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The overlap of health care and food systems is multifaceted. Nourish convened 22 leaders from across healthcare, government, food systems and philanthropy together for a four day retreat on Wasan Island in order to explore the opportunities around environmental nutrition in health care. Environmental nutrition (2014), a concept coined by Health Care Without Harm, reframes healthy food as contributing beyond individual well-being towards a collective social responsibility for creating healthy communities and a sustainable food system.
Participants at the retreat explored how healthy food can be sustainable food when it is connected to how it is grown, sourced, and builds community value from a constellation of different points in the food and health care systems. In particular, the perspectives of indigenous participants and an organic farmer were appreciated by the group as being uniquely critical in understanding the system. There were also discussions about expanding the network and acknowledging who else could be at the table to further the work, including physicians, nurses, provincial health organizations and other indigenous associations.
Facilitated by Alex Ryan from MaRs Solutions Lab, the retreat involved creative and collaborative exercises to explore personal perspectives in the current system, and to generate visions of ideal futures together based on shared values. The group was then able to identify short-and-long-term windows of opportunity and create strategic partnerships for interventions that can shift the system towards healthier patients and a healthier planet.
While we can’t recreate the experience of the retreat with this report, we hope to take you through key moments sharing insights and momentum for moving forward in our collective work. The concept of public narrative from Marshall Gantz, “A story of the self, a story of us, and now” introduced in one of the sessions, mirrors the path of the retreat. The story of self is a personal story that connects us to others, the story of us is a collective and shared identity and purpose, and the story of now is about the choices we make in the present to face urgent challenges. Join us as we reflect on the collective story and practice of environmental nutrition.
The story of “self”: Understanding perspectives in generative tension
Retreat participants work in different parts of food and health systems including an organic farmer, dietitians, a food writer, Indigenous leaders, food and nutrition managers, a nutritionist, foundations and non-profit food and health organizations. The group leveraged their diversity of backgrounds and experience to explore different perspectives of “healthy food” that are in tension with one another in the health care settings. These discussions revealed the complex nature of balancing different stakeholder needs in a food-health system where there are no obvious right answers. However, these generative tensions are also starting points to examine opportunities for systems change. A few such tensions were:
The tension in empowering more patient cultural preferences and choice of food while acknowledging the reality that certain nutritional needs of patients require expert dietary oversight
In a highly culturally diverse country, the cultural food preferences of individuals need to be better taken into account. Patients also should be offered choice about what and when they eat, but there will be situation-specific times when certain diets with be prescribed. More comprehensively balancing all of these needs would be a new path for food in health care..
The tension in continuing to work within a budget-constrained health care environment with the imperative to shift to more sustainable food purchasing, potentially at a higher cost.
While there is the reality that health care budgets are limited, some believed that budget constraints can lead to more creative and cost-effective solutions around how to provide sustainable diets (e.g. plant-based proteins). Others saw how current agricultural practices are already stretching the threshold for environmental resiliency, and there is no other option but to advocate for spending more money on sustainable food as a lever to shift agriculture towards sustainability, something that is urgent in the face of climate change.
The tension in wanting to redesign food production centred on sustainable, small-scale farming systems while needing to shift mainstream agriculture towards more sustainable practices.
Many felt that a full redesign of mainstream agriculture -- defined as large conventional farms with practices that are degrading the soil and damaging water systems -- needs to occur but currently small, sustainable farms are not scaled out and need supports. However, some also believe we should not alienate farmers who are trying to survive in a constrained system, but provide them pathways for change.
The tension in how advocating for purchasing local as a bridge to sustainable may potentially be reinforcing unsustainable practices.
While there was optimism that advocating for purchasing local can be an effective bridge to encouraging more sustainable agriculture practices, many in the group raised the concern that purchasing food based on geography alone without looking at unsustainable farming practices may reinforce a problematic status quo -- and that promoting local gives a false sense of accomplishment. The group also reflected on how the concept of “local” differs for Indigenous communities where it signifies going back to the traditional practices of harvesting and eating the “foods of the land” that are inherently sustainable.
The tension in striking a balance with evidence-based research to inform change, while acknowledging that the current criteria for validity in research can be expanded.
Many of the group felt that evidence and research is necessary in order to reinforce the validity and value of more sustainable practices around food and health. However, the criteria of what is considered valid scientific research (e.g. quantifiable, scalable replicability) does not take into consideration the qualitative lived experience of people and cultures. There was a desire to see how values can be integrated alongside research to make informed and inclusive decisions.
The tension in articulating the need for immediate change in the food-health system, while moving cautiously to ensure that everyone is engaged.
Some participants felt that creating consensus may take too long when the urgency of climate change demands changes to culture to be enacted swiftly. Others believed that cultural change cannot happen without broader public and consumer engagement and advocated for a cautious and inclusive approach to change. There is a shared belief that diversity of influencers is needed to impact the system and shift the trends in a positive direction (e.g. engagement with youth).
Negotiating through these generative tensions in the food-health system revealed new pathways of change. The opportunities of working in the “radical middle” was raised where rather than polarizing to positions in the extreme, there can be ways to be inclusive of different positions (left, right, and elsewhere) and reform institutions while being realistic and practical.
Some of the key opportunity insights include:
We need to critically examine current incentive structures for their effects, adverse or not, on sustainable food production.
In a budget-constrained healthcare environment, we need to make food and nutrition a higher priority by articulating and making visible the social, economic, and environmental costs of inaction in the current system.
It is critical to engage consumers and bring more public awareness around sustainable practices. The rising popularity of plant-based diets among youth is an example how cultural trends can shift behaviour in a positive direction.
Using positive narratives around the possibility of flourishing and community-based futures rather than narratives of admonishment and sacrifice can inspire more people to be involved with change.
