How do we connect the health of people with the health of the planet through food? Nourish held a two-day symposium at Evergreen Brickworks in Toronto, gathering over 170 people from the health care and food sectors to learn about how health care can take leadership in making food a fundamental part of health and healing. This event was also an opportunity for the 26 Nourish Innovators -- food service managers, dietitians and leaders from across Canada -- to share learning from their two-year fellowship program and grow the Food for Health movement.
The Food for Health Symposium began with acknowledgements of the territory from Emma Bilodeau, who gave the Thanksgiving Address; Valerie King, representing the Mississaugas of Credit River, offering a Welcome to the Territory; and Evergreen’s on-site Indigenous garden coordinator, Isaac Crosby, with Ojibwa and Black Canadian heritage, who offered a welcome to the Brick Works site. Symposium host Hayley Lapalme framed the importance of these acknowledgements by sharing a lesson learned from Nourish Innovator Kelly Gordon, asking, “How can we talk about food and health without talking about land with Indigenous peoples?”
The two days were programmed around ambitiously exploring the power of hospital food to nourish the health of patients, communities, and planet -- and of its potential to transform our relationships to land, to health, and to each other.
Experiential Journeys through the Food and Health System
Food for Health was about gathering people together to talk about the connections between food and about health that are complex, cultural, personal, and multifaceted. The opening plenary “Journey through the Food and Health System” featured diverse perspectives to explore how the food and health systems need to be reconnected in an era of climate change, reconciliation, food insecurity and rapidly increasing rates of diet-related disease.
One of the critical beliefs of Nourish is the value of bringing people into experiential and land-based learning, enabling participants to step into different perspectives within the food and health systems. The afternoon took Food for Health participants out of the typical conference format on four different experiential workshop tours. Participants visited University Health Network (UHN)’s Bickle Garden to explore how they use onsite gardens to contribute to the health of staff and patients. Another group went to Black Creek Community Farm and were co-hosted by the Black Creek Community Health Centre and Afri-Can FoodBasket to learn about community-based efforts in the Jane & Finch neighbourhood to improve food security and health and wellness through food and farm programming. Taking advantage of the beautiful location at the Evergreen Brickworks, there was a guided Traditional Medicine walk through the Don Valley ravine with Johl Whiteduck Ringuette (NishDish) to learn about local plants and traditional medicines. The Kairos Blanket Exercise, which is an experiential journey through the history of colonization in Canada, was described as a deeply profound learning experience for its participants during the share-back session over pizza and three-sisters stew.
Healing People and the Planet
The second day of the Food for Health Symposium kicked off with the premier of the short documentary “Miichim”, a film about Nourish Innovator Kathy Loon and her work with Sioux Lookout Meno Ya Win Health Centre in Northwestern Ontario to bring traditional foods to their Indigenous patients. This was followed by a powerful morning keynote by Sheila Watt-Cloutier, an Inuk advocate and Nobel-prize nominee who passionately defends the Inuit “right to be cold” in the North. Sheila discussed the importance of seeing climate change not just as a political, scientific and economic issue, but first and foremost, as a human rights issue. She ended on a provocation for people to take leadership by not losing sight of the interconnectedness of the issues at hand, and to imagine a different way of living together on the planet that reconnects personal and planetary health.
Nourish innovators Shelly Crack (Northern Health), Kelly Gordon (Six Nations Health Authority), Kathy Loon (Sioux Lookout Meno Ya Win Health Centre) then joined Sheila Watt-Cloutier in a panel conversation with Hayley Lapalme about the importance of hunting and gathering on the land and the lifelong learnings that people can gain from it. They discussed how the foods that provides comfort and healing to people are as diverse as the communities consuming it, and how it is critical for health care organizations to root themselves in the places where they work to build relationships with the people of that territory and to integrate land-based approaches to healing.
Three Pathways to Transform Food in Health care
The three major themes of the Food for Health Symposium were based around the collaborative project work of the Nourish cohort around Food Service Innovation, Traditional Food Ways, and Sustainable Menus and Procurement.
The Food Service Innovation stream kicked off with the workshop “The Hospital Tray: Patient Food Stories & Professional Paradigms”, a fishbowl exercise arranging the group in a circle to listen to and centre the voices of patients, including Cheryl Prescod (Black Creek Community Health Centre), Serena Thompson (Minister's Patient and Family Advisory Council), Jillian with her mother Cheryl (patient-family advisors at Holland Bloorview Kids Rehabilitation Hospital) and Sharon O'Keeweehow (Patient Advisory Council, Saskatchewan Health Authority). In the afternoon, the Nourish Innovators then shared the results of a process to create a national tool for measuring patient food experience across Canada. They collected data from 43 hospital sites to catalyze a nationwide effort to value and improve the patient meal experience. The presenters also provided case studies showcasing the benefits of menu liberalization, room service models and staff education to improve patient experience and enhance patient choice.
The workshop “Seeing through Two Eyes: Indigenous Foodways in Health Care” in the Traditional Food Ways stream was led by the Nourish Traditional Foods Programs (TFP) team. They shared the journey of pivoting from developing a “How To” guide for traditional food programming to embracing a direction of listening to and building relationships with Elders and communities. A key takeaway was the importance for Western institutions to suspend judgements and respect and value Indigenous worldviews. This was followed by the workshop “Land-Based Teachings with Traditional Knowledge Keepers,” which took participants outdoors around a fire with First Nation and Métis elders.
The Sustainable Menus and Procurement stream started with the workshop “Practical Guide to Building Sustainable Menus” led by the Sustainable Menus collaborative team, who presented on the opportunity of more plant-based protein diets in the shift to more sustainable menus. The team was joined by Dr Tushar Mehta, who emphasized the benefits of plant-based diets for both patient and planetary health. The team announced the forthcoming launch of a digital guide to support health care food service teams to design less carbon-intensive and more sustainable menus. The afternoon workshop “Values-Based Procurement: Stories and Strategies” explored the opportunity around procurement to add more social value to existing purchasing and presented ways in which health care institutions can buy food based on quality considerations like social and environmental benefits, not only the lowest cost. They also invited participation in testing a new national RFP tool for health care, which will occur through the summer of 2019.
The Hospital Food Experience from the Future (2030)
Nourish sees the hospital tray as a platform to dream big and transform the food-health system, asking how we can provide comfort and healing to patients, how to create more resilient communities and how to address planetary health and climate change (Watch our video manifesto: Ode to the Hospital Tray). The lunchtime event “The Hospital Food Experience from the Future” transported the audience to the future of 2030 to be a part of what might be possible. The exuberant and playful event invited three hospitals: CHEO, Holland Bloorview Kid’s Rehabilitation Hospital, and Unity Health, to work with three “celebrity” chefs: Chef Rich Francis, Chef Joshna Maharaj and Chef Simon Wiseman to wow audiences with three ambitious dishes that embody the future of what hospital food could look and taste like.
The plant-forward plate: CHEO chef Simon Wiseman with his team members, Darlene Arseneau (VP Corporate Services & CFO), and Bernice Wolf (Director of Food and Marketed Services), prepared a “plant-forward plate” that was a delicious home-made tofu burger.
The comforting bowl: Chef Joshna Maharaj with her Holland Bloorview team members Julia Hanisgberg (President and CEO), Aman Siam (Director of Client and Family Integrated Care), and mother-daughter patient duo Jillian and Cheryl Peters prepared a roasted carrot recipe that was transformed into a carrot soup, roasted carrot salad and carrot rice wraps.
The Indigenous dish: Haudenosaunee and Gwich'in Chef Rich Francis worked with the Unity Health team, Maggie Bruneau (VP Clinical Programs, Providence) and Heather Fletcher (Senior Director of Support Services) to create a herb-crusted salmon with wild rice and oat risotto and blueberry wild sage compote.
Judged by a taste panel made up of Elder Margaret Edgars (Haida Elder), Tessie Harris (Dietitian), Abena & Aiden (Age 7 and 8), André Picard (Globe & Mail Health Columnist) and Dr. Edward Xie, (Emergency Doctor), the panel collectively determined which dishes best embodied the success criteria: Patient-friendly, Planet-friendly and Scale-friendly.
All three teams put enormous creativity, thought and effort into the dishes they prepared for the Hospital Food Experience from the Future. Faced with a difficult choice, Team Unity Health won over the taste panel with their traditional salmon dish with Chef Rich Francis concluding the event saying “Indigenous food is health care.”
Ultimately, the food and health system will be transformed by the people who are in it, and the Food for Health Symposium ended with keynote presenter Peter Senge asking the audience in small groups to share their most impactful and touching moments. The reality of a healthcare culture that focuses on scarcity and short-term cost-constraints is that it limits ambitions around what we can collectively achieve. As Senge said: “we can measure the immediate costs but we do a terrible job of measuring the long-term costs that are distributed and paid for by someone else.” So it is up to health care leaders and citizens to pay attention to how we can co-design a health care system that nourishes patient, community and planetary well-being the way food does -- interconnected across multiple dimensions, physically, emotionally and spiritually.