INTRODUCTION AND GLOBAL PERSPECTIVE
The earth is warming rapidly because of increased greenhouse gas (GhG) emissions, whereas the rising air and ocean temperatures in the Arctic and Antarctica are responsible for the increasing ice loss, resulting in sea level rise. This process often is characterized as earth’s energy imbalance, and climate scientists are calling on all of us to help reduce GhG emissions to protect young people, future generations, and nature (25,28).
Climate-related extremes, such as heat waves, droughts, wildfires, or storms, have already increased across the past decades and show disruption of infrastructures such as food production and water supply with risk to human well-being and even ecosystem stability (28). Furthermore, there will be considerable inequity to those affected, especially from lower socioeconomic status, and geographical regions most exposed (coastal regions and developing nations) are likely the most vulnerable (28). Recognizing the rise in population growth, current trends in hunger and malnutrition in the developing world, and food insecurity and obesity in developed nations, it is clear that climate change probably is the biggest global health threat of the 21st century (7).
As health professionals, we are concerned about the enormous economic cost of the current trends in obesity and related chronic diseases. Is earth’s energy imbalance associated with the energy imbalance of its people? From a health professional’s point of view, we must recognize this crossroad. Although we act interdisciplinarily within our fields, we need to consider the bigger picture — the link between the health of the people and the planet. Where is the connection between the food we eat, our health, and sustainability?
WHAT IS SUSTAINABILITY?
Most commonly, sustainability is defined as “meeting the needs of the present generation without compromising the ability of future generations to meet their needs (42). Sustainable development and resilience are two terms often used to describe more contemporary and dynamic phenomena that may imply a paradigm shift or adaptation to a new situation (see Table 1 for definitions). Sustainable development often also is expressed by the three Es that stand for Environment, Economy, and Equity. Theoretically, these key fields all are important to consider when addressing sustainability; however, there exists considerable debate how this is achievable on a global level (32).
How would you define sustainability and what does it mean in an applied sense, especially related to the health professions and on a local rather than a global level?
A good entry point may be this example. Visualize a community that incorporates easy access to services, such as city parks and open space for leisure and sports surrounded by walkable neighborhoods, including businesses and grocery stores, schools with school gardens, a hospital, food bank and pantry, an urban farm, post office, and a year-round farmer’s market. Ideally, this community also uses alternative energy such as solar and wind.
This community meets the three Es:
- Environment: through establishment of various ecosystems, enhancing biodiversity and natural beauty in an urban setting.
- Equity: through access to physical activity, healthy and secure food, and a social network.
- Economy: through local businesses and promoting to keep dollars in the community.
From this example, we quickly connect the dots and see that such a sustainably developed community also facilitates health-promoting behaviors. Unfortunately today, such environments still are rare and inaccessible or not affordable to everyone. A further issue is that the connection between sustainability and health is not clear and, thus, these topics are tackled separately — locally, city planners may work with ecologists but forget about the health professional who focuses on the built environment inviting citizens to walk, run, and bike. Likewise, health promotion initiatives often fail to include sustainability. For example, health and fitness events, held in the city, may fail to address local food sourcing or waste and recycling. In schools, sustainability is only sparsely integrated, if at all, and health sciences students, including nutrition students, often lag behind those in environmental sciences in knowledge and skill pertaining to sustainable food systems. Finally, in sport nutrition, performance-based menus often lack the integration of sustainable choices, considerations of local farms, or discussions surrounding meat as a choice. In these examples, important links are missed and so are the leveraging opportunities of health and sustainability, had these two fields been integrated.
When we look at our food system, it becomes apparent how we literally have distanced ourselves, our families, students, clients, and patients from good food grown close to us, thereby losing the story of where food comes from, food traditions and culture, farming and gardening, a biodiverse ecosystem with crop varieties unique to the area, and sharing pleasures of cooking and eating together. Wendell Berry said it correctly that “Eating is an agricultural act” (5) and, thus, without local food production, “eaters” become ever more alienated from agriculture, losing an important connection to land, people, animals, and an intact health-promoting ecosystem. Likewise, we must realize that obesity cannot be viewed simply as a health sector issue but must be related back to agriculture and the food we grow and eat today (27,41).
Recently, the Food and Agriculture Organization of the United Nations defined a sustainable diet as follows: “A diet with low environmental impacts, which contributes to food and nutrition security and to healthy life for present and future generations. A sustainable food system is protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable, nutritionally adequate, safe and healthy, while optimizing natural and human resources”(17).
Currently, there are few countries that have adopted sustainable food principles into governmental nutrition recommendations. Some of the best examples are the Mediterranean diet (2), the Health Council of the Netherlands (26), and the New Nordic Diet (37).
ENVIRONMENTAL IMPACT OF FOOD
Although many factors contribute to GhG emissions (e.g., transportation, industries), the current food system accounts for 10% to 14% of global emissions. When deforestation is added, the numbers creep up to nearly 30% (44). Depending on the country, livestock production is estimated to account for up to 51% of global GhG emissions (18). Thus, industrialized agriculture, while highly efficient, now contributes heavily to Earth’s energy imbalance.
Agriculture contributes to GhG emissions through preproduction (e.g., fertilizer, pesticide, herbicide manufacture, energy use in feed production), production (direct emissions of agriculture, including carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) and indirect from deforestation), and postproduction (processing, transport, refrigeration, cooking, waste); however, the total impact varies by region and country. Direct emissions from soil (N2O), enteric fermentation and manure (CH4), biomass burning, and rice production (CH4) and indirect from deforestation are the most burdensome (44). GhGs also differ in global-warming potential. For example, warming potential for CH4 is 72 times greater when quantified over the next 20-year time span than that of CO2 (28). Thus, short-term strategies, including those of a sustainable diet and waste recovery, targeting CH4, are gaining more in-depth attention as a low-hanging fruit.
Considering the projected population growth to 9 billion people by 2045, global food demands are expected to rise an additional 60% (16). Logically, this will result in higher food production and greater emissions for decades to come. Besides emissions, further environmental impacts of intensive agriculture include land and water use, loss of biodiversity, and pollution of waterways.
There are at least four environmental hotspots related to our food system that burden planet Earth, and these are discussed below. Taking action related to these four hotspots appears no longer a choice but a necessity. How we tackle these hotspots is entirely up to us (at least for now), especially if we want to safeguard long-term ecological sustainability, satisfy basic human needs, and promote cross-generational equity, good health, and longevity.
Hotspot 1: Meat
The largest environmental impact from the industrialized food system stems from meat, which accounts for about 20% of global GhG emissions and requires high water inputs. Livestock-based food production also can contribute to displacing biodiversity because of land clearing (12). The most polluting part of livestock production is its feed (e.g., corn), which is accompanied by expanding needs for more land using large inputs of fossil fuel. Meat production’s impact on the environment is well documented (6,10,41), and scientists also are addressing animal and human welfare (8,9), antibiotic use (29), and water pollution from runoffs (38) and leaching fertilizer (40).
Recent research has examined livestock production and its effects on GhG emissions, water, and land use (12). Compared with plant staples (potatoes, rice, wheat), U.S. beef production requires 160 times more land and 8 times more irrigation water for feed while emitting 11 times more GhG and 19 times more N2O compared with nonbeef categories. Although pork, poultry, eggs, and dairy fare better, they too require substantially more land and water, with greater emissions than plant staples. Although dairy products need less input and emit less than beef, dairy is not necessarily cleaner than nonbeef animal sources. When feed is converted to food (kcal) and protein (g), 35 to 45 kcal are needed to produce 1 kcal of beef (compared with 2 kcal input for 1 kcal of plant protein). Per gram of protein, GhG emissions are 250 times greater for ruminants compared with plant protein from legumes. As expected, eggs, dairy, poultry, and pork exceed GhG emissions compared with plant protein from legumes, but they all have much lower emissions than ruminants (41).
Two questions arise. Is eating from the nonbeef category a better choice? Yes and No. Eating poultry, pork, eggs, or dairy leads to lower emissions and a decrease in land use than eating beef. However, industrial production of poultry or pork similarly questions animal welfare, water pollution, and health impacts on animal and people (e.g., antibiotics) and, thus, simply switching to these protein options without considering overall quantity and production method, while not replacing protein calories with nutrient-dense alternatives, such as fruit, vegetables, grains, or legumes, will not be a straightforward solution.
Furthermore, is sustainable meat production, such as grass-fed beef (and dairy), a better choice? Certainly, pasture-fed meat (and dairy) production may well be part of an intact ecosystem or in areas where crop production is limited because of topographical issues. Furthermore, such production systems also promote a better-quality product and reduce food insecurity (11). However, GhG emissions and land use are still of concern, especially if the aim was to meet current and projected meat demands using sustainable production.
Considering the rise in meat consumption patterns across the world, including the United States and European countries, with a per capita intake often exceeding 200 lbs per year (13), and many Asian countries increasing meat consumption, the first approach should be to eat less meat (and other animal products). According to a recent study, cutting meat, dairy, and egg intake by 50% would achieve a 40% reduction in N2O emissions, a 25% to 40% reduction in GhG, and a 23% per capita reduction in cropland use that could be cultivated for food rather than feed (45). In addition, reducing intake also would benefit health, especially cardiovascular health and diabetes (20,45,41), promote weight loss (4), and reduce all-cause morbidity and mortality (39,41). Lower meat consumption would still enable athletes and active individuals to meet their protein needs, especially if meat calories were replaced by a plant-based equivalent (e.g., beans, grains, nuts).
For solutions to eating less meat and associated tricks to keeping balance on the plate and resources, see Tables 2 and 3.
Hotspot 2: Fish
Environmental impacts of dietary choices vary across food groups and changes are needed across multiple sectors. In the past 50 years, fish consumption per capita nearly doubled (20). Two thirds of the world’s fish consumption occurs in Asia, with the highest consumption in China. Similar to China, in Europe, the United States, and Australia, fish consumption exceeds 44 lbs per capita per year and nearly 50% of this fish supply comes from aquacultures. Despite the fact that sustainable practices in aquacultures are rising, there still are considerable issues related to traditional nonrecirculating aquacultures, including high GhG emissions and adverse health effects (41). Currently, the supply of sustainably farmed or wild caught fish is inadequate to meet consumer demand without leaving deep environmental marks (19).
Water contamination (eutrophication) from industries, including agriculture, and overfishing practices, with consequential marine stock exploitation, have put seafood resources and fishing livelihoods at risk and question the viability of marine life worldwide. Of available fish stock today, 80% are fully exploited or overexploited, requiring careful management (19). Major environmental groups are calling on consumers to eat less fish and purchase fish caught using sustainable practices (these also reduce GhG) while awaiting cleaner technologies of aquacultures to meet rising demands of fish. Further disruption of ocean ecosystems is inevitable, considering rising levels of CO2, which will lead to further loss of marine zones and biodiversity and eventually irreversible changes in commercially available fish stock (19).
Eating less fish, fish lower on the food chain (e.g., smaller fish), and choosing from consumer guides such as the World Seafood Watch may be the only way to save our oceans. The developed world consumes a lot more fish than those who depend on it for protein (e.g., coastal regions). Per capita fish consumption in Sub-Saharan Africa has not changed in the last three decades (19) most likely caused by increased exports to meet the demand of the developed world. Fish has become the food of the rich, whereas various organizational and national nutrition guidelines continue to push for multiple servings of fish per week, despite the issue of dwindling supply. There is no better example to illustrate the disconnect between health and sustainability than with the case of fish.
How much fish is really needed for health and does a sustainable option exist in the absence of reducing overall intake? Research shows that 250 mg of omega-3 fatty acids is needed to favor cardiovascular health (34). This amount of fish oil is found in one serving of oily fish. Thus, eating more than one serving of fish per week may not be needed. With the current state of marine ecosystems, consumers are asked not to eat more fish (26). In addition, using guides for sustainable fish is valuable and replacing fish with alternative sources of essential fatty acids also may offer some benefit. Recent data point to wild plants, berries, seeds, and nuts (1).
For solutions to eating less fish and resources, see Tables 2 and 3.
Hotspot 3: Biodiversity
Of edible plant varieties, 75% have been lost irreversibly in the last century (14). Today, 60% of our energy (kcals) is supplied by the world’s main crops: wheat, rice, and corn. It is estimated that, of the 10,000 plant species once supplying the nutrients of our diets, 75% of what we eat today is generated from 12 plants and 5 animal species. Loss of biodiversity means loss of diet quality, which increases the risk of micronutrient deficiencies, as limited plant varieties no longer provide the nutritional profile (27,46). The industrialized food system has altered nutritional diversity while it added unwanted chemicals (3). Thus, to understand food’s contribution to dietary variety, how, when, and where it was grown need to be considered. Relying on a few crops to meet the nutrient needs of people is short sighted because dietary variety has long been recognized to boost human health (17).
Biodiversity provides the building blocks of a working ecosystem and contributes to local livelihoods. One of the best examples of a fragile food system is the example of the Irish Potato Famine in 1845 that led to starvation and deaths because only one variety of potatoes was planted. This potato was affected by a fungus and resulted in crop loss for years. Loss of biodiversity may mean reduced pest resistance, food insecurity, and hunger, as well as loss of cultural diversity. Ultimately, human health depends on biodiversity and should be viewed as its foundation and, thus, conservation, while a global priority (17), should link to the local community (e.g., reawakening the biodiversity of a regional and local food system).
There are many factors responsible for biodiversity loss. One of the biggest threats is the conversion of natural habitats, rich in animal and plant life, to uniform monocultures. Monocultures (e.g., wheat, corn, soy, rice) are typical in today’s industrialized agriculture and especially found in intensive farming systems. This production usually occurs with large areas of land use and heavy inputs. In the United States, less than 1% of agricultural land is cultivated using certified organic methods and, thus, the majority of U.S. farmland grows crops using conventional means (43). Intense farming systems use agrochemicals, which affect pollinators necessary to maintain an intact ecosystem and to supply food to people. The recent declines in bee populations have affected pollination greatly (17), especially in pollinator-dependent crops, ultimately leading to a decline in yields (21). Conventional farming systems also are characterized by reduced soil quality (nutrient density) and biodiversity, greater erosion leading to increased N2O emissions, and leaching of synthetic fertilizers into waterways, causing pollution and loss of further ecosystems (40). Thus, biodiversity needs to become valued, conserved, restored, and carefully used so that ecosystem services can be provided more sustainably to both the planet and its people (17). For solutions to this problem and resources, see Tables 2 and 3.
Hotspot 4: Waste
Americans waste up to 40% of their food, equal to about 220 lbs of food per capita per year (35). This compares with a 30% food waste in Europe. In developing countries, food waste is much less and mostly pertains to preconsumer loss (e.g., lack of cold storage). In developed nations, food waste mainly occurs through postconsumer losses. Of these losses, 50% to 60% occur in households. Data show the greatest losses occur in fresh produce and fish, followed by grains, meat, and milk (15).
Reasons for food waste in developed countries include:
- food is cheap
- lack of value and connection
- bulk buying at reduced price
- lack of planning
- expiration dates
Considering the costly inputs for food production, it seems that there would be enough food for everyone if waste was reduced, distribution was improved, and access was increased, even in the presence of a growing population (30). Food waste, as it turns into garbage (not compost), represents the second highest waste source in U.S. landfills and accounts for 23% of U.S. CH4 emissions (35). Minimizing food waste going to landfill is considered one of the lowest-hanging fruit to decrease GhG emissions. In addition, if this waste instead is redirected to feed the many millions of hungry and food-insecure people or it is recycled in compost and reused in agriculture, both planet and people will profit. While waste is of global scale, solutions often originate at the local level. Food rescue groups, waste recovery restaurants, and community composting programs are only a few examples that contribute to sustainable solutions, and many strategies start at home. For solutions to this problem and resources, see Tables 2 and 3.
Applications for the Health Professional
Health and an active life with good food are more than the absence of disease. Through a better socioecological understanding of health promotion and sustainability (23,31), health professionals are able to offer their clients and patients a refreshed look at their lifestyles in the context of daily choices, and here with focus on food. Bringing health and sustainability together enables both and constrains neither (31,33). To understand these two concepts, their relationships for fostering a healthy and sustainable future, is key (36). Most importantly, by addressing both, like integrating sustainable food options into a worksite wellness program or an elite sports team, reducing the amount of bottled beverages at a gym, or considering fad diets using an ecological perspective, their cobenefits can be leveraged with the result of being healthier in a more sustainable world. In addition, enhancing such changes through education (e.g., newsletters, guides for sustainable shopping, recipes) with tastings brings the message home while social media supports its mobility and continuity, and these strategies deepen the meaning, which ultimately propagate beyond the gym. For becoming health professionals, including dietitians, curricula should be modified and include sustainability in the context of health. However, to accomplish this paradigm shift, creativity and a vision for the future, including innovative programs that teach people about food and the link to agriculture, are needed. It will require that practitioners reflect on their own values, political views, and an openness to change in response (24).
Table 3 shows simple steps toward sustainable dietary choices and Table 4 provides various case examples that illustrate the integration of these concepts in the practical setting of health and fitness professionals.
The industrialized food system accounts for up to 30% of global GhG emissions and contributes to loss of land and biodiversity, an overexploited marine ecosystem, and high amounts of food waste. Whereas many production pathways must become more sustainable, “engaged eaters” also can make an impact on the four environmental hotspots — meat, fish, biodiversity, and waste — that have a significant effect on the three Es of sustainability, environment, economy, and equity.
Integrating sustainability into the health professions, while presenting challenges at first, promises opportunities for innovative educational approaches and community engagement. Besides making better choices for home and family, health professionals may address sustainability in various other areas, including their gym’s refueling bar, product purchasing, or special events. Providing students in the health professions experiential and service learning opportunities linked to a sustainable food system gives rise to new connections, including a revitalized curriculum that is integrative, ecological, ethical, creative, reflective, and beautiful (24).
BRIDGING THE GAP
The industrialized food system accounts for up to 30% of global greenhouse gas emissions and impacts on soil and food quality, food safety, terrestrial and aquatic biodiversity and ecosystems, and human health. Paradoxically, 30% to 40% of food is wasted. Food insecurity, along with obesity and chronic disease, in the face of population growth and climate change, is creating great challenges to both agriculture and health sectors. Although these issues are global in scale and overwhelmingly challenging to solve, health professionals need to learn about concepts of sustainability, including related issues of our food system, and tackle health-promoting services by integrating such concepts on the local level. Although full of difficult questions to answer and barriers to overcome, addressing a sustainable diet in the context of good health awakens a socioecological understanding of eating and this gives rise to new opportunities.
1. Abedi E, Sahari MA. Long-chain polyunsaturated fatty acid sources and evaluation of their nutritional and functional properties. Food Sci Nutr. 2014; 2 (5): 443–63.
2. Back-Faig A, Berry EM, Lairon D, et al Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011; 14 (12A): 2274–84.
3. Barański M, Srednicka-Tober D, Volakakis N, et al Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: a systematic literature review and meta-analyses. Br J Nutr. 2014; 112 (5): 794–811.
4. Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. Jan 17. pii: S2212-2672(14)01763-8. doi: 10.1016/j.jand.2014.11.016.
5. Berry W. Pleasures of eating. In: What Are People For? Wendell Barry. 1990.
6. Bouwman L, Goldewijk KK, Van Der Hoek KW, et al Exploring global changes in nitrogen and phosphorus cycles in agriculture induced by livestock production over the 1900–2050 period. Proc Natl Acad Sci U S A. 2013; 110: 20882–7.
7. Costello A, Abbas M, Allen A, et al Managing the health effects of climate change. Lancet. 2009; 373: 1693–733.
8. Deckers J. Should the consumption of farmed animal products be restricted and if so by how much? Food Policy. 2010; 35: 497–503.
9. Deckers J. What policy should be adopted to curtail the negative global health impacts associated with the consumption of farmed animal products? Res Publica. 2010; 16: 57–72.
10. De Vries M, de Boer IJM. Comparing environmental impacts for livestock products: a review of life cycle assessments. Livestock Sci. 2010; 128: 1–11.
11. Eisler MC, Lee MR, Tarlton JF, et al Agriculture: steps to sustainable livestock. Nature. 2014; 507 (7490): 32–4.
12. Eshel G, Shepon A, Makov T, Milo R. Land, irrigation water, greenhouse gas, and reactive nitrogen burdens of meat, eggs, and dairy production in the United States. Proc Natl Acad Sci U S A. 2014;19: 111 (33): 1196–2001.
13. Food and Agriculture Organization. Worldwide Annual Meat Consumption per Capita 2011. Food Supply, Livestock and Fish Primary Equivalent, Meat. Food Supply Quantity (kg/capita/yr). Rome (IT): Food and Agriculture Organization of the United Nations; 2014 [cited 2015 Jan]. Available from: http://faostat3.fao.org/faostat-gateway/go/to/download/FB/CL/S
14. Food and Agriculture Organization. What Is Agrobiodiversity? Rome (IT): Food and Agriculture Organization of the United Nations; 1999 [cited 2014 Sept 2]. Available from: http://www.fao.org/docrep/007/y5609e/y5609e02.htm
15. Food and Agriculture Organization. Global Food Losses and Food Waste — Extent, Causes and Prevention. Rome (IT): Technical Report Food and Agriculture Organization of the United Nations; 2011 [cited 2014 Sept 2]. Available from: http://www.fao.org/docrep/014/mb060e/mb060e00.pdf
16. Food and Agriculture Organization. World Agriculture Towards 2030/2050: The 2012 Revision. ESA Working paper no. 12-03. Rome (IT): Food and Agriculture Organization of the United Nations; 2012 [cited 2014 Sept 2]. Available from: http://www.fao.org/docrep/016/ap106e/ap106e.pdf
17. Food and Agriculture Organization. Sustainable Diets and Biodiversity. Rome (IT): Food and Agriculture Organization of the United Nations; 2012 [cited 2014 Sept 1]. 83 p. Available from: http://www.fao.org/docrep/016/i3004e/i3004e.pdf
18. Food and Agriculture Organization. Tackling Climate Change Through Livestock — A Global Assessment of Emissions and Mitigation Opportunities. Rome (IT): Technical Report Food and Agriculture Organization of the United Nations, 2013 [cited 2014 Sept 2]. Available from: http://www.fao.org/docrep/018/i3437e/i3437e.pdf
19. Food and Agriculture Organization. The State of World Fisheries and Aquaculture: Opportunities and Challenges. 14. Rome (IT): Technical Report Food and Agriculture Organization of the United Nations; 2014 [cited 2014 Sept 1]. Available from: http://www.fao.org/fishery/publications/sofia/en
20. Friel S, Dangour AD, Garnett T, et al Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture. Lancet. 2009; 374: 2016–25.
21. Garibaldi LA, Aizen MA, Klein AM, Cunningham SA, Harder LD. Global growth and stability of agricultural yield decrease with pollinator dependence. Proc Natl Acad Sci U S A. 2011; 108 (14): 5909–14.
22. Garnett T. Changing what we eat. A call for research & action on widespread adoption of sustainable healthy eating. Report by Food Climate Research Network, June, 2014 [cited 2015 Feb 1]. Available from: http://www.fcrn.org.uk/fcrn/publications/new-fcrn-report-changing-what-we-eat-call-research-action-widespread-adoption-sust
23. Hancock T. Health care reform and reform for health: creating a health system for communities in the 21st century. Futures. 1999; 31: 417–47.
24. Hanlon P, Carlisle S, Hannah M, Lyon A, Reilly D. A perspective on the future of public health: an integrative and ecological framework. Perspect Publ Health. 2012; 132: 313–9.
25. Hansen J, Kharecha P, Sato M, et al Assessing “Dangerous Climate Change”: required reduction of carbon emissions to protect young people, future generations and nature. PLoS One. 2013; 8 (12): e81648.
26. Health Council of the Netherlands. Guidelines for a Healthy Diet: The Ecological Perspective. Publication no. 2011/08E. The Hague: Health Council of the Netherlands; 2011 [cited 2015 Jan 15]. Available from: http://www.gezondheidsraad.nl/sites/default/files/201108E.pdf
27. Institute of Medicine. Sustainable Diets: Food for Healthy People and a Healthy Planet: Workshop Summary. Washington (DC): The National Academies Press; 2014 [2014 Sep 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK184585/
28. IPCC, 2014: summary for policymakers. In: Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change Field CB, Barros VR, Dokken DJ, et al editors. Cambridge (UK): Cambridge University Press. p. 1–32 [cited 2015 Jan 15]. Available from: http://www.ipcc.ch/report/ar5/wg2/
29. Jones BA, Grace D, Kock R, et al Zoonosis emergence linked to agricultural intensification and environmental change. Proc Natl Acad Sci U S A. 2013; 110: 8399–404.
30. Johnston JL, Fanzo JC, Cogill B. Understanding sustainable diets: a descriptive analysis of the determinants and processes that influence diets and their impact on health, food security, and environmental sustainability. Adv Nutr. 2014; 5: 418–29.
31. Kickbusch I. Trigger debate, white paper: the food system — a prism of present and future challenges for health promotion and sustainable development. Health Promotion Switzerland, 2010 [cited 2014 Sep 15]. Available at http://www.ilonakickbusch.com/kickbusch-wAssets/docs/White-Paper—The-Food-System.pdf
32. Kiss K. Rise and fall of the concept of sustainability. J Environ Sustain. 2011; 1: 7–18.
33. Kjaergard B, Land B, Pedersen KB. Health and sustainability. Health Promot Int. 2014; 29 (3): 558–68.
34. Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006; 296 (15): 1885–99.
35. National Resource Defense Council. Wasted: How America Is Losing Up to 40 Percent of Its Food From Farm to Fork to Landfill. Issue Paper: National Resource Defense Council August 2012 [cited 2014 Sept 15]. Available from: http://www.nrdc.org/food/files/wasted-food-ip.pdf
36. Petersen KB, Land B. Health, food, and sustainability
. In: Nielson KA, Elling B, Figueroa M, Jesoe E, editors. A New Agenda for Sustainability. Ashgate (UK); 2010. p. 251–69.
37. Saxe H. The New Nordic Diet is an effective tool in environmental protection: it reduces the associated socioeconomic cost of diets. Am J Clin Nutr. 2014; 99 (5): 1117–25.
38. Smith P, Gregory PJ. Climate change and sustainable food production. Proc Nutr Soc. 2013; 72: 21–8.
39. Soret S, Mejia A, Batech M, Jaceldo-Siegl K, Harwatt H, Sabaté J. Climate change mitigation and health effects of varied dietary patterns in real-life settings throughout North America. Am J Clin Nutr. 2014; 100( Suppl.): 490S–495S.
40. Tilman D. Global environmental impacts of agricultural expansion: the need for sustainable and efficient practices. Proc Natl Acad Sci U S A. 1999; 96: 5995–6000.
41. Tilman D, Clark M. Global diets link environmental sustainability and human health. Nature. 2014;27; 515 (7528): 518–22.
42. United Nations. World Commission on Environment and Development: Our Common Future. The Brundtland Report. Geneva (Switzerland): United Nations, 1987 [cited 2014 Sep 15]. Available from: http://www.un-documents.net/wced-ocf.htm
43. U.S. Department of Agriculture (USDA). Organic Production [cited 2014 Sep 2]. Available from: http://www.ers.usda.gov/data-products/organic-production.aspx#.VAZ_61Y8uzA
44. Vermeulen SJ, Campbell BM, Ingram JSI. Climate change and food systems. Annu Rev Environ Res. 2012; 37: 195–222.
45. Westhoek H, Lesschen JP, Rood T, et al Food choices, health and environment: effects of cutting Europe’s meat and dairy intake. Glob Environ Change. 2014; 26: 196–205.
46. Worthington V. Nutritional quality of organic versus conventional fruits, vegetables, and grains. J Altern Complement Med. 2001; 7 (2): 161–73.
Ackerman-Leist P. Rebuilding the Foodshed: How to Create Local, Sustainable, and Secure Food Systems. 2013.
Greenberg P. Four Fish: The Future of the Last Wild Food. 2010.
Hauter W. Foodopoly. The Battle Over the Future of Food and Farming in America. 2012.
Pollan M. Cooked: A Natural History of Transformation. 2013.
Pollan M. The Omnivore’s Dilemma: A Natural History of Four Meals. 2006.