Sustainable hospital food - a reality or merely a dream?


Hospital food on a tray

Environmental degradation and climate change are amongst the biggest and most pressing issues our world faces today. All parts of the food system are affected by and contribute to these issues. Hospitals are key players in food systems, feeding thousands of patients every single day. But what is the impact of this on the environment, what can be done to reduce these impacts, and what are the perspectives of those that work in this system on the relationship between hospital foodservices and environmental sustainability? 
Visualise this: all food starts off on a farm, grown by farmers, requiring intensive amounts of water and land, then harvested, washed, processed and transported for retail, often across very large distances. A central production kitchen (which produces meals for a group of hospitals and healthcare settings) purchases these raw ingredients, and a team of chefs and cooks bulk produce large volumes of meals. Meals are vacuum sealed in large bags or trays and transported to an array of different hospitals. The distance for example between the Central Production Kitchen and one particular hospital in Victoria, is 62 km (covered daily), equating to 14 tonnes of CO2 emissions per year, the equivalent to the CO2 emissions produced from 2.4 homes’ electricity use in a year.

The foodservice staff at the receiving hospitals plate, heat and serve the food to patients on trays, accompanied by a range of additional commercial portion controlled items in plastic packaging, sometimes up to 14 different items. When the meal arrives at the patient’s bedside they may be very hungry or not at all. If they have dexterity issues they may receive help from a nurse, or they may not, resulting in the food left on the tray untouched. Once the meal time is over, the foodservice staff collect the trays and any packaging and leftover food is sent to landfill. This is the cook-chill commissary foodservice model, which occurs at many Victorian hospitals.

There are many models of foodservice used across hospitals in Australia. Despite the model used, all food preparation and delivery processes have environmental impacts at every stage of the food supply chain – production, distribution, preparation, consumption and waste management. Hospitals must recognise their role given their responsibility for human health. Something needs to change to ensure food systems are protected for future generations.

PhD candidate Stefanie Carino and her research colleagues conducted a systematic review (published in the Journal of the Academy of Nutrition and Dietetics) which looked at published research from across the world that described the environmental impacts across the food supply chain in hospitals, the strategies being used to reduce them and the perspectives of those involved. “At the moment, the majority of research published in this space has focused on the consumption stage of the food supply chain, with a focus on increasing patient consumption to reduce food waste” explained Stefanie. According to Stefanie, these studies found that the amount of wasted food on a patient’s plate ranged from 6-42%. Not only does this cause significant economic losses, when this wasted food is disposed of in landfill, methane is produced which contributes to global warming. Stefanie did note that it was pleasing to see that there were also studies which focused on ways to increase purchasing of food produced locally.

“People working within hospital systems such as foodservice staff, nurses, dietitians as well as managers share a vision for sustainable foodservices however there are many barriers in practice to moving towards change” Stefanie said. “We found that there was a lack of research which focused on the distribution, preparation and waste management stages as well as studies which tested whole system strategies that covered a range of food supply chain stages” Stefanie continued (Figure 1).
Figure 1. Distribution of results categorised across the food supply chain identified in systematic review of environmental sustainability of hospital foodservices.
Figure 1: Distribution of results categorised across the food supply chain identified in systematic review of environmental sustainability of hospital foodservices
“In nutrition and dietetics, we highly value scientific evidence to make decisions about clinical treatments or public health programs, and we need to have the same outlook for foodservice research” enthused Stefanie. “Capacity must be built for high quality and innovative foodservice research that develops our understanding of solutions to these big problems” she said.

Dietitians, given their clinical and foodservice roles, are well positioned to advocate for change towards environmentally sustainable foodservices, and work with those involved in making decisions within hospitals. This could include a range of sustainable practices such as: 
  • Increase in local food procurement
  • Introduction of food growing gardens on site at hospitals
  • Redesign menus to increase appropriate vegetarian and vegan options
  • Reduction in food packaging
  • Meal ordering closer to meal time consumption
  • Increase in mealtime assistance for patients with dexterity issues
  • Quality improvement projects to reduce nutrition supplement wastage
  • Repurposing untouched food waste
  • Monitoring of food waste and sharing of results with staff
  • Food waste used to produce compost 
  • Policy development for managing food waste
  • Patient education that incorporates aspects of sustainable food and diets
  • Formation of sustainability groups in hospitals supported by leadership
  • Professional development opportunities for dietitians, foodservice personnel and managers to learn the importance of sustainable food
  • Local environmental sustainability forums to share successes and learnings
Regardless of the setting, we can realise much opportunity for change if we consider the impacts of our food at all the stages that happened before it ended up on a person’s plate. If we’re able to work towards more environmentally sustainable foodservice in hospitals, not only will it benefit the environment and long term human health, hospitals will be able to position themselves as leaders against environmental degradation and climate change. They will be able to educate the community to bring about positive and sustainable change for our food system and the environment for years to come. 

More information
Stefanie Carino is an Accredited Practising Dietitian and PhD student in the Department of Nutrition, Dietetics and Food at Monash University. Her current research focuses on exploring the environmental sustainability of hospital food services. You can follow Stefanie on Twitter via @StefanieCarino.

Judi Porter is an Associate Professor of Nutrition at Monash University and Eastern Health. She leads the Clinical Nutrition research theme. You can follow Judi on Twitter via @JudiPorter_.

Shirin Malekpour is a Senior Lecturer at Monash Sustainable Development Institute. She develops and leads interdisciplinary research on planning and governance for sustainable development. You can follow Shirin’s team on Twitter at @MonashMSDI.

Jorja Collins is an Advanced Accredited Practicing Dietitian who works in foodservice at Eastern Health and as a lecturer and researcher in the Department of Nutrition, Dietetics and Food at Monash University. She was awarded a Churchill Fellowship to explore environmentally sustainable hospital foodservice. You can follow Jorja on Twitter via @Jorja_Collins

Stay up to date with the Monash University Department of Nutrition, Dietetics and Food on Twitter via @MonashNutrition

Publication information
Reference: Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review Carino, Stefanie et al. Journal of the Academy of Nutrition and Dietetics, In Press. DOI https://doi.org/10.1016/j.jand.2020.01.001
Click here to access the paper published in the Journal of the Academy of Nutrition and Dietetics.
The Journal of the Academy of Nutrition and Dietetics is a Q1 ranked journal for Nutrition and Dietetics with an impact factor of 4.14.
Image Source: rawpixel on Unsplash, images in Figure 1 sourced from Pixabay.

Popular Posts

Monash Nutrition Twitter