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Lawaczeck L, Rudolph J, Norz V, Tsaur I, Rausch S. The role of planetary health in urologic oncology. Expert Rev Anticancer Ther 2024; 24:513-523. [PMID: 38709157 DOI: 10.1080/14737140.2024.2350631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Climate change and global warming are an omnipresent topic in our daily lives. Planetary health and oncology represent two critical domains within the broader spectrum of healthcare, each addressing distinct yet interconnected aspects of human well-being. We are encouraged to do our part in saving our planet. This should include the decisions we make in our professional life, especially in uro-oncology, as the healthcare sector significantly contributes to environmental pollution. AREAS COVERED There are many aspects that can be addressed in the healthcare sector in general, as there are structural problems in terms of energy consumption, water waste, therapeutic techniques, transportation and drug manufacturing, as well as in uro-oncology specific areas. For example, the use of different surgical techniques, forms of anesthesia and the use of disposable or reusable instruments, each has a different impact on our environment. The literature search was carried out using PubMed, a medical database. EXPERT OPINION We are used to making decisions based on the best outcome for patients without considering the impact that each decision can have on the environment. In the present article, we outline options and choices for a more climate-friendly approach in urologic oncology.
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Affiliation(s)
- Laura Lawaczeck
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Julia Rudolph
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Valentina Norz
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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Chatzipavlou M, Karayiannis D, Chaloulakou S, Georgakopoulou E, Poulia KA. Implementation of sustainable food service systems in hospitals to achieve current sustainability goals: A scoping review. Clin Nutr ESPEN 2024; 61:237-252. [PMID: 38777440 DOI: 10.1016/j.clnesp.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Food waste is a pivotal contributor to environmental degradation in the modern world. Vast amounts of food are wasted and many individual efforts and collective initiatives being underway to deal with this challenge. Hospitals are institutions that produce and provide food, but at the same time contribute greatly to food waste. The objective of this scoping review is to present available data regarding quantity of food waste generated in public hospitals and summarizes studies that assess and quantify the greenhouse gas emissions (carbon footprint) associated to food service management in hospitals. METHODS A systematic literature research was conducted by two qualified researchers in PubMed, Scopus, ISI Web of Science and Science Direct. The publication date was set to the last ten years, i.e., 2013-2023. All the abstracts retrieved were screened, and the eligible articles were selected after a two-step process. Abstracts from the retrieved full papers' references were also screened for eligibility. The selected papers were included in the final scoping review. RESULTS Overall, 2870 studies were identified and 69 were included in the review. Most of the studies (n = 33) assessed the causes and quantified the amount of food waste generated in hospitals. A small number of studies (5) estimated carbon dioxide equivalent (CO2-eq) produced by food waste. Although several studies suggested strategies and measures to reduce the environmental impact of foodservice operations, none of them implemented a comprehensive foodservice management system. CONCLUSION This scoping review suggests that hospital diets contribute to food waste and may have a negative environmental impact. There are several internal and external factors and practices that influence positively or negatively the sustainability of hospital food service systems. Systematic efforts are needed to identify and enhance parameters that could improve the environmental footprint of hospitals in terms of more effective management of food waste.
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Affiliation(s)
- Maria Chatzipavlou
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece
| | - Dimitrios Karayiannis
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece
| | - Stavroula Chaloulakou
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece
| | - Efthymia Georgakopoulou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, 11855 Athens, Greece
| | - Kalliopi Anna Poulia
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, 11855 Athens, Greece.
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Cook N, Porter J, Goodwin D, Collins J. Diverting Food Waste From Landfill in Exemplar Hospital Foodservices: A Qualitative Study. J Acad Nutr Diet 2024; 124:725-739. [PMID: 38142741 DOI: 10.1016/j.jand.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The US Environmental Protection Agency Food Recovery Hierarchy suggests methods for diverting food waste from landfill. Knowledge of how hospital foodservices implement food waste management strategies could help modernize food waste practices. OBJECTIVE The aim of this study was to explore hospital staff members' experiences of implementing a food waste management strategy to divert food waste from landfill in their hospital foodservice, including the journey, challenges, and facilitators of this practice change. DESIGN A qualitative study was conducted in 2022-2023 using semi-structured interviews. PARTICIPANTS/SETTING Eighteen participants were staff members with knowledge of the food waste management strategy from 14 exemplar hospitals in United States, Spain, Scotland, and Australia using strategies to divert food waste from landfill within the last 10 years. ANALYSES PERFORMED Mapping and thematic analysis were undertaken to code and identify themes from the interviews that described staff members' experiences of the journey to implement the strategy. RESULTS Six hospitals donated food, 1 transferred food waste for animal feed, 4 used an industrial solution, and 3 sent food waste for composting. A common journey pathway for successful implementation was identified from participants' experiences. It features the following 6 phases: idea, preparation, roll out, maintenance, established practice, and evolution. Facilitators included legislation, enthusiastic staff members, executive support, and "luck." Challenges were smells, occasions when food waste was not collected, equipment breakage, and funding depletion. CONCLUSIONS This study identified a common journey pathway for implementing a food waste management strategy in hospital foodservices that can be used to anticipate and prepare for the steps in the implementation process.
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Affiliation(s)
- Nathan Cook
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
| | - Judi Porter
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia; Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Denise Goodwin
- BehaviourWorks Australia Health & Social Programs, Monash University, Clayton, VIC, Australia; Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia; Eastern Health, Box Hill, VIC, Australia
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Issa R, Forbes C, Baker C, Morgan M, Womersley K, Klaber B, Mulcahy E, Stancliffe R. Sustainability is critical for future proofing the NHS. BMJ 2024; 385:e079259. [PMID: 38604667 DOI: 10.1136/bmj-2024-079259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Rita Issa
- School of Global Development, University of East Anglia, Norwich, UK
- FXB Center for Health and Human Rights, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Institute for Global Health, University College London, London, UK
| | - Callum Forbes
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Catherine Baker
- Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Matt Morgan
- Cardiff University, Cardiff, UK
- University Hospital of Wales, Cardiff, UK
- Curtin University, Perth, WA, Australia
| | - Kate Womersley
- The George Institute for Global Health at Imperial College London, London, UK
- NHS Lothian, Scotland, UK
| | - Bob Klaber
- Imperial College Healthcare NHS Trust, London, UK
- School of Public Health, Imperial College London, London, UK
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Buller M, Di Stefano J, D'Anna N, Haimovich J, Indovino A, Leeson T, Muscat C, Triskelidis A, Cook N, Porter J. Benefits, limitations and implementation issues for integrating organic foods into hospital foodservices: a systematic review. J Hum Nutr Diet 2023; 36:2234-2245. [PMID: 36562660 DOI: 10.1111/jhn.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Public institutions have the opportunity to implement environmental sustainability policies through leveraging their buying potential. Given the role of hospitals within the food system, the implementation of sustainable initiatives into hospital foodservices is a priority. Compared to conventional agricultural methods, organic food production uses more sustainable practices and warrants consideration for utilisation in hospitals. This systematic review aimed to synthesise the published literature to identify benefits, limitations and implementation issues regarding the use of organic foods in hospital foodservice settings. METHODS The review protocol was prospectively published (PROSPERO registration CRD42022322245) and reported consistent with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of four databases was undertaken for papers published from January 2000 to March 2022; key outcome data were extracted and synthesised. Study quality was assessed using the Quality Criteria Checklist for Primary Research or the Critical Appraisal Skills Programme checklist. RESULTS After review of 4102 titles/abstracts and 113 full-text papers, the final library comprised 10 papers of moderate to high quality. The implementation of organic foods increased quality in addition to environmental sustainability improvements. The price premium, additional production requirements, change to kitchen routines and concerns with food quality and security of supply were reported as barriers. Government targets for increasing organic food, organisational support, and staff knowledge and training supported implementation. CONCLUSIONS This review identified opportunities for the implementation of organic foods into hospital foodservices, but there are numerous barriers to be overcome through strategies including organisational support and staff training.
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Affiliation(s)
- Marnie Buller
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Jack Di Stefano
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Natalie D'Anna
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Julia Haimovich
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Alessia Indovino
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Taylor Leeson
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Cassie Muscat
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Ariana Triskelidis
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Nathan Cook
- Department of Nutrition, Monash University, Notting Hill, Victoria, Australia
| | - Judi Porter
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
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Aboueid S, Beyene M, Nur T. Barriers and enablers to implementing environmentally sustainable practices in healthcare: A scoping review and proposed roadmap. Healthc Manage Forum 2023; 36:405-413. [PMID: 37357691 PMCID: PMC10604425 DOI: 10.1177/08404704231183601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
This scoping review sought to identify the barriers and enablers to implementing environmentally sustainable practices in healthcare, as well as propose a multi-phased approach to enable such implementation. The three concepts guiding the search were (1) environmental sustainability; (2) healthcare; and (3) barriers or enablers. The PRISMA checklist for scoping reviews was used to guide this search. A total of 16 articles were included and reviewed for data extraction. While most articles focused on healthcare in general, dentistry and surgery were the most recurring clinical areas of focus. Barriers and enablers were related to the individual (e.g. knowledge, skills, and attitude), institutional (e.g. budget, strategy, and readiness), geographical/infrastructural (e.g. infrastructure and public awareness), political (e.g. regulations and incentives), and other (e.g. patient awareness and knowledge). A key enabler identified was having transformational leadership with a clear vision and collaborative approach.
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Affiliation(s)
| | | | - Teeyaa Nur
- University of Waterloo, Waterloo, Ontario, Canada
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Carino S, Collins J, Malekpour S, Porter J. The role of policy in supporting environmentally sustainable foodservice in healthcare: lessons from exemplar hospitals. Front Nutr 2023; 10:1122911. [PMID: 37465142 PMCID: PMC10350494 DOI: 10.3389/fnut.2023.1122911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Background Foodservice in hospitals contributes to the environmental footprint of healthcare delivery. There is little known about the role of policy in supporting environmentally sustainable foodservices. The aim of the study was to explore policy in exemplar environmentally sustainable hospital foodservices from the perspective of hospital staff, toward what makes a policy effective, the limitations of policy, and the influential levels and types of policy. Methods A generic qualitative inquiry approach was utilized. Staff involved in foodservices were interviewed about the role of policy during 2020-2021 from 14 hospitals across nine countries. Data were analyzed using framework and thematic analysis. Results Policies spanned across high level policies at the level of the healthcare organization, local hospital procedures and protocols, as well as public policy from local, state/provincial and national government. Internal organizational policy was used to embed practices within the organization in the long term and help to build a shared vision and goal where public policy had lacked guidance. The creation, content and methods of communication and creating accountability made internal organizational policy successful. Public policy was most effective when it was mandatory, had clearly defined targets and funding to assist implementation. These exemplar hospitals also demonstrated attributes of policy entrepreneurs by engaging with policy makers to share their stories and lobby government for policy change. Discussion Policy from within the healthcare organization is an important mechanism for enabling hospitals to deliver and maintain environmentally sustainable foodservice. Public policy must be designed considering the unique implementation challenges hospitals face to ensure they are successful.
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Affiliation(s)
- Stefanie Carino
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Department of Dietetics, Eastern Health, Box Hill, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Department of Dietetics, Eastern Health, Box Hill, VIC, Australia
| | - Shirin Malekpour
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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Guinto RR, Baluyot CJ, Gan CCR, Ghosh U, Mahadzir MDA. Health sector solutions for promoting sustainable and nutritious diets. BMJ 2022; 378:e071535. [PMID: 36175023 PMCID: PMC9518010 DOI: 10.1136/bmj-2022-071535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Renzo R Guinto and colleagues discuss why the health sector must embrace the planetary health approach and advocate concrete solutions for fixing the food system
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Affiliation(s)
- Renzo R Guinto
- Sunway Centre for Planetary Health, Sunway University, Selangor, Malaysia
- Planetary and Global Health Program, St Luke's Medical Center College of Medicine-William H Quasha Memorial, Quezon City, Philippines
| | - Christian Joseph Baluyot
- Planetary and Global Health Program, St Luke's Medical Center College of Medicine-William H Quasha Memorial, Quezon City, Philippines
| | - Connie C R Gan
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Upasona Ghosh
- Indian Institute of Public Health, Bhubaneswar, India
| | - M Daniel A Mahadzir
- Center for Population Health Sciences, Nanyang Technological University, Singapore
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Carino S, Collins J, Malekpour S, Porter J. Harnessing the pillars of institutions to drive environmentally sustainable hospital foodservices. Front Nutr 2022; 9:905932. [PMID: 36172519 PMCID: PMC9511788 DOI: 10.3389/fnut.2022.905932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the “sustainability phase model” from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals). Methods For this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared. Findings There was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy. Interpretation These findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.
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Affiliation(s)
- Stefanie Carino
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Dietetics Department, Eastern Health, Box Hill, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Dietetics Department, Eastern Health, Box Hill, VIC, Australia
| | - Shirin Malekpour
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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