Dr. Kassam is a radiation oncologist at the Stronach Regional Cancer Centre and an assistant professor in the Department of Radiation Oncology at the University of Toronto. As well, she is the director/founder of Plant-Based Canada, co-author of Eating Plant-Based, co-editor Plant-Based Nutrition in Clinical Practice, as well as co-chair of the Canadian Member Interest Group for American College of Lifestyle Medicine (ACLM).
Discover below how Kassam advocates for a shift to a plant-based food system, highlighting its potential to improve human health, mitigate environmental damage, and address social injustices caused by current food production practices. She urges health care professionals to lead this change by integrating plant-based nutrition into clinical practice, medical education, and public health initiatives, emphasizing the co-benefits for both people and the planet.
Read the full blog below.
The Imperative for a Sustainable Plant-Based Food System: A Call to Action
“Global food production is the single largest human pressure on Earth, threatening local ecosystems, driving a sixth mass extinction of species, and impacting the stability of the entire Earth system.” "Food is the single strongest lever to optimise human health and environmental sustainability on Earth.” Eat Lancet Commission
What inspires you to be involved in this work?
Witnessing the detrimental effects of our current food system inspires me to advocate for a shift towards a plant-based food system that is healthful, sustainable, just, accessible, affordable, and compassionate. The existing paradigm presents significant justice issues impacting people, the planet, and non-human animals. The latest UN IPCC states ‘reduction of excess meat consumption is amongst the most effective measures to mitigate GHG emissions with a high potential for environmental health, food security, biodiversity and animal welfare co-benefits’.
As health professionals, we must advocate for the health of both people and the planet, recognizing that healthy individuals cannot exist on an unhealthy planet.
What do you believe is the most significant change health care should undertake?
Health care should comprehensively overhaul its approach to nutrition, integrating it into public and medical education, clinical practice, and institutional leadership. Advocating for and implementing a predominantly plant-based diet in health care settings can help to address the root causes of many of our common chronic diseases, supported by our clinical guidelines, reducing the burden on our overstretched health care system. This shift will also lower our carbon footprint and mitigate negative impacts on other planetary boundaries, often overlooked in sustainability discussions. By using this approach as a teachable moment, we can educate patients and their families, fostering a cultural shift within health care institutions supported by robust public health campaigns. And an added bonus is that making this shift has been shown to save money.
The Eat Lancet Commission has provided a seminal contribution to the understanding of sustainable diets with their Planetary Health Plate. This dietary model emphasizes a predominantly plant-based diet to achieve both human health and environmental sustainability. It includes a variety of fruits, vegetables, whole grains, plant-based proteins such as legumes and nuts, and unsaturated plant oils. Animal-source foods and added sugars should be consumed in very modest amounts, whilst also acknowledging that animal foods are not required, but if included should not be more than 13% of the diet. The EAT-Lancet Commission's findings reinforce the necessity of transforming our food system to meet the dietary needs of a growing global population while minimizing the environmental impact. A recent study from Harvard showed that those most closely adhering to the Planetary Health Diet had a 30% lower risk of premature death with a 29% reduction in greenhouse gas emissions, illustrating the co-benefits of personal and planetary health.
What are the health consequences of our food system?
Individual Health
The Western diet, characterized by high consumption of animal products and processed foods, is fueling a global epidemic of non-communicable diseases. Chronic diseases, such as cardiovascular disease, cancer, and type 2 diabetes, are linked to suboptimal diets and are a significant burden on our health care systems. The Global Burden of Disease study showed that globally, in 2017, dietary risks were responsible for 11 million deaths (22% of all deaths among adults). Cardiovascular disease was the leading cause of diet-related deaths followed by cancers and type 2 diabetes. Importantly, poor diet accounts for more deaths globally than tobacco. The study concluded, “Our findings show that a suboptimal diet is responsible for more deaths than any other risks globally, including tobacco smoking, highlighting the urgent need for improving human diet across nations.” Statistics for Canada mirror these results.
Our clinical guidelines now also endorse the use of plant-based diets in clinical practice. The 2019 American College of Cardiology guidelines for primary prevention of cardiovascular disease support plant-based diets, including vegetarian and vegan diets, as part of their recommendations. The American Association of Clinical Endocrinologists and American College of Endocrinology recommend a primarily plant-based eating plan as the first line lifestyle intervention for treatment of type 2 diabetes. The American Diabetes Association’s consensus on nutrition therapy for diabetes and prediabetes acknowledge that vegetarian and vegan diets are beneficial for the prevention and treatment of diabetes. The World Cancer Research Fund and American Institute for Cancer Research recommend a diet centred around fruits, vegetables, whole grains and beans for cancer prevention and after a diagnosis of cancer. The American College of Lifestyle Medicine dietary lifestyle position statement for treatment and potential reversal of disease recommends ‘an eating plan based predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds’.
