership, transparency, diplomacy, values and systems),
  • Alliance and Allyship (i.e. support, collaborate, represent, community and citizenship) and
  • Advocacy and Activism (i.e. disrupt, co-design, transform, empower and urgency).

The framework and its descriptors support enhanced understanding and are modifiable and flexible in their application to guide the participation of dietitians and nutrition professionals in transformational change in personal, population and planetary health. This guide acknowledges that First Nations knowledge and customs are important to current and future work within this field.


Alongside the international body of work progressing in this field, this framework and visual guide will support dietitians and nutrition professionals to achieve urgent, transformational change in personal, population and planetary health.

JHND Special Issue: Sustainable Food Systems and Dietary Patterns in Nutrition and Dietetic Practice (2023 Dec)

The British Dietetic Association’s Journal of Human Nutrition and Dietetics (JHND) published a Special Issue on Sustainable Food Systems and Dietary Patterns in Nutrition and Dietetic Practice edited by: Liesel Carlsson, Angela Madden, and Kalliopi-Anna Poulia (Volume 36, Issue 6, Pages: 2121-2350, December 2023).

Twelve of the sixteen articles are open access and cover a wide range of practice settings.

  • Open Access – Conceptualising sustainability in Canadian dietetic practice: A scoping review – Dietitians are well-positioned to promote sustainable food systems and diets. This research identifies practice activities described in the Canadian published literature and compares these with dietetic competency standards. Increasing practitioners’ ability to analyse issues using systems thinking will help address complex challenges. Updates to competency standards and curricular supports are needed to support this area of practice.
  • Open Access – Local food procurement by hospitals: a scoping review – There is a paucity of peer-reviewed studies describing local food procurement by hospitals. Details of local food procurement models were generally lacking: categorisable as either purchases made ‘on-contract’ via conventional means or ‘off-contract’. If hospital foodservices are to increase their local food procurement, they require access to a suitable, reliable and traceable supply, that acknowledges their complexity and budgetary constraints.

Factors influencing implementation of food and food-related waste audits in hospital foodservices (2022)

Cook N, Collins J, Goodwin D and Porter J (2022) Factors influencing implementation of food and food-related waste audits in hospital foodservices. Front. Nutr. 9:1062619. doi: 10.3389/fnut.2022.1062619

Open access link to article: 


Relevant to: 

  • Foodservice dietitians, sustainability dietitians, foodservice manager and workers

Bottom line for nutrition practice: 

  • What are the perspectives of individuals working close or within hospital foodservices on a previous developed food waste audit tool and what do they perceive to be the major factors supporting and or blocking the completion of a food waste audit?
  • Consider the barriers and enablers to the completion of a food waste audit in your facility before pursuing one including the design, completion and analysis of an audit.


  • Background: Designing a food waste audit tool for novel hospital foodservice practice does not guarantee uptake. Intended users must be consulted to understand the tool’s feasibility and face validity. This study aimed to identify the perspectives of staff involved in the operation of hospital foodservices on (1) how an evidenced based consensus pathway food waste audit tool is perceived to translate into practice, and (2) to determine the factors that influence the completion of food and food-related waste audits within this setting.
  • Materials and methods: Purposeful sampling was used to recruit staff with knowledge on the operation/governance of foodservices within hospitals in Victoria, Australia. Semi-structured interviews (n = 20) were conducted via Zoom to explore barriers and enablers to completing food and food-related waste audits and a previously published food waste audit tool. NVivo was used for inductive thematic analysis.
  • Results: Three factors determined the completion of food and food-related waste audits in hospital foodservices, and each factor could be a barrier or an enabler; (1) capacity: the availability of time, labour and materials to complete an audit (2) change: staff resistance to audit procedures and how to gain their buy-in (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present. The consensus tool appeared to have face validity. Planning audit operations, conducting stakeholder meetings, providing education/training to foodservice team members, and facilitating communication between managers and staff were described to support consensus tool use and audit completion.
  • Conclusion: The consensus tool can be used to support hospital foodservices to complete food and food-related waste audits, although it may need to be customised to be fit for purpose. Optimising the capacity, change management and processes, governance and leadership of the foodservice department may improve the experience and success of a food and food-related waste audit.

