Reports – 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.

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

TABLE (website)

TABLE’s mission: ingredients for better dialogue. TABLE is a food systems platform that sets out the evidence, assumptions and values that people bring to debates about resilient and sustainable food futures. They explore the data, the biases and the beliefs behind those debates in order to support better dialogue, decision making and action.

TABLE is for everyone with an interest in food. Acting as an interface between the worlds of research and practice, our work reflects and interrogates real and relevant food system debates. We are in constant dialogue with people working within the food system, including civil society, policy makers, advocates and practitioners.

TABLE puts together many resources such as explainers, blog posts, podcasts, letterbox series, other publications in their resource library, and a list of events and job opportunities. They have a page in Spanish as well. TABLE es MESA en América Latina.

A useful resource for busy people is their summary series which break down some of their explainers into a brief format. Short summaries are now available for the following explainers:

What is regenerative agriculture?
What is ecomodernism?
What is feed food competition?
What is the land sparing-land sharing continuum?
What is agroecology?
What is food sovereignty?
Soy: food, feed and land use change
Rewilding and its implications for agriculture
Agricultural methane
What is malnutrition?
What is the nutrition transition?
What is ultra-processed food? And why do people disagree about its utility as a concept?

TABLE was created in collaboration with the University of Oxford, building on the work of the Food Climate Research Network; the Swedish University of Agricultural Sciences (SLU), via the SLU Future Food platform; and Wageningen University & Research, and then expanded to include la Universidad de los Andes (Colombia), la Universidad Nacional Autónoma de México, and Cornell CALS (USA).

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.
Healthcar eLCA 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.

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.

A conceptual framework for understanding the environmental impacts of ultra-processed foods and implications for sustainable food systems (2022)

K. Anastasiou, P. Baker, M. Hadjikakou, G.A. Hendrie, M. Lawrence. A conceptual framework for understanding the environmental impacts of ultra-processed foods and implications for sustainable food systems. Journal of Cleaner Production. Volume 368, 2022, 133155, ISSN 0959-6526, https://doi.org/10.1016/j.jclepro.2022.133155 (paywall).

Relevant to:

Dietitians interested in understanding the environmental impacts of UPFs.

Question:

Research aim: to determine the types of environmental impacts resulting from each stage of UPF production, and the magnitude of these impacts in the context of dietary consumption patterns

Bottom line for nutrition practice:

The findings highlight that environmental degradation associated with UPFs is of significant concern due to the substantial resources used in the production and processing of such products, and also because UPFs are superfluous to basic human needs.

Abstract:

Minimising environmental impacts and prioritising the production of nutritious foods are essential qualities of a sustainable food system. Ultra-processed foods (UFPs) are potentially counterproductive to these objectives.
This review aims to summarise the magnitude and types of environmental impacts resulting from each stage of the UPF supply chain and to develop a conceptual framework to display these impacts. It also aims to identify the terms used to describe UPFs in the sustainability literature, and the methods used to measure the associated environmental impacts.
A narrative review approach with a systematic search strategy was used. Fifty-two studies were included that either described or quantified the environmental impacts of UPFs.
This review found that UPFs are responsible for significant diet-related environmental impacts.
- Included studies reported that UPFs accounted for between 17 and 39% of total diet-related energy use, 36–45% of total diet-related biodiversity loss, up to one-third of total diet-related greenhouse gas emissions, land use and food waste and up to one-quarter of total diet-related water-use among adults in a range of high-income countries.
- These results varied depending on the scope of the term used to describe UPFs, stages of the lifecycle included in the analyses and country.
- Studies also identified that UPF production and consumption has impacts on land degradation, herbicide use, eutrophication and packaging use, although these impacts were not quantified in relation to dietary contribution.
The findings highlight that environmental degradation associated with UPFs is of significant concern due to the substantial resources used in the production and processing of such products, and also because UPFs are superfluous to basic human needs.
The conceptual framework and findings presented can be used to inform food policy and dietary guideline development, as well as provide recommendations for future research.

Details of results:

From a resource-use perspective, UPFs are not a necessary component of diets and therefore environmental impacts are avoidable. Environmental impacts from UPFs occur across the entire supply chain. These impacts range in magnitude, but research on Australian discretionary food consumption indicates that they are significant; approximately one-third of diet-related energy, greenhouse gas emissions, land use, and water use was driven by the production of discretionary foods in Australia.

UPFs reliance on low-cost, high-yield commodities is a driver of diet-related greenhouse gas emissions and biodiversity loss, intensive processing technologies is a driver of diet-related energy use and reliance on packaging drives plastic pollution.

Meat-based UPFs appear to be significant drivers of UPF-related greenhouse gas emissions. Plant-based UPFs also contribute to greenhouse gas emissions but their impacts on biodiversity and deforestation are perhaps more concerning.

Of additional interest:

The ways in which foods were classified in the original research articles influenced study findings. This highlights the importance of considering the most relevant food classification system, and the potential impacts of the classification on the findings. Specifically, some outcomes, such as greenhouse gas emissions and land use, appeared to be driven by whether or not studies included processed meats in their ‘unhealthy food’ category.None

Conflict of interest/ Funding:

none

External relevant links:

Ultra-processed foods should be central to global food systems dialogue and action on biodiversity (2022) – The contribution of ultra-processed foods to agrobiodiversity loss is significant, but so far has been overlooked in global food systems summits, biodiversity conventions and climate change conferences. Ultra-processed foods need to be given urgent and high priority in the agendas of such meetings, and policies and action agreed.

Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation (2020) – This study assessed the intake of ultra-processed foods (UPFs) and unprocessed foods within a group of meat eaters and vegetarians (pesco-vegetarians, vegetarians, and vegans) in France.

2022-Anastasiou-author-version-conceptual-framework-environmental-impacts-UPFs Download

Corresponding author:

Kim Anastasiou, Ms, kim.anastasiou@adelaide.edu.au

Conceptualising the drivers of ultra-processed food production and consumption and their environmental impacts: A group model-building exercise (2023)

Kim Anastasiou, Phillip Baker, Gilly A. Hendrie, Michalis Hadjikakou, Sinead Boylan, Abhishek Chaudhary, Michael Clark, Fabrice A.J. DeClerck, Jessica Fanzo, Anthony Fardet, Fernanda Helena Marrocos Leite, Daniel Mason-D’Croz, Rob Percival, Christian Reynolds, Mark Lawrence. Conceptualising the drivers of ultra-processed food production and consumption and their environmental impacts: A group model-building exercise. Global Food Security, Volume 37, 2023, 100688, ISSN 2211-9124. https://doi.org/10.1016/j.gfs.2023.100688 (paywall)

Relevant to:

Policy makers and dietitians interested in system-wide policy change.

Question:

This study aimed to develop and validate a conceptual model of the known and potential environmental impacts across ultra-processed food (UPF) systems.

Bottom line for nutrition practice:

UPFs are associated with a wide range of environmental harms, driven by a profit-based, corporatized food system and enforced by product design and a food environment structured to encourage UPF consumption. Effectively reducing UPF production and consumption would require a suite of policies acting on the political economy, food environment and production system.

Abstract:

Using group model building we developed a series of causal loop diagrams identifying the environmental impacts of ultra-processed food (UPF) systems, and underlying system drivers, which was subsequently validated against the peer-reviewed literature.
The final conceptual model displays the commercial, biological and social drivers of the UPF system, and the impacts on environmental sub-systems including climate, land, water and waste. It displays complex interactions between various environmental impacts, demonstrating how changes to one component of the system could have flow-on effects on other components. Trade-offs and uncertainties are discussed.
The model has a wide range of applications including informing the design of quantitative analyses, identifying research gaps and potential policy trade-offs resulting from a reduction of ultra-processed food production and consumption.

Details of results:

There are a range of mechanisms by which UPFs harm the environment. Impacts do not occur in isolation and many are cumulative, whereby one type of environmental damage acts to further degrade other forms of environmental damage. Impacts include climate change, land and soil degradation, water scarcity, biodiversity and agrobiodiversity loss, eutrophication, food loss and waste, plastic waste and air pollution.

Drivers of environmental degradation include a political economy system which acts to reinforce profits of UPF corporations, drive corporate political power and ultimately weaken protective food policies. Other drivers include product design, whereby UPFs are designed to be as palatable as possible and a food environment which enables access to inexpensive UPFs around the globe.

Ultimately a shift in production is required to meet the goals of healthy, sustainable and equitable food systems. However, policies which encourage a shift away from UPF production towards unprocessed, minimally processed and processed foods, need to account for trade-offs. Trade-offs relate to production efficiency, time pressures, food loss and waste, land use, cost and convenience (see Table 1).

Of additional interest:

The model highlights research gaps which could be used by future researchers to determine UPF-related research studies. Furthermore, the model can be used to guide researchers on designing quantitative environmental impact assessments, as well as to provide a guide for interpreting quantitative findings in the context of complex and dynamic food systems.

Conflict of interest/ Funding:

This research received no specific grant from any funding agency, commercial or not-for-profit sectors. KA was funded by a Deakin University Postgraduate Research Scholarship.

External relevant links:

2023-Anastasiou-author-version-Conceptualising-the-drivers-and-impacts-of-UPFs Download

Corresponding author:

Kim Anastasiou, Ms – kim.anastasiou@adelaide.edu.au

Ultra-processed foods should be central to global food systems dialogue and action on biodiversity (2022)

Leite FHM, Khandpur N, Andrade GC, et al. Ultra-processed foods should be central to global food systems dialogue and action on biodiversity. BMJ Global Health 2022;7:e008269. doi:10.1136/bmjgh-2021-008269

This commentary highlights the impact of global diets characterised by a high intake of ultra-processed foods on agrobiodiversity. It calls for prioritising and addressing ultra-processed foods in global food system dialogues and policy, and country-level action.

Summary box

► The global industrial food system and consequent rapid rise of ultra-processed foods is severely impairing biodiversity. Yet although the impacts of existing land use and food production practices on biodiversity have received much attention, the role of ultra-processed foods has been largely ignored.

► An increasingly prominent ‘globalised diet’, characterised by an abundance of branded ultra-processed food products made and distributed on an industrial scale, comes at the expense of the cultivation, manufacture and consumption of traditional foods, cuisines and diets, comprising mostly fresh and minimally processed foods.

► Ultra-processed foods are typically manufactured using ingredients extracted from a handful of high-yielding plant species, including maize, wheat, soy and oil seed crops. Animal-sourced ingredients used in many ultra-processed foods are often derived from confined animals fed on the same crops.

► The contribution of ultra-processed foods to agrobiodiversity loss is significant, but so far has been overlooked in global food systems summits, biodiversity conventions and climate change conferences. Ultra-processed foods need to be given urgent and high priority in the agendas of such meetings, and policies and action agreed.

Conclusion

The very rapid rise of ultra-processed foods in human diets will continue to place pressure on the diversity of plant species available for human consumption. Future global food systems fora, biodiversity conventions and climate change conferences need to highlight the destruction of agrobiodiversity caused by ultra-processed foods, and to agree on policies and actions designed to slow and reverse this disaster. Relevant policymakers at all levels, researchers, professional and civil society organisations, and citizen action groups, need to be part of this process.