Many country based nutrition guidelines are now promoting plant-based eating, including our excellent 2019 Canadian Food Guide, whose review process excluded lobby groups for the first time, and were therefore able to follow the evidence! What a concept! Dairy was removed as an essential food group and of the quarter of the plate that is dedicated to protein, the guidance is that at least half should be plant protein making the food plate at least 87.5% from plant foods. There was a lot of pushback from Animal Ag who did not enjoy this evidence based approach. Although perhaps they need not have worried given that most individuals and institutions are not in general putting the guideline into practice.
Antibiotic Resistance
Animal agriculture is the leading cause of antibiotic resistance which the World Health Organisation lists as one of the top 10 threats for global health. The extensive use of antibiotics in farm animals contributes significantly to the development of antibiotic-resistant infections in humans. In Canada, a staggering 82% of antimicrobials are sold for use in animals raised for food, exacerbating this issue and highlighting the urgent need for sustainable farming practices. This shortsighted practice so that we can eat meat means we are entering a post-antibiotic era where it is no longer unusual to be treating patients with infections for which there are no suitable antibiotics. This will be catastrophic.
Pandemic Risk and Social Justice
Animal agriculture contributes to the emergence of pandemics by creating conditions that facilitate the transmission of infectious diseases from animals to humans. High-density farming practices often involve keeping large numbers of animals in close quarters, which can lead to the rapid spread of pathogens among farmed animals. These pathogens can mutate and jump to humans. Overall, the intensive and often unsanitary conditions of animal agriculture create a breeding ground for zoonotic diseases, increasing the likelihood of pandemics.
The COVID-19 pandemic exposed the vulnerabilities of our food system, particularly for marginalized populations working in meatpacking and slaughterhouses. These workers in general experience increased physical and mental health risks and poor working conditions. No child dreams of growing up to be a slaughterhouse worker, nor do consumers in general want to kill their own food, but are happy to let someone else do it. The environmental impact of animal agriculture also disproportionately affects indigenous and marginalized communities through habitat destruction and pollution. A shift towards a plant-based food system can alleviate these social injustices and promote a healthier, more equitable society.
Planetary Health
Global food production accounts for 35% of all greenhouse gas emissions, with animal agriculture responsible for nearly 60% of these emissions. Transitioning to a plant-based diet can significantly reduce our environmental impact. Research by Poore and Nemecek (2018) shows that a global shift to plant-based diets could cut food-related greenhouse gas emissions by about 50%. Furthermore, this shift would reduce the need for extensive land use, freeing up land for rewilding and helping to restore biodiversity. This farm to fork research also clearly showed that only a small portion of greenhouse gas emissions were due to the transport of foods. What you choose to eat is far more important than how far it has travelled.
To have any hope of meeting the central goal of the Paris Agreement, which is to limit global warming to 2°C or less, our carbon emissions must be reduced considerably, including those coming from agriculture. Clark et al. show that even if fossil fuel emissions were eliminated immediately, emissions from the global food system alone would make it impossible to limit warming to 1.5°C and difficult even to realize the 2°C target. Thus, major changes in how food is produced are needed if we want to meet the goals of the Paris Agreement.
Although we often focus on GHGE, the global food system, particularly animal agriculture, has a broader and deeper impact on planetary health. Animal agriculture is the biggest driver of wildlife and biodiversity loss, species extinction, freshwater use, water pollution, and ocean destruction. Half of all habitable land is used for agriculture, 80% of which is used for animal agriculture which only supplies 18% of global calories. Land use change, mainly land conversion for crop production (mostly for farmed animals feed), raising farmed animals, and plantations is the strongest driver of our destruction of nature. Transitioning to a plant-based food system will free up to 75% of land that can be used for rewilding.
What are the barriers to implementing a plant-based food system into health care?
Most health professionals lack education on the benefits of plant-based nutrition for human and planetary health. This is not our fault, as we are not given this education during our training. Misconceptions amongst health professionals and public about plant-based diets being restrictive, nutritionally inadequate, or costly persist, despite sound evidence to the contrary. Major dietetic organisations affirm that well-planned vegetarian and vegan diets are nutritionally adequate and beneficial for all life stages including athletes, from cradle to grave and are associated with a lower incidence of chronic diseases.
The animal agriculture industry heavily lobbies to influence policy and public perception, shaping nutritional guidelines, subsidizing meat and dairy, and downplaying negative impacts. These tactics mirror those of Big Oil and Big Tobacco, as noted in "The New Merchants of Doubt: How Big Meat and Dairy Avoid Climate Action."
Government subsidies make animal products cheaper than sustainable plant-based options, distorting the market and supporting unsustainable practices. Despite its significant climate impact, the food system receives little media and policy attention. A 2023 analysis revealed that only 7% of climate articles mentioned animal agriculture, and they rarely discussed its impact on climate change.
Lastly, resistance to change due to personal biases and cultural norms presents a significant barrier. A cultural shift is necessary to prioritize environmental and public health over individual dietary preferences. Culture refers to the shared values, practices, and beliefs of a group that makes sense at a particular time, and therefore by definition culture is evolving. It should not be accepted culture to suffer from a heavy burden of chronic disease, live our last one to 2 decades in ill health, and bring up children in whom the prevalence of obesity and diabetes is increasing and whose life expectancy is less than ours.
We have also normalized a culture where 8 billion humans slaughter 90 billion land animals per year and two to three trillion aquatic animals per year for their consumption and taste, and that even in the presence of our looming planetary collapse, we cannot change our perceptions. If we killed humans at the rate we kill land animals, humans would be extinct in 17 days. Our current system treats animals as mere commodities, disregarding their sentience and capacity for suffering leading to unimaginable suffering for billions of animals each year. By choosing plant-based diets, we can create a more just and compassionate world for all beings.
What are the opportunities for plant-based food in health care?
Plant-Based Nutrition Advocacy
Health care institutions should model best practices for individual health and sustainability by promoting plant-based nutrition in hospitals, canteens, conferences, medical meetings, and public health campaigns. This aligns with the current Canada Food Guide, with clinical practice guidelines for preventing and managing chronic diseases, and with the American Medical Association’s (AMA) new policy announced at the 2024 Annual Meeting of the AMA House of Delegates that “recognizes that animal-based agriculture is a significant contributor to greenhouse gas emissions and supports efforts to increase and promote plant-based menu options in hospital food services, for both health and environmental reasons.”
Innovative Models Resulting in Lower Greenhouse Gas Emissions and Cost Savings
Plant-based meals need to be normalised within institutional and public sector dining to showcase the broader change we need to witness. Programs like Greener by Default, which offers plant-based foods as the default option while preserving personal choice and patient satisfaction, have been successful in reducing costs by 59 cents per meal and carbon emissions by 36% in the New York Health and Hospitals system, the largest public health care system in US. In the UK, research has shown that implementing meat-free defaults in public catering could save the National Health Service £74M a year [$132,408,197 CDN]. Similar initiatives are underway in Canada, with Vancouver General Hospital launching a Planetary Health Menu Project. Hospitals in Germany have also started to adopt the Planetary Health Diet. Hospitals in the US have created fully plant-based inpatient menus alongside education initiatives to support better nutrition. A wider roll-out of these successful projects is now warranted.
Lifestyle Medicine
Our overstretched health system has competing issues to deal with and does not prioritize disease prevention or sustainability. Our current system cannot support the level of illness in our communities, and the more health care required for our communities, the more environmental and societal impact it has. The medical specialty of Lifestyle Medicine, championed by the American College of Lifestyle Medicine (ACLM), emphasizes the use of evidence-based lifestyle interventions to prevent, treat, and often reverse chronic diseases. Lifestyle Medicine advocates for whole food plant-based nutrition, physical activity, stress management, sleep, social connections, and avoidance of risky substances. By becoming educated in Lifestyle Medicine, health care professionals can lead the way towards a more sustainable health system. The ACLM provides resources, education, and community support to help practitioners integrate these principles into their practice, thereby promoting both individual and planetary health. Join the ACLM as a member so you can also join us in the Canadian Lifestyle Medicine Member Group of the ALCM where Canadian health professionals are coming together to network and collaborate on educational and research initiatives. There is a growing number of Canadian health professionals who are now certified in Lifestyle Medicine through the American Board of Lifestyle Medicine.
Education and Training
Incorporating nutrition into medical education and training programs can equip future health care professionals with the knowledge and skills to advocate for and implement healthful and sustainable nutrition practices. Until this is more uniformly integrated into our education there are wonderful courses that can be taken including the University of Winchester Plant-Based Nutrition Course and the University of Guelph Plant-Based Nutrition Certificate, and courses through the ACLM.
Collaborative Efforts
Health care professionals must work with their health care institutions, educational bodies, medical associations, policymakers, industry leaders, and community organisations to promote sustainable and healthful nutrition. Volunteer with organisations already doing this work such as the Canadian Coalition for Green Health Care, Canadian Association of Physicians for the Environment (CAPE Ontario has an AgriFood Working Group), and Plant-Based Treaty.
Conclusion
We are at a critical juncture in human history. The health of our people and our planet are intertwined, and the actions we take now will determine the future of both. There is a moral imperative of the medical profession to promote plant-based nutrition given the substantial evidence on the benefits of plant-based nutrition for individual and planetary health.
As health care professionals, we must educate ourselves, overcome biases, and advocate for the well-being of our people and the planet.
There is no time to lose.
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The Coalition thanks Dr. Kassam for her expertise and continued excellence in the field of healthy and sustainable foods. If you have any further questions, reach out to Dr. Kassam at, zahrakassam13@yahoo.co.uk or https://www.plantbasedcanada.org/
To learn more and get involved in healthy and sustainable foods, check out our Healthy and Sustainable Foods webpage.
