Because farmers’ markets include a variety of fruits and vegetables, shopping at farmers’ markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers’ market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers’ markets and associations between shopping at farmers’ markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI.

Cross-sectional analyses of associations between farmers’ market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI.

Department of Social Services, Pitt County, eastern North Carolina, USA.

Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey.

Barriers to shopping at farmers’ markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers’ market shopping was associated with awareness of farmers’ markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers’ market shopping (estimate =1·06 (se 0·32), P=0·001).

Our study is one of the first to examine SNAP participants’ farmers’ market shopping, distance to farmers’ markets and dietary behaviours. Barriers to shopping at farmers’ markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants’ use of farmers’ markets, ultimately improving diet quality in this high-risk group.

To determine key points of intervention in urban food systems to improve the climate resilience, equity and healthfulness of the whole system.

The paper brings together evidence from a 3-year, Australia-based mixed-methods research project focused on climate change adaptation, cities, food systems and health. In an integrated analysis of the three research domains – encompassing the production, distribution and consumption sectors of the food chain – the paper examines the efficacy of various food subsystems (industrial, alternative commercial and civic) in achieving climate resilience and good nutrition.

Greater Western Sydney, Australia.

Primary producers, retailers and consumers in Western Sydney.

This overarching analysis of the tripartite study found that: (i) industrial food production systems can be more environmentally sustainable than alternative systems, indicating the importance of multiple food subsystems for food security; (ii) a variety of food distributors stocking healthy and sustainable items is required to ensure that these items are accessible, affordable and available to all; and (iii) it is not enough that healthy and sustainable foods are produced or sold, consumers must also want to consume them. In summary, a resilient urban food system requires that healthy and sustainable food items are produced, that consumers can attain them and that they actually wish to purchase them.

This capstone paper found that the interconnected nature of the different sectors in the food system means that to improve environmental sustainability, equity and population health outcomes, action should focus on the system as a whole and not just on any one sector.

The objective of the present study was to explore the influence of participation in community-supported agriculture (CSA) on vegetable exposure, vegetable intake during and after the CSA season, and preference related to locally produced vegetables acquired directly from CSA growers.

Quantitative surveys were administered at three time points in two harvest seasons to four groups of CSA participants: new full-paying, returning full-paying, new subsidized and returning subsidized members. Questionnaires included a vegetable frequency measure and measures of new and changed vegetable preference. Comparisons were made between new and returning CSA members and between those receiving subsidies and full-paying members.

The research was conducted in a rural county in New York, USA.

CSA members who agreed to participate in the study.

Analysis was based on 151 usable questionnaires. CSA participants reported higher intake of eleven different vegetables during the CSA season, with a sustained increase in some winter vegetables. Over half of the respondents reported trying at least one, and up to eleven, new vegetables. Sustained preferences for CSA items were reported.

While those who choose to join a CSA may be more likely to acquire new and expanded vegetable preferences than those who do not, the CSA experience has the potential to enhance vegetable exposure, augment vegetable preference and increase overall vegetable consumption. Dietary patterns encouraged through CSA participation can promote preferences and consumer demand that support local production and seasonal availability. Emphasis on fresh and fresh stored locally produced vegetables is consistent with sustainable community-based food systems.

To understand current public perceptions of in vitro meat (IVM) in light of its potential to be a more environmentally sustainable alternative to conventional meat.

A qualitative content analysis of the comments made on online news articles highlighting the development of IVM and the world’s first IVM hamburger in August 2013.

News article comment sections across seven US-based online news sources (The New York Times, The Los Angeles Times, The Washington Post, The Wall Street Journal, USA Today, Cable News Network and National Public Radio).

Four hundred and sixty-two commenters who made eight hundred and fourteen publicly available online comments addressing IVM.

Key themes in commenter perceptions of IVM included environmental and public health benefits, but also negative themes such as IVM’s status as an unnatural and unappealing food. Overall, the tone of comments was more negative than positive.

Findings suggest that while the environmental and public health motivations for developing and in turn consuming IVM resonate with some segments of the population, others find that reasoning both uncompelling and problematic. Concerns about IVM as an unnatural and risky product also appear to be a significant barrier to public acceptance of IVM. Supporters of IVM may wish to begin to develop a regulatory strategy for IVM to build public trust and explore messaging strategies that cast IVM as a new technology with benefits to individuals rather than primarily a solution to global challenges. Those in the public health nutrition field can make an important contribution to the emerging public discussion about IVM.

