[MUSIC PLAYING] SPEAKER: One of the most important things to consider as public health professionals is how to best communicate and encourage the most needed shifts in consumption and production. As you probably understand by now, our food system is quite complicated. Dietary choices and behaviors are part of this large, dynamic system. It is influenced and shaped by many of the same factors that shape the broader food system, for example, culture, policy, access, and affordability. Individuals and consumers are influenced across the system. Different food-related decisions and choices happen within the context of these systems, and consumers can influence the entire supply chain through their purchases. It's not always easy to change our big, messy food system, of course, but understanding the systems enforces the shaped decisions by consumers and those upstream along the supply chain is key to finding those opportunities and barriers that will have the most impact, and ideally, it would help both health and the environment. For the rest of the section, we'll focus on shifting meat consumption. And we'll be more US-focused because it's high-income countries like the US they need the most dramatic shifts. Let's look more closely at that now. To encourage dietary shifts towards less meat and more plant-based foods, we need contextual understanding of meat consumption patterns and influences on consumption among individuals in different groups of people. It's also necessary to understand a little more about behavior change, especially related to food choices. By doing so, we can better identify strategies for meat reduction and consider policy options at federal, local, and institutional levels to support shifts in dietary patterns. This diagram is based on a review of literature we did on the factors behind meat consumption. It's crowded, but categorization by the levels of influence demonstrates the complexity of food choices. The macro level factors involve state, local, and federal policies. The community level includes institutional or organizational relationships and characteristics, such as neighborhoods, worksites, and school. This also includes a food environment and access to desired food. Interpersonal level includes social relationships, culture, and socioeconomic factors, which also influence lifestyle behaviors. The intrapersonal level factors are those mostly situated within the control of an individual. This is where the food decision is ultimately made. CLF fielded a national representative survey in 2015 with questions about meat consumption and changes over the past year. Here we see that across all income groups, the belief that meat is needed for a healthy and complete diet is the overarching reason that people don't reduce meat. On the other hand, in the 2017 consumer survey, the reasons for reducing meat consumption were most commonly health, followed by cost and taste preferences. Interestingly, the environment and animal welfare are less common motivating factors across this in many other surveys. This could be an issue of awareness and education, or just attitudes and beliefs, as we saw from the diagram a few slides back. Of note, more recently, we do see awareness of climate environment growing, which could signal an opportunity for building an awareness of the important connection with diet. Another approach is understanding how people make changes. In the 2015 CLF survey, over half of the respondents reported that they ate less red meat, poultry, or fish in the past year. Of those, 32% ate less by cutting meat out of their diet one day a week, 43% by eliminating from at least one meal, 66% by buying less, 56% by eating smaller portions, and only 8% by cutting it out completely. These results suggest that people are more receptive to smaller changes than eliminating meat entirely. We also know from a consumer survey of former and current vegetarians by Phonalytics that successful longer-term vegetarians shifted gradually, not all at once, and had multiple reasons for reducing meat. The study also pointed out that an emphasis on reduction versus pure diet is more effective in decreasing overall animal product consumption, and added that former vegetarians still eat a lot less meat than the average US population. Back to our role as public health professionals, we are truly successful if we can help the people we work with shift perspectives on where food comes from, how it's produced, and how it impacts the broader food system. The recent survey comparing American and Dutch consumers showed that most Americans are not aware that meat reduction is an effective option for addressing climate change. While the majority of those surveyed recognize meat reduction as an option, the outstanding effectiveness of this option in comparison to other options was only clear to 6% of the US population, and only 12% of the Dutch population. We know from research that the food environment is highly influential in what consumers purchase and eat. Our food system has gone through major shifts over the last two decades, influencing and being influenced by urban sprawl, consolidation of agriculture, climate change, farmland loss, production method concerns, water, and an increase in diet-related diseases and health disparities. The food environment, where, and how people get their food, can also be a lever for change, though. The good news is that consumer interest in the food they eat is growing. One of the most influential parts of our food environment is the food service sector. This figure shows the number of meals and the dollars spent on eating out have grown at a higher rate than food at home over the past 30 years. For that reason, the food service sector touches many consumers and provides opportunities to influence consumers, food trends, and also demonstrate leadership in health and sustainability. It goes both ways. In the US, more and more consumers are asking for changes in their food system. In the last three years, it appears that awareness about food's role in sustainability is starting to grow. Many new year's food trend predictions highlight consumer interest in whole foods, transparency, new ingredients, health and sustainability, and reflect growing consumer interest in eating less meat, or at least eating more plants. This has driven chefs, food service, and food brands to adjust menus and products. Procurement policies can guide spending and local purchasing, but they can also impact the many people in the food chain, and drive transparent and equitable food system change. The Good Food Purchasing Program encourages cities, schools, and other large institutions to leverage their billions of dollars in buying power toward five core values-- local economies, environmental sustainability, animal welfare, nutrition, and the valued workforce. Their broad coalition of partners and labor sustainability policy in public health are working with dozens of cities and large school districts to transform procurement policies and direct purchases toward more sustainable, healthier food and food systems. The Menus of Change Initiative is a collaborative of the Culinary Institute of America, food industry, and researchers. Their principles of healthy, sustainable menus offers 20 actions that food service can take to make their menus and business practice both healthier and sustainable. These are being instituted across the country and even globally. CLF is partnering with the Compass Group for online training modules and sustainable food systems for their registered dietitians and others working across the various sectors and affiliates. They have made a commitment to sustainability that will touch customers through over 100 million meals every day, as well as over 280,000 employees. Tracking their progress demonstrates their collective impact on workers, consumers, and future generations, working toward good livelihoods, thriving rural communities, and nutritious food that is