Details of results: 

  • The two major perspectives participants shared for a food waste audit to come to fruition were appropriate preparation and implementation. Other recommendations included adequate support, having a clear goal in mind, planning, organising logistics and having clear communication between all levels of staff delivered through meetings and education sessions.
  • Most of participants believed the tool was: detailed, supportive to their practice, helpful for decision making and ready to use. However others viewed it as busy, confusing and that it requires extra knowledge to understand and use. Future iterations of the tool were suggested to be customisable to participants facilities, demonstrate solutions to reduce food waste and have separate sections compared to the one page only.
  • The three factors relating to food waste audit completion were –
    • (1) capacity: the availability of time, labour and materials to complete an audit.
    • (2) change: staff resistance to audit procedures and how to gain their buy-in.
    • (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present.
  • A key finding related to the factors which may support or hinder a food waste audits completion were that the enablers suggested would solve the barriers discussed. This demonstrates individuals who work close or within hospital foodservices already know what to do for a food waste audit if this task was asked of them to complete.

Of additional interest: 

Collection of research on food waste measurement by this group on Google Scholar.

Conflict of interest/ Funding:  

No conflict of interest. NC received a departmental scholarship for his Ph.D. from Monash University’s Department of Nutrition, Dietetics and Food, and a King and Amy O’Malley Trust Scholarship during this study

External relevant links:  

Corresponding author: 

Mr. Nathan Cook Nathan.cook@monash.edu

Impacto ecológico de la alimentación en España (2022)

Presentamos la nueva edición (31) de Cuadernos de las Cooperativas de Consumidores con un monográfico sobre el «Impacto ecológico de la alimentación en España». Nuestros hábitos de alimentación y el sistema actual de producción y consumo de alimentos tienen un indudable impacto en la salud del planeta, de manera que las decisiones de compra y consumo deberían ser tomadas con la mayor información posible.

Como sociedad, es necesario avanzar hacia modelos más sostenibles y todos los eslabones de la cadena alimentaria deben contribuir a mitigar el impacto ambiental de nuestras prácticas y actividades. Analizado en términos de oportunidad, el camino hacia la sostenibilidad se presenta como un buen momento para transformar nuestro sistema alimentario.

En este trabajo se aborda, desde el punto de vista del sector de la alimentación, cómo nuestros comportamientos y decisiones de consumo generan considerables impactos ambientales y qué se necesita para minimizar los efectos de nuestros hábitos cotidianos con respecto a los alimentos. Esta publicación forma parte del Proyecto “Impacto ecológico de la alimentación”, subvencionado por Ministerio de Consumo, y cuenta con el apoyo y colaboración del Ministerio de Agricultura, Pesca y Alimentación.

Hemos conseguido reunir las reflexiones de responsables en la materia y reconocidos especialistas, incluyendo los aspectos normativos y nutricionales, dando voz al sector de la producción y la distribución comercial. Cada artículo se aproxima al problema con un punto de vista diferente, configurando un completo trabajo de lectura recomendada.

Las personas consumidoras quieren reducir su huella ecológica y ya apuestan por las empresas que se comprometen y actúan para reducir tanto sus emisiones como los impactos ambientales. Pero cada día es más patente la gran distancia que existe entre la intención y la acción. A esto se añade el aumento del coste de la vida, que impide tomar decisiones de forma responsable con el planeta. En esta situación, el precio se ha convertido en una barrera para el comportamiento sostenible, por lo que debemos tener en consideración a aquellos colectivos de personas vulnerables para que no se queden fuera en estos momentos y avancen igualmente en el camino hacia la reducción del impacto ambiental de los hábitos de compra y consumo de alimentos. 

En la apuesta por la sostenibilidad, compartida de forma unánime por todos los sectores, hay muchas lagunas y la persona consumidora, como último eslabón de la cadena, reclama más información y un compromiso real y contrastable del sector de la alimentación con el medio ambiente, para que se ofrezcan productos que nos permita seguir unos patrones de alimentación más saludables, a la vez que sostenibles. 

