Food Is Health Infrastructure A policy framework for healthy, sustainable food in Canadian Health Care NourishLeadership.ca
The health care system harnesses the power of food to advance health for patients, communities, and the planet. Nourish Vision
Support health care providers to apply the healing power of food to advance health equity, climate action, and community well-being. Nourish Mission
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Summary: Policy Recommendations Federal, provincial and territorial Ministers of Health, working in partnership with Indigenous governments and communities, and intermediary organizations like Nourish, should establish and fund a pan-Canadian healthy and sustainable healthcare food initiative.[1] The initiative should resource and enable publicly-funded hospitals and long-term care organizations to: Maintain protected, nutritionally and culturally adequate food budgets indexed to food-price inflation. Establish measurable targets for regional, sustainable and Indigenous food procurement that strengthen regional food-system resilience, create predictable demand for producers, and advance Indigenous food sovereignty and economic self-determination. Adopt measurable food strategies informed by Canada’s Dietary Guidelines,[2] the Planetary Health Diet,[3] and Indigenous-led guidance on Indigenous Foodways.[4] Deliver plant-forward, low-carbon, culturally informed and appealing nutrition, including greater use of whole and minimally processed foods.[3] Reduce food-related greenhouse gas emissions by at least 30% from an established baseline by 2030.[5] Report on common indicators for menus, procurement, food investment, patient and resident experience, cultural and traditional food access, food waste and food-related emissions. Access national networks and communities of practice to share learning to spread and adapt what works. The initiative should explicitly aim to deploy public procurement as a strategic lever to advance the health and well-being of people in Canada. It should improve patient and resident nutrition and improve healthcare food environments while strengthening regional food systems, supporting Indigenous food sovereignty, building resilient supply chains, and reducing health care’s environmental footprint.
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The Opportunity Food is not an ancillary service in health care. Food is health infrastructure: a daily clinical, cultural, environmental, and economic intervention reaching patients, residents, staff and communities. Canadian healthcare food service spending is estimated at approximately $5 billion annually in 2026 dollars, based on an inflation adjustment of the sector’s original 2012 estimate of $4 billion. [7] Even a modest shift in how these resources are allocated could generate significant benefits for patients, communities, regional food systems and the environment. Food is medicine. Food served in health care can support prevention, treatment and recovery; improve patient and resident experience; and help address diet-related disease and malnutrition. What is served on the patient tray, health care food environments, and patient education can all support care - but a lot is being left on the table. Realizing this potential requires attention not only to nutritional quality, but also to how food is sourced, prepared and integrated into care. Publicly funded healthcare institutions purchase food at a scale that can shape markets and supply chains. By integrating good food sourcing into their food is medicine strategies, these institutions can act not only as care providers but also as anchor institutions that direct significant and predictable purchasing power toward healthier populations, stronger regional economies, more resilient food systems and a livable planet. In short, they become better stewards of health and wealth. This anchor role extends beyond purchasing: healthcare institutions can use their economic, human, intellectual, and institutional assets to strengthen the well-being of the communities and ecosystems in which they are rooted.[8]
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Why Coordinated Action is Needed Health Canada explicitly identifies Canada’s Food Guide and its underlying Dietary Guidelines as resources for developing procurement policies in hospitals and long-term care.[2] Globally, the 2025 EAT–Lancet Commission recommends a similar Planetary Health Diet pattern to achieve just and sustainable food systems within planetary boundaries.[3] Indigenous communities also articulate their own guidance around Indigenous Foodways, often grounded in relationship and responsibility, as reflected in the working definition of Haudenosaunee foods.[4] Yet Canada has no publicly mandated and adequately funded mechanism for translating these complementary forms of guidance into institutional practice at scale. Because healthcare delivery and most healthcare procurement fall primarily within provincial and territorial jurisdiction, federal procurement policy alone will not reach most hospitals or long-term care facilities.[9] A foundational pan-Canadian policy scan undertaken by Nourish mapped these policy gaps and identified opportunities to align health, agriculture and procurement policy around healthier, more sustainable and culturally meaningful food in health care. [10] Since then, healthcare organizations across Canada have increasingly acted together, supported by the national coordination, shared frameworks and implementation infrastructure developed by intermediary organizations like Nourish and its partners. Notably, the 100 Million Better Bites provides a common national framework for translating health, climate, cultural and food-system goals into measurable changes in healthcare menus and procurement.[11] This work has demonstrated both the readiness of the health sector and the potential for coordinated change, but it remains significantly underfunded and too reliant on the discretionary efforts of individual champions and philanthropists. Reaching national scale now requires sustained public investment in a shared, culturally informed mandate; protected food budgets; procurement targets that strengthen regional food-system resilience; implementation and field-building capacity; and common measurement. The foundations for systems change are already in place. The task now is to resource them at the scale of the opportunity.