The story of us: Seeing the future we want to create
The group went through an exercise of creative destruction called TRIZ to reflect on the question: “what must we stop doing to make progress on our deepest purpose?”. Participants brainstormed the most counterproductive attributes of the worst possible food-health system (e.g. nutrition, not food, is the only priority for the patient; systems is entirely centralized; zero concern for the environment...) and then reflected on whether any of these practices resemble the current system.
Before shifting attention to the ideal future, participants shared personal stories of great experiences of food, or food in healthcare. A common thread was how the powerful human and social experience of preparing and eating the food can be even more important than the food itself.
Next, the exercise of idealized design enabled the group to co-design what an ideal food-health system that is 10x better could look like. Each group was given a different assemblage of personas across the system –- honeybees, dietitians, hospital CEOs, patients, physicians, nurses, food service directors and distributors -– to ground how their experiences would change within the new system.
The groups generated ideas outside the limitations of the current system around what contributes to a healthy and flourishing system. A surprising number of common themes emerged the descriptions of ideal food-health systems:
Alignment of home values with institutional values: Many of the personal values around eating, such as the cultural, social and spiritual dimensions of food, are reflected within the public institutions as well.
Emphasizing connection to nature: The ideal systems revealed a deeper connection to nature, where gardens and farms were embedded within and closely involved community.
Prioritization of preventative health care: The importance of preventative health and well-being, holistically fostered through healthy eating and addressing other social determinants of health, is advocated for and invested in.
Strong connection of health care to community: There is a strong belief that the health of people is not the responsibility of individuals, but of the community.
Connectedness as opposed to silos: Institutions and silo-ed roles start to reshape and even collapse as people work in more connected ways to deliver well-being.
The group also realized that elements of the idealized system already exist in what we can think of “pockets of the future in the present” . For example, existing innovations like the projects of the Nourish innovators, or Community Food Centres Canada that connect community support with access to fresh foods, can be further amplified and scaled. These are exciting opportunities to connect to existing initiatives, bolster them up and build on them.
The story of now: Creating the future we want to be
Inspired by the potential in their idealized food-health systems, participants came up with tangible opportunities in the present to create pathways towards these possible futures. These projects were proposed as actionable ideas that different members of the group committed to collaborating on and experimenting with. They included:
Mobilizing around the revised Canada Food Guide
Educate Canadians about the overlap between healthy food and sustainability with the release of the new Canada Food Guide. For example, this is an opportunity to promote the benefits of regular intake of plant-based foods and proteins. This is a chance for many sectors to support the messages in Canada’s Food Guide.Increasing access to local/organic/sustainable food
Enable ways in which hospitals can work with local and sustainable farms to impact menu to distribution through distributors like 100km foods which sources from local, sustainable farmers.Incentivizing sustainable consumption
Create incentive structures that nudges positive behaviour change around sustainable purchasing and consumption. For example, a point system that rewards sustainable action by letting individuals redeem it for value that matters to them.Promoting plant-centred eating in an inclusive way
Design and communicate new narratives through effective Action Learning with peer change agents that promote plant-based diets for a diversity of consumer age groups.Positioning the sovereignty of Indigenous food ways outside of an exploitative capitalist system
Become allies (or co-conspirators) of Indigenous reconciliation in Canada, finding opportunities for sustainable food and health practices in Indigenous as well as non-Indigenous communities which recognizing their parallel paths of development, the need to distribute power more equitably, and the opportunities for respectful collaboration -- a vision inspired by the Wampum Belt agreements.
After an exercise to reflect on how this work relates to personal purpose and to surface individual and group commitments, participants shared final reflections.. A common thread among the group was feeling inspired about the increased understanding and commitments to environmental nutrition (even as we continue to define it…), with hopes and expectations that the work will continue through new connections created.
Nourish Wasan Retreat Participant List
This report is not endorsed by organizations who attended but rather a documentation of the discussions that occurred.
Alex Ryan, VP of Systems Innovation and Program Director of the MaRS Solutions Lab
Amy Ma, Co-chair, Montreal Children’s Hospital’s Family Advisory Forum
Annie Marquez, Registered Dietician and Manager of Menu Management and Nutritional Information System, CIUSSS Centre-Sud-de-l’ile-de-Montréal
Bernard Lavallée, Journalist, Writer and Dietitian
Beth Hunter, Program Director, McConnell Foundation / Nourish
Cheryl Hsu, Design Researcher and Communications Strategist, Nourish
Colleen Hill, Manager, Children and Youth, Heart and Stroke Foundation
Gillian Flies, Owner, The New Farm
Heather Fletcher, Senior Director, Environmental, Patient Food and Transport Services, St. Michael’s Hospital
Jennifer Reynolds, Institutional Food Program Manager, Food Secure Canada / Nourish
Joannah Lawson, Nutrition Consultant and Philanthropist, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto
Karen Williams, Senior Director of Health, Wellness & Environmental Sustainability strategies, Aramark Canada Ltd.
Kelly Gordon, Community Dietitian and Acting Program Supervisor, Six Nations Health Services
Krista Burns, Advisor, Health Canada
Leslie Whittington-Carter, Public Affairs Manager of Health Systems, Dietitians of Canada
Lyn Baptist, Board member, McConnell Foundation
Malek Batal, Professor of public health nutrition, University of Montreal
Marilyn Lo, Divisional Dietary Systems Specialist, Region of Peel
Murielle Vrins, Food advisor, Équiterre
Nelson Alisappi, Health Policy Analyst, Assembly of First Nations
Stacia Clinton, National Director for the Healthy Food in Health Care Program, Health Care Without Harm
Suzanne House, Patient Experience Leader, Central Health, Newfoundland and Labrador