Con este Monográfico también queremos hacer, en nombre de las cooperativas de consumo un llamamiento al compromiso sincero con la sostenibilidad, impulsando innovaciones y nuevas oportunidades empresariales, que permitan avanzar hacia un sistema alimentario más sostenible y respetuoso con el planeta y las personas.

‘It’s a constant changing environment, and we’re just playing catch up’: Hospital food services, food waste, and COVID-19 (2022 Jun)

(available for download at the bottom)

Cook N, Goodwin D,Collins J, Porter J.‘It’s a constant changingenvironment, and we’re just playing catch up’:Hospital food services, food waste, and COVID-19.Nutrition & Dietetics. 2022;1‐10. doi:10.1111/1747-0080.12762

Open access link to article: 


Relevant to: 

Foodservice dietitians


The research wanted to understand the impacts of COVID-19 on hospital foodservice practices. Specifically, how COVID-19 impacted the completion of food waste audits and the generation of food waste in hospital foodservice.

Bottom line for nutrition practice: 

  • Foodservice staff are a resilient workforce group
  • Forced changes in resource allocation and usage allowed foodservices to adapt and learn to work with COVID-19 restrictions, potentially beginning the path to post-pandemic services.
  • This stage of the ‘green recovery’ can be led by dietitians and may incorporate food waste audits as a higher priority.
  • The success of electronic menu management tools during this period to combat contact restrictions may see them remain as ‘standard procedure’ for food waste data collection and be selected for uptake in additional hospitals who do not have this technology currently.


  • Aims: Hospital food service operations have been affected by the COVID-19pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID-19 pandemic on hospital food ser-vices, particularly on food waste and the completion of food waste audits.
  • Methods: A qualitative interview research design was used. Semi-structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty-one participants were interviewed from 12 hospitals. No questions were related o the COVID-19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis.
  • Results: Five themes were generated from the interviews related to COVID-19and hospital food services; impacts on practice, labour, change, technology and post-pandemic expectations. Participants reported COVID-19 negatively affected food service operations. Changes included increased food waste, con-tact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID-19 restrictions.
  • Conclusions: Despite the impact COVID-19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post-pandemic, and may be facilitated through the operational changes forced by COVID-19.

Details of results: 

Five themes were generated from the data after inductive coding was completed: these are below in dot point format with some of the dominant responses presented.

  1. Impacts on practice
    • Infection prevention led to increased pre-packaged single serve food, utensils, crockery and their waste
    • The re-use, storage, or donation of used items was prohibited
    • Waste disposed of in patient rooms
    • Forecasting was impacted by COVID peaks
  2. Change
    • Some changes occurred immediately, others took time
    • Reduction in hospital catering services
    • COVID-19 as an excuse to trialing new practice
    • Ingredients inaccessible and out of stock
  3. Technology
    • Room service was recommended to forecast meal numbers and support food service delivery
    • Electronic menu management systems with waste measurement capabilities were supportive in plate waste data collection but not available at all sites due to cost, equipment, and manual data collection still being part of standard practice
  4. Labour
    • Higher than usual sick leave
    • Failure to hire new staff (>300 interviews completed at one site)
    • Individuals forced to step in to new and unfamiliar roles (e.g. manager to chef)
    • Cumulative pressure on staff throughout COVID including vaccine mandate in Victoria which resulted in loss of staff
    • Nutrition students unavailable to hospitals for placement
  5. Post Pandemic expectations
    • Hope for practice to return to normal as soon as possible or when the pandemic is ‘over’
    • Planning for future emergencies already to counteract drastic changes in service and practice

Of additional interest: 

Editor’s comment:  

@nathan_cook includes the audit tool with descriptions for you available at this link in the side bar.

Conflict of interest/ Funding:  

One author of the research is an editor at the journal, however the journal undergoes a blinded peer review process. Funding was received by Nathan Cook in the form of a scholarship from the King and Amy O’Malley Trust Scholarship and the Department of Nutrition, Dietetics and Food at Monash University as part of his PhD.

External relevant links:  

A blog describing the research article – http://monashnutrition.blogspot.com/2022/09/hospitals-covid-food-waste-dilemma.html

Corresponding author: 

Nathan Cook, @nathan_cook, PhD candidate, nathan.cook@monash.edu