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A Complete Policy Package Protect food budgets. Build on the model used in Long-Term Care Homes, where dedicated food budgets help safeguard investment in resident nutrition, by extending protected food budgets to hospitals. Recognize food as fundamental to care, not an ancillary service. Require healthcare food budgets that are nutritionally and culturally adequate, protected, and indexed to food-price inflation. Invest in food services and public procurement as anchor strategies for patient, community and planetary health. Set strategic procurement targets. Treat sourcing as an integral part of healthcare’s food is medicine mandate, and treat healthcare organizations as creators of health and value within the food system, not as neutral or passive purchasers optimizing for price.[12] Establish measurable targets for regional, sustainable and Indigenous food procurement that prioritize nutritious food, create stable and predictable demand for small and mid-sized producers, support regenerative production practices, strengthen regional food-system resilience, and advance Indigenous food sovereignty and economic self-determination. Support the targets with clear definitions, baselines, implementation plans and public reporting.[1,6] Target design should account for trade agreements and procurement rules that may constrain explicit geographic preferences, while making full use of legally available criteria related to freshness, sustainability, social value, supplier diversity and regional food-system resilience.[13] Align menus with health and planetary boundaries. Require measurable food strategies informed by Canada’s Food Guide and Dietary Guidelines, the Planetary Health Diet, and Indigenous-led guidance on Indigenous Foodways. These strategies should increase plant-forward, culturally informed and appealing meals; expand the use of whole and minimally processed foods; and reduce food-related greenhouse gas emissions by at least 30% from an established baseline by 2030. Advance cultural safety and Indigenous food sovereignty. Support Indigenous-led pathways for traditional and culturally meaningful foods. Indigenous governments, communities, knowledge holders and suppliers should have meaningful, funded opportunities to shape procurement, menus and foodservice models according to their own priorities, protocols and definitions of success. Healthcare food should also reflect the broader cultural traditions of the patients, residents and communities institutions serve.
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Cut waste and reinvest savings. Ensure that savings generated through food-waste reduction and more efficient, plant-forward menu design remain within food services. These savings should be reinvested in food quality, workforce capacity, supplier relationships, kitchens and other necessary infrastructure, not absorbed into general operating budgets. Measure what matters. Establish common indicators for: Food budgets and investment Nutritional quality Patient and resident experience Food waste Regional, sustainable and Indigenous procurement Cultural and traditional food access Food-related greenhouse gas emissions Take a systems approach. Where feasible, connect these measures with clinical and system outcomes, including malnutrition risk, length of stay, readmissions, patient and resident experience, and total cost of care.[14] Reporting should align with existing measurement frameworks so that organizations can track local progress while contributing to a shared national picture.[11] Investment in shared measurement should also help close evidence gaps concerning the combined health, economic and environmental effects of better institutional food and sourcing.
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Enabling Infrastructure for Scale Policy direction and institutional targets are necessary, but alone they are not sufficient. Achieving healthy, sustainable public food procurement at scale will require sustained investment in intermediary and field-building organizations. These organizations provide the connective tissue between governments, institutions, producers and communities. They help align institutional demand with regional supply, support implementation teams, build communities of practice, develop shared tools and translate policy commitments into operational change.[8,12] Organizations such as Nourish Leadership in health care and Farm to Cafeteria Canada in school food bridge the persistent gap between policy ambition and operational reality. They convene actors who do not otherwise work together, identify barriers across jurisdictions, support organizational change teams, and help successful local practices become durable systems change. Governments should fund intermediary capacity as a core component of public-food policy, not as a short-term project or communications add-on. This requires sustained support for coordination, technical assistance, supplier engagement, shared measurement, implementation learning and knowledge mobilization.
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Roles and Accountabilities Provincial and Territorial Health Ministries Provincial and territorial (PT) health ministries should embed protected food budgets, procurement targets and reporting requirements in health authority funding and accountability agreements.[1,9] They should provide dedicated funding for healthcare organizations to participate in national implementation networks and shared measurement frameworks, establish baselines, strengthen food-service capacity and implement measurable changes. The Federal Minister of Health The federal Minister of Health should convene the initiative through the federal–PT health ministers’ table and provide dedicated funding for implementation, field-building, and shared measurement. The federal government should use its convening, funding, and standard-setting roles to support consistent national direction while respecting provincial, territorial and Indigenous jurisdiction.[8] Indigenous Governments, Communities, and Knowledge Holders Indigenous governments, communities, and knowledge holders should be resourced to determine how Indigenous Foodways, food sovereignty, and procurement priorities are reflected within participating institutions. Indigenous involvement must be governed by Indigenous priorities, protocols and definitions of success, and resourced accordingly. Health Authorities and Healthcare Organizations Health authorities and healthcare organizations should use dedicated funding to participate in national implementation networks and shared measurement frameworks. This support should enable them to establish baselines, review menus and procurement practices, invest in food-service teams and infrastructure, engage suppliers and communities, implement measurable changes, and report publicly on outcomes. Intermediary and Field-building Organizations Intermediary organizations should be resourced to coordinate implementation across jurisdictions, support institutional teams, develop shared tools and measurement systems, connect regional supply with institutional demand, and accelerate collective learning.
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Build on What Already Exists Existing national infrastructure created by the food and health ecosystem, Indigenous-led initiatives, and regional procurement collaborations provide a foundation that governments can strengthen and connect rather than replace. Together, the Nourish Commons and 100 Million Better Bites is an example of an existing national implementation network with a shared measurement framework: The Nourish Commons is a membership-based network that brings together organizations and individuals committed to transforming food in health care through collaboration, implementation, and shared learning using a virtual platform. Nourish’s 100 Million Better Bites initiative provides an existing Canadian implementation framework organized around five measurable shifts.[11] These shifts are designed around five pillars to support patient and planetary health, including reduced food waste, through: Low-carbon, plant-forward menus (Pillar 1) Delicious nutrition from whole and minimally processed foods (Pillar 2) Culturally appropriate and traditional food access (Pillar 3) Regional and Indigenous procurement (Pillar 4) Sourcing from sustainable, regenerative agriculture (Pillar 5) An improvement, or “better bite”, reflects progress toward meals that are lower-carbon, local, nourishing, culturally mindful, and sustainably produced. To achieve this, members are supported with resources and data collection tools to track the better bites they create, supporting facility, health system, and system-wide joined-up action. Through the Nourish Commons, healthcare organizations can access the implementation support, shared tools, peer learning and communities of practice needed to turn these commitments into measurable action. Healthcare leaders, policymakers, procurement professionals and food-service teams should also have access to Indigenous-led reconciliation learning that builds the cultural understanding and relational capacity needed to advance this work responsibly. Nourish’s Food is Our Medicine learning journey is one existing Canadian resource for this purpose. Governments can build on this existing infrastructure and the experience already developing across Canadian health systems rather than creating a new implementation system from scratch.
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Food is Our Medicine is Nourish’s Truth and Reconciliation learning journey focused on Indigenous Foodways, colonialism, and relational practice. It is distinct from the broader concept of food is medicine, which refers to integrating food and nutrition into health care to prevent, manage, and treat illness and support recovery. This is one example of learning infrastructure all orders of government can harness for system-level action on the TRC Calls to Action for health care.
An Invitation to Strengthen these Recommendations Nourish invites healthcare leaders, food-service teams, policymakers, producers, Indigenous partners, researchