For Canadian hospitals, food is an untapped opportunity to advance patient and planetary health. Despite how we relish food as a centerpiece of holiday gatherings and connection in our personal lives, food is often relegated to the literal and figurative basement of the hospital.
The dominant paradigm pits food budgets against medicine rather than contending with its therapeutic role in recovery, reducing length of stay or hospital readmissions; its importance to disease prevention and management; and its value in offering comfort to patients and staff alike, who are otherwise left hungry and hunting for something nourishing.
Ironically, the dominant food system also misunderstands food. Reducing it to a mere commodity—packaged, processed, and divorced from the soil that once nourished it and fed its cultural, ecological, and health-giving dimensions.
These fundamental disconnects have contributed to two intersecting crises: an overburdened health system and a food system that makes us sick.
The intersection of these crises is the niche of Nourish, a Canadian organization transforming health care food systems through multi-sectoral leadership development across institutional, community, and policy scales.
Nourish is showing how hospital meals, menu design, procurement, and food environments can improve patient and staff well-being, invest in regenerative agriculture and inclusive local economies, and reduce environmental impacts.
Costing roughly eight dollars a day to feed one patient, hospital food has long been a target of criticism.
The criticism is embodied by the roughly 50 per cent of food that goes wasted on the tray.
In Canada, where health care systems are strained by aging populations and chronic disease, research shows that nutritious and delicious meals can support faster recovery, reduce complications, and improve quality of life.
Despite these benefits, Canadian hospitals often serve meals lacking in fresh, sustainable, and delicious ingredients due to perceived and real budgetary and procurement constraints.
Nourish is dedicated to reframing food as a vital component of patient care and to fostering a new culture of leadership from hospitals across Canada. It positions food as a pathway to enact anchor leadership that harnesses the place-based mission, budgets, reputation, and influence of hospitals. Anchor leadership builds health and wealth within and beyond hospital walls.
At a planetary level, food is a powerful intervention point in the fight against climate change, notably through shifts to plant-based diets and food waste reduction, as well as shifts to more regenerative agricultural practices. The EAT-Lancet Commission states that “Food is the single strongest lever to optimize human health and environmental sustainability on Earth.”
Research published in the American Journal of Clinical Nutrition in July 2024 found that following a Planetary Health Diet, one that is plant-forward, is associated with reduced mortality risks from cardiovascular disease, cancer, respiratory disease, and neurodegenerative conditions.
Feasting on plant-rich foods supports individual health and significantly lowers greenhouse gas emissions and other environmental impacts.
It’s a poetic reminder that we can’t separate human health from planetary health. As Thomas Berry puts it, “We cannot have well humans on a sick planet.”
Fortunately for Canadians, the new food guide released in 2019 tracks closely to a planetary health diet.
But no matter the diet, food is only helpful if it’s eaten. Until it’s accessible, affordable, and culturally appropriate, it’s not doing much good.
Central to Nourish’s approach is the belief that the hospital tray is a platform for creating just, inclusive, and regenerative food and health systems.
Going well beyond food charity, Nourish sets the table for experiments around more fundamental transformations in the way we think about and work with food.
What if health care institutions acted as investors in regional economies, building partnerships with local farmers, Indigenous food producers, or women-owned businesses, through shifts in patterns of sourcing and purchasing foods?
With an annual food service spend of four billion dollars, hospitals have the potential to deploy millions of dollars of public funds into local economies, fostering meaningful job creation, food sector innovation, economic reconciliation, biodiversity preservation, and contributing to regional food sovereignty.
This orientation intentionally extends the duty of care beyond the immediate needs of the patient out to the community, and ultimately, to a planetary scale. But until executive leadership teams are codifying these strategies into corporate plans, as Nourish alumni Vancouver Coastal Health did with their Planetary Health Strategy, these efforts can be exercises in burnout for passionate food service managers working off the side of their desk by the dying light of the basement window.
The Food System Economics Commission’s 2024 Global Policy Report found that a shift from our current food systems to ones that are inclusive, health-enhancing, and sustainable “is not only possible, but could generate net economic benefits worth $5 to $10 trillion USD annually.
Across its leadership programs, health care facilities engaged with Nourish serve roughly 20 million meals annually, representing approximately 20 per cent of all hospital food served across Canada.
These facilities are engaged in projects that take a systemic approach to planetary health, marrying efforts toward values-based procurement with sustainable menu redesign and engagement with Indigenous communities.
An early majority of hospitals have signed on to the Coolfood Pledge, which pursues science-based targets to reduce the climate impact of meals served. Even more have taken Nourish’s self-directed Food is Our Medicine learning journey, exploring pathways to reconciliation that include challenging colonial biases and understanding the important connections between land, culture, and well-being that have long been practiced by Indigenous communities.
Cohort members in Nourish’s flagship two-year leadership programs are generating evidence around the cost effectiveness of bringing food to a more central place in health and healing— through savings from waste reduction, seasonal local purchasing, or shifts from animal to plant proteins.
From Labrador to Haida Gwaii and the metropolises in between, past and current Nourish cohort members are also revealing the upper limits of what is possible in the absence of deeper paradigmatic shifts.
Policies are urgently needed to protect health care food budgets, as they currently do in Ontario’s long-term care sector. Food in health care should be recognized as a critical therapeutic intervention, a catalyst for regenerative supply chains, and a longer-term strategy for preventative health. Food often lives in the ancillary services arm of the organization, with laundry and parking. But another Nourish alumni, the Saskatchewan Health Authority (SHA), recently reorganized food to the clinical support services arm of the organization, where it lives with pharmacy and diagnostic imaging. “We believe strongly that we have positioned nutrition and food services to harness its full power in healing,” says CEO Andrew Will.
More enabling conditions are also needed to deploy food procurement for long-term value creation, through policies that enable hospitals—and other public sector buyers, like universities and municipalities—to use their purchasing as an investment tool.
As many Indigenous health leaders have repeatedly reminded Canadians, the enactment of the Truth and Reconciliation Commission’s Calls to Action and the United Nations Declaration on the Rights of Indigenous People will address fundamental social and environmental parameters that are essential to achieving well-being for all.
Activating health care anchor leadership in food systems has the potential to close health disparities, relieve pressure on our overburdened health system, and position Canada as a global leader in regenerative food and health systems.