affordable. Health professionals have a unique and influential role through their connection to patients in health conversations. Nutrition professionals in particular work across the food sector, from hospitals to food service to communities. They can also influence procurement policies in local and federal dietary guidelines. Training programs like the one in this report from Frontiers in Nutrition are growing in number and scope for those preparing for the field, as well as those already working in the food and health sectors. Chefs themself are important allies when it comes to shifting consumption. As plant-based foods become more mainstream in the United States and globally, chefs are driving it with new ingredients, flavors, and cuisines. More recently, chefs have come together in different collaborative efforts to address food's role in crisis and other health and environmental concerns. For example, Chef Rob Graham of Fresh Med in New York City is a doctor chef prescribing, preparing, and teaching food as medicine. Chef José Andrés' organization, World Central Kitchen, kicked into gear after the Puerto Rico hurricanes to bring food relief, and has grown exponentially since then, now feeding thousands of people during COVID-19. Beyond restaurants and cafeterias, schools are another influential sector when it comes to dietary guidance. School food is mandated by national and local food policies. Guidelines determine what can or can't be served to students, how food is procured, and the availability of food to the students through free and reduced lunches, breakfast programs, et cetera. The cafeteria can also be considered a living laboratory where healthy meals can be modeled and new flavors introduced. Schools offer another level of influence through education, which can complement what students experience in the cafeteria. This can be in the classroom, but also in the cafeteria itself through signage, menus, and more. This diagram by Marteau drives another important point home by demonstrating how most of our behavior is under the control of the faster automatic system, rather than the reflective system. While we often focus our educational efforts primarily on values, beliefs, and intentions, in fact, most decisions are made in an instant and are highly influenced by environmental clues. Over time, choices become more habitual, but they are driven by experiences and new associations. Effective strategies that reduce the consumption of meat will need to address this decision-making system. Meatless Monday is one way of addressing awareness and behavior change. Meatless Monday began in 2003 with a simple message of one day a week go without meat for the health of people and the planet. It's now one, if not the most, well-known meat reduction campaign. The Monday has significance as the first day of the week. Findings from a study of Google health searches show that the beginning of the week, especially Mondays, are when more people are seeking to change health behaviors, such as losing weight and quitting smoking. Another study identified the cyclical weekly reminder of Monday was an effective prompt for behavior change. As our research has shown, compared to other dietary changes, Meatless Monday is not going to solve the climate or even health crisis alone. However, programs such as Meatless Monday are entry points, and can be useful to spark broader changes. Meatless Monday can reach across sectors and agendas, be it health, environment, climate change, or food worker safety. Cities have initiated Meatless Monday proclamations and instituted Meatless Monday in municipal buildings. Government institutions have aligned procurement policies with Meatless Monday. Food policy councils and even food banks have implemented Meatless Monday. A town in New York promoted a successful 12-week Meatless Monday campaign as part of its climate action plan. These are just a few examples of where the campaign has been used as a vehicle for education and outreach. Meatless Monday has been used in several school districts to help students learn about the health and environmental benefits of eating less meat. New York City is the largest school system in the United States. Their adoption of Meatless Monday across the system has a huge influence on students, but also on other districts across the country. In New York City's recent 10-year Food Policy Plan, Meatless Monday was included as a primary action toward health and sustainability. Whitsons, a food service provider, instituted Meatless Monday in nearly 95% districts in the Northeast. They worked with Meatless Monday to develop signage, tool kits, and training for food service managers. Students love conceptual models, so let's look at a few behavior models that exemplify how programs like Meatless Monday might work to shift behaviors. The first on the right is called the persuasive design by BJ Fogg, a professor at Stanford. He proposes three things have to be in place-- motivation, ability or simplicity, and then the third is the trigger necessary to increase the likelihood of performing a new behavior. Meatless Monday can work on all three, building motivation and confidence. But perhaps its most unique contribution is a trigger or spark of a weekly reminder to try a meatless meal. The buying funnel on the left explains the process customers go through to make a purchase. Knowing one's audience is key to designing campaigns that will bring the customer through the funnel to the final point of making the decision and acting on it. Finally, Meatless Monday has been described as a behavior prompt. Similar to the persuasive design model, the weekly prompt triggers action, especially when there's a targeted feedback, and when it's relevant to the specific consumer. Meatless Monday has worked through awareness campaigns and social movements via science-informed celebrities, champions, and media, driving alternative discourses. And CLF has been observing, learning, and evaluating along the way. Some of the lessons we've learned with them are, one, in the end, it's all about the food, and it has to taste good and meet individual preferences. Two, what others around me are doing is highly influential. Three, what is available and easy to grab impacts the ultimate decision. And four, the more experience and awareness someone has, the more empowered they are to make a decision. Along these lines, a few years ago, we completed a qualitative study of chefs and food service managers who implemented Meatless Monday or a similar campaign at their institutions. Most were from universities. Here are a few of the best practices we drew out from our interviews. They reflect the importance of involving everyone in the process, including staff and customers. Taste and appearance are prime. Take the time to prepare, train, then adapt. Find champions in staff, customers, and allies, and make it visible. No matter which approach is taken, if it's a communication campaign or policy approach, understanding where people are coming from should frame the message and goals. People may be motivated by health concerns, food quality, animal welfare, saving money, or fitness. Focus on benefits, tastes, and factors that encourage positive outcomes rather than shaming. So in conclusion, the environmental climate and public health impacts of food from production to consumption call for a significant reduction in meat consumption, along with a greater focus on plants. The reasons people do or don't consume meat, how much, or what kind, are complex and differ by individual. There are interventions and influences that have promise for helping people shift toward consuming more plants and less meat. And finally, understanding the consumer is critical to successful initiatives. Thank you for spending time with me today. Please feel free to contact me with any questions. You can also visit the CLF website for many amazing resources on the food system and public health. [MUSIC PLAYING]