In life-cycle assessment, the functional unit defines the unit for calculation of environmental indicators. The objective of the present study was to assess the influence of two functional units, 100 g and 100 kcal (420 kJ), on the associations between three dimensions for identifying sustainable foods, namely environmental impact (via greenhouse gas emissions (GHGE)), nutritional quality (using two distinct nutrient profiling systems) and price.

GHGE and price data were collected for individual foods, and were each expressed per 100 g and per 100 kcal. Two nutrient profiling models, SAIN,LIM and UK Ofcom, were used to assess foods’ nutritional quality. Spearman correlations were used to assess associations between variables. Sustainable foods were identified as those having more favourable values for all three dimensions.

The French Individual and National Dietary Survey (INCA2), 2006–2007.

Three hundred and seventy-three foods highly consumed in INCA2, covering 65 % of total energy intake of adult participants.

When GHGE and price were expressed per 100 g, low-GHGE foods had a lower price and higher SAIN,LIM and Ofcom scores (r=0·59, −0·34 and −0·43, respectively), suggesting a compatibility between the three dimensions; 101 and 100 sustainable foods were identified with SAIN,LIM and Ofcom, respectively. When GHGE and price were expressed per 100 kcal, low-GHGE foods had a lower price but also lower SAIN,LIM and Ofcom scores (r=0·67, 0·51 and 0·47, respectively), suggesting that more environment-friendly foods were less expensive but also less healthy; thirty-four sustainable foods were identified with both SAIN,LIM and Ofcom.

The choice of functional unit strongly influenced the compatibility between the sustainability dimensions and the identification of sustainable foods.

To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools.

The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food.

Vancouver, Canada.

A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education.

Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus.

More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

Higher intakes of red and processed meat are associated with poorer health outcomes and negative environmental impacts. Drawing upon a population survey the present paper investigates meat consumption behaviours, exploring perceived impacts for human health, animal welfare and the environment.

Structured self-completion postal survey relating to red and processed meat, capturing data on attitudes, sustainable meat purchasing behaviour, red and processed meat intake, plus sociodemographic characteristics of respondents.

Urban and rural districts of Nottinghamshire, East Midlands, UK, drawn from the electoral register.

UK adults (n 842) aged 18–91 years, 497 females and 345 males, representing a 35·6 % response rate from 2500 randomly selected residents.

Women were significantly more likely (P<0·01) to consume≤1 portion of meat/d compared with men. Females and older respondents (>60 years) were more likely to hold positive attitudes towards animal welfare (P<0·01). Less than a fifth (18·4 %) of the sample agreed that the impact of climate change could be reduced by consuming less meat, dairy products and eggs. Positive attitudes towards animal welfare were associated with consuming less meat and a greater frequency of ‘higher welfare’ meat purchases.

Human health and animal welfare are more common motivations to avoid red and processed meat than environmental sustainability. Policy makers, nutritionists and health professionals need to increase the public’s awareness of the environmental impact of eating red and processed meat. A first step could be to ensure that dietary guidelines integrate the nutritional, animal welfare and environmental components of sustainable diets.

School garden programmes have become popular action-oriented learning environments in many countries, often driven by converging priorities of environmental sustainability and healthful diets. Many of these programmes have assessed the impact on dietary intake, specifically fruit and vegetable intake, and related dietary behaviours, such as knowledge, preference, motivation, intention and self-efficacy to eat and prepare fruit and vegetables. The objective of the present study was twofold: (i) to review published garden-based programmes conducted in schools targeting dietary intake and/or determinants of dietary behaviour in children; and (ii) to identify similar strategies and components employed by these garden-based programmes.

The review included thirteen studies that have examined the impact of garden-based programmes conducted in school, either during school hours or in after-school settings, on dietary behaviours in children (kindergarten through 8th grade students).

Three of the reviewed studies did not have a comparison or control group and simply evaluated within-group changes after a garden intervention. None of the reviewed studies were randomized, but were assigned based on school’s interest and timing of new school gardens being built. Out of the eleven programmes that examined dietary intake, six found that the programme resulted in increased vegetable intake, whereas four showed no effect. Seven of the eight studies that measured preference found that the programmes resulted in increased preference for vegetables. Gardening programmes also resulted in improved attitudes towards, willingness to taste, identification of and self-efficacy to prepare/cook fruit and vegetables. Similar strategies/components employed by the majority of the programmes included: ‘hands on’ curriculum, incorporation of a cooking component, providing the instructors, parental and stakeholder support, food provision and using the garden as the focal point for media promotion.

Some of the garden programmes resulted in increased vegetable intake, which has positive implications for both environment sustainability and health-related outcomes. Further, the majority resulted in some improvement in behaviour determinants more generally. However, more research is warranted to understand how to achieve long-term improvements in dietary behaviours and how to sustain the garden-based programmes in schools.

To position the concept of sustainability within the context of food security.

An overview of the interrelationships between food security and sustainability based on a non-systematic literature review and informed discussions based principally on a quasi-historical approach from meetings and reports.

International and global food security and nutrition.

The Rome Declaration on World Food Security in 1996 defined its three basic dimensions as: availability, accessibility and utilization, with a focus on nutritional well-being. It also stressed the importance of sustainable management of natural resources and the elimination of unsustainable patterns of food consumption and production. In 2009, at the World Summit on Food Security, the concept of stability/vulnerability was added as the short-term time indicator of the ability of food systems to withstand shocks, whether natural or man-made, as part of the Five Rome Principles for Sustainable Global Food Security. More recently, intergovernmental processes have emphasized the importance of sustainability to preserve the environment, natural resources and agro-ecosystems (and thus the overlying social system), as well as the importance of food security as part of sustainability and vice versa.

Sustainability should be considered as part of the long-term time dimension in the assessment of food security. From such a perspective the concept of sustainable diets can play a key role as a goal and a way of maintaining nutritional well-being and health, while ensuring the sustainability for future food security. Without integrating sustainability as an explicit (fifth?) dimension of food security, today’s policies and programmes could become the very cause of increased food insecurity in the future.

The development of food policy is strongly influenced by the understanding and position actors adopt in their ‘framing’ of sustainability. The Australian Government developed a National Food Plan (2010–2013). In public consultations on the National Food Plan Green Paper, the government sought stakeholders’ views on sustainability. The present study examined the way in which the food industry and civil society organizations framed sustainability in their submissions to the Green Paper.

Submissions by food industry actors and civil society organizations were analysed using a framing matrix that examined positioning, drivers, underlying principles and policy solutions related to sustainability. Submissions were open coded and subsequently organized based on themes within the framing matrix.

Australia.

One hundred and twenty-four written submissions (1420 pages).

While submissions from industry and civil society organizations often framed sustainability similarly, there were also major differences. Civil society organizations were more likely to make the link between the food supply and population health, while industry was more likely to focus on economic sustainability. Both viewed consumer demand as a driver of sustainability, welcomed the idea of a whole-of-government approach and stressed the need for investment in research and development to improve productivity and sustainable farming practices.

The meaning of sustainability shifted throughout the policy process. There are opportunities for creating shared value in food policy, where the health, environment and economic dimensions of sustainability can be compatible. However, despite pockets of optimism there is a need for a shared vision of sustainability if Australia is to have a food policy integrating these dimensions.

The Balanced Menus Challenge (BMC) is a national effort to bring the healthiest, most sustainably produced meat available into health-care settings to preserve antibiotic effectiveness and promote good nutrition. The present study evaluated the outcomes of the BMC in the Maryland/Washington, DC region.

The BMC is a cost-effective programme whereby participating hospitals reduce meat purchases by 20 % of their budget, then invest the savings into purchasing sustainably produced meat. A mixed-methods retrospective assessment was conducted to assess (i) utilization of the BMC ‘implementation toolkit’ and (ii) achievement of the 20 % reduction in meat purchases. Previous survey data were reviewed and semi-structured interviews were conducted.

Hospitals located in the Maryland/Washington, DC region, USA, that adopted the BMC.

Twelve hospitals signed the BMC in the Maryland/Washington, DC region and six were available for interview.

Three hospitals in the Maryland/Washington, DC region that signed the BMC tracked their progress and two achieved a reduction in meat procurement by ≥20 %. One hospital demonstrated that the final outcome goal of switching to a local and sustainable source for meat is possible to achieve, at least for a portion of the meal budget. The three hospitals that reduced meat purchases also received and used the highest number of BMC implementation tools. There was a positive correlation between receipt and usage of implementation tools (r=0·93, P=0·005).

The study demonstrates that hospitals in the Maryland/Washington, DC region that sign the BMC can increase the amount of sustainably produced meat purchased and served.

To evaluate the greenhouse gas emission (GHGE) of diets in Dutch girls, boys, women and men and to explore associations with diet composition.

Descriptive analyses for the total population as well as stratified for gender, age and dietary environmental load.

The Netherlands.

Dutch children and adults aged 7–69 years (n 3818).

The GHGE of daily diets was on average 3·2 kg CO2-equivalents (CO2e) for girls, 3·6 kg CO2e for boys, 3·7 kg CO2e for women and 4·8 kg CO2e for men. Meat and cheese contributed about 40 % and drinks (including milk and alcoholic drinks) 20 % to daily GHGE. Considerable differences in environmental loads of diets existed within age and gender groups. Persons with higher-GHGE diets consumed more (in quantity of foods and especially drinks) than their counterparts of a similar sex and age with low-GHGE diets. Major differences between high- and low-GHGE diets were in meat, cheese and dairy consumption as well as in soft drinks (girls, boys and women) and alcoholic drinks (men). Of those, differences in meat consumption determined the differences in GHGE most. Diets with higher GHGE were associated with higher saturated fat intake and lower fibre intake

GHGE of daily diets in the Netherlands is between 3 and 5 kg CO2e, with considerable differences between individuals. Meat, dairy and drinks contribute most to GHGE. The insights of the study may be used in developing (age- and gender-specific) food-based dietary guidelines that take into account both health and sustainability aspects.

To describe how Indigenous Peoples understand how to enhance use of their food systems to promote sustainability, as demonstrated in several food-based interventions.

Comments contributed by partners from case studies of Indigenous Peoples and their food systems attending an international meeting were implemented with public health interventions at the community level in nine countries.

The Rockefeller Foundation Bellagio Conference Center in Bellagio, Italy, where experiences from case studies of Indigenous Peoples were considered and then conducted in their home communities in rural areas.

Leaders of the Indigenous Peoples’ case studies, their communities and their academic partners.

Reported strategies on how to improve use of local food systems in case study communities of Indigenous Peoples.

Indigenous Peoples’ reflections on their local food systems should be encouraged and acted upon to protect and promote sustainability of the cultures and ecosystems that derive their food systems. Promoting use of local traditional food biodiversity is an essential driver of food system sustainability for Indigenous Peoples, and contributes to global consciousness for protecting food biodiversity and food system sustainability more broadly. Key lessons learned, key messages and good practices for nutrition and public health practitioners and policy makers are given.

To compare the use of water, energy, pesticides and fertilizer to produce commodities for two dietary patterns that vary in the content of plant and animal products.

A unique analysis using ‘real-world’ data was performed, in contrast to previous analyses which applied simulated data. Consumption data from the Adventist Health Study were used to identify two dietary patterns with a markedly different consumption of several plant and animal products. State agricultural data were collected and applied to commodity production statistics. Indices were created to allow a comparison of the resource requirements for each dietary pattern.

California, USA.

None.

The diet containing more animal products required an additional 10 252 litres of water, 9910 kJ of energy, 186 g of fertilizer and 6 g of pesticides per week in comparison to the diet containing less animal products. The greatest contribution to the difference came from the consumption of animal products, particularly beef.

Consuming a more plant-based diet could to an extent alleviate the negative environmental impacts related to food production. As a method to feed ourselves more sustainably, behavioural adjustments appear to be a very important tool.

To present one of the first national dietary guidelines that incorporates food sustainability principles into its public health recommendations.

The paper outlines recommendations and utilizes an ecological framework of policy analysis to examine context, drivers, consequences and future suggestions in establishing and maintaining sustainability principles within the Qatar Dietary Guidelines.

Qatar.

Population of Qatar.

Qatar has produced one of the first national dietary guidelines to integrate principles of food sustainability. National interest in environmental sustainability and food security, population concern over food waste (reinforced by Islamic religious law), strong authority of the Supreme Council of Health (supported by an Emirate government), a small domestic food industry and a lack of food industry influence on the guidelines have contributed to the inclusion of sustainability principles within the document.

Whether these principles will be embraced or rejected by the population in the long term will likely be determined by the Dietary Guidelines Task Force and the Supreme Council of Health’s commitment to educating the population about the relevance and importance of these principles and establishing champions to advocate for them.