Fixing food in our hospitals

It is our duty as medical professionals to champion sustainable diets in healthcare settings

As a doctor working in gastroenterology, I am regularly asked for advice about healthy eating. What type of diet is best for my Crohn’s disease? What types of foods will help with my symptoms of IBS? How can my patient with metabolic syndrome improve their health through diet?

For most of my career, when thinking about what comprised a healthy diet, I would have reverted to the well-known food pyramid, perhaps the studies I had read about the Mediterranean-style diet, and more recently the science surrounding our gut microbes. I would have thought about what types of foods will help nourish the healthy body and encourage healing.

However, in recent years, in response to global heating and imminent climate and ecological collapse, I have had to reappraise my understanding of healthy eating. No diet can be considered healthy while being detrimental to the environment. Our individual health in the future, and that of our children, will require a robust environment. In a future of mass climate-related migration, more frequent natural disasters, and the collapse of many of our natural ecosystems, healthcare systems will fail. So, it is time for a paradigm shift. We need to live within our means. We need sustainable diets.

Unfortunately, this is not the current trend. Food systems contribute up to a third of greenhouse gas emissions, the largest component of which comes from the rearing of livestock. Globally, there is an increased consumption of animal-based foods, the current trajectory of which is unsustainable.

As doctors and healthcare workers, it is our duty to champion sustainable diets. We must lead by example. Our hospitals should be beacons of healthy, sustainable eating, but this is not the case. As an NCHD working night shifts, I have found myself more times than I would like to admit sitting next to a vending machine, eating a chocolate bar and downing a fizzy drink – the only food options available. While the 2019 HSE vending machine policy now ensures that today’s snack was of no more than 200 calories and it was the aspartame-containing ‘free’ version of
the fizzy drink, this is not nutritious eating. We must do better.

Hospitals offer little opportunity to source good quality, fresh, nourishing food. Canteen offerings can lack nutritionally adequate options for those wanting to reduce or avoid meat. Alternative food options available in the hospitals include vending machines, shops selling ultra-processed foods and corporate café chains who are more focused on profit and margins than nourishing patients and staff. We haven’t yet followed suit of US hospitals housing McDonald’s franchises, but we are falling far short of the mark.

What can be done?

Although outlined as aspirational by the HSE, we need to see, in practice, hospital vendors sourcing locally grown and seasonal food, offering more thoughtful plant-based options, limiting the availability of ultra-processed, ultra-packaged foods, filling the vending machines with more nutritionally sound options, and limiting the availability of disposable cutlery and cups. Coffee shop tenders should also target smaller, local vendors with a green ethos. Individual healthcare facilities need to be practically empowered to make these changes.

Instead of three corporate cafes and coffee shops selling roughly the same pre-made snacks and sandwiches, produced and packaged in a factory far away, we could have three independent, local vendors: A sushi bar, selling freshly made sushi using Irish fish; a smoothie bar using Irish fruit and vegetables; and a local bakery outlet selling homemade sandwiches with wholesome ingredients. Make it about sustainability. Make it about the food you want to eat, the food that could turn a bad day into a good day, and food that would boost your health. And cafes and coffee shops should not be about income for hospitals or profit for global conglomerates.

The enthusiasm for a move to sustainable food provision in our hospitals, I believe, exists and could be realised with appropriate resource allocation

Green innovators

We can look to exciting examples from all over the world for encouragement in this space. In New York, NYC Health and Hospitals group recently celebrated having served 1.2 million plant-based meals in one year in an effort to improve the health outcomes of patients and reduce carbon emissions. In addition, the hospital group reported a cost saving of 59 cents per meal – a win/win.

We can look to innovations such as those undertaken in the German LWL-Klinik Münster who create produce in the form of apple juice from an onsite orchard. Imagine, a hospital surrounded by an orchard. This group has also built sustainability into their catering practices, sourcing local, seasonal and, when possible, organic produce with an additional focus on waste reduction. They have adopted simple policies such as the ‘small order’, whereby customers are encouraged to request a modest portion with an option to return for seconds if not satiated.

The enthusiasm for a move to sustainable food provision in our hospitals, I believe, exists and could be realised with appropriate resource allocation, a move away from a profit-based model, and by putting sustainability at the core of hospital food.

If the HSE is to achieve their aspiration of creating a sustainable healthcare service, we need to change what people eat and drink both within our hospital walls and beyond.

References available on request

Author: Dr Aoife O’Sullivan , Gastroenterology SpR and Chair of Irish Doctors for the Environment’s Sustainable Diet in Healthcare Facilities Working Group