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.

Co-production of research for food systems transformation: mapping and exploring examples of co-production activities across Transforming the UK Food System (TUKFS) projects (2024)

About this project

Led by Dr Clare Pettinger (University of Plymouth, FoodSEqual) and Professor Charlotte Hardman (University of Liverpool, FIO FoodBeanMeals), this interdisciplinary, cross-project collaboration has engaged researchers from multiple academic institutions in order to better understand how to facilitate, support, and invest in future co-produced research for food systems transformation. 

There is an urgent need for transformation of the UK food system. The ways in which food is currently produced, accessed, and eaten are having significant negative impacts on human health and causing damage to our environment.

To address these issues, there has been a recent shift towards the use of creative and participatory methods of research, including co-production. In line with this, “co-producing research across disciplines and stakeholders to provide evidence for coherent policymaking” is a key strategic aim of the UK Research and Innovation (UKRI) Transforming UK Food Systems (TUKFS) SPF Programme.  

As part of the TUKFS Annual Synergy Fund, this research project identified and mapped examples of where co-production, co-design or co-creation methods are being employed for food system transformation across six TUKFS projects.

This toolkit shares the outputs of this research project, including 11 case studies of co-production, a ‘messy map’ representing our key findings, as well as practical considerations intended for researchers, academic institutions, and funders engaging with these innovative methodological approaches.

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.

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

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

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

Abstract

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

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

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

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

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

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

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

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

The main sister alliances that Sustain works with include:

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

The Economics of the Food System Transformation (2024)

On 29 January 2024, leading experts from the Food System Economics Commission (FSEC) unveiled a new economic model that maps the impacts of two possible futures for the global food system. The report is extremely useful for Dietitians and Nutritionists, with diet central to improving our food system.

The text emphasizes the urgent need for a transformation of food systems, highlighting the economic, environmental, and social benefits of such a transformation. It outlines the negative impacts of current food systems on health, the environment, and climate change, identifying unaccounted costs estimated at 15 trillion USD a year. The report also discusses the unsustainable trajectory of the global food system and the potential economic benefits of a transformation, estimating them to be worth 5 to 10 trillion USD a year.

Proposed Solutions for Food System Transformation:

  1. Shifting consumption patterns towards healthy diets: The report suggests regulating the marketing of unhealthy foods to children, providing front-of-pack nutritional guidance, targeting public food procurement on healthy options, taxing sugar-sweetened beverages and unhealthy foods, and reformulating packaged food to encourage healthier dietary choices.
  2. Resetting incentives by repurposing government support for agriculture: It is recommended to repurpose subsidies to improve access to healthy diets and make them more affordable. This involves reforming agricultural support to incentivize choices in line with the goals of the food system transformation, with a focus on lowering the hidden costs of food systems.
  3. Targeting revenue from new taxes to support food system transformation: The report recommends taxing carbon and nitrogen pollution to help achieve positive outcomes and align with expert recommendations from bodies such as the IPCC and OECD. Designing new taxes to suit the local context and targeting resulting revenues towards direct and progressive benefits for poorer households is essential to ensure inclusive outcomes and garner political support for a food system transformation.
  4. Innovating to increase labor productivity and workers’ livelihood opportunities: Public institutions can accelerate the development and diffusion of innovations that meet the needs of poorer producers and remove barriers to their adoption. Priority areas for public research and innovation include improving plant breeding, supporting environmentally sustainable, biodiversity-friendly, and low-emission farming systems, and developing digital technologies useful to small farmers.
  5. Scaling-up safety nets to keep food affordable for the poorest: Developing and strengthening safety nets is crucial to making food system transformations inclusive and politically feasible. Countries should prioritize targeting limited transfer resources on children’s nutritional needs and mobilizing more resources to put in place comprehensive safety nets.

Additionally, the report addresses various tensions and obstacles in transforming food systems, highlighting the need to manage concerns such as fears of food price rises, job losses, policy siloes, global inequalities, and entrenched vested interests. It emphasizes the importance of addressing these concerns to facilitate change and ensure that the benefits of food system transformation can be realized. The report also highlights the rising visibility of transforming food systems as a policy priority, as well as the new ambition to seize the opportunities offered by such transformation, as evidenced by the COP28 UAE declaration on Sustainable Agriculture, Resilient Food Systems, and Climate Action signed by over 150 countries.

Source: Food Systems Economics. (2024). The Economics of the Food System Transformation. Knowledge for policy.
https://knowledge4policy.ec.europa.eu/publication/economics-food-system-transformation_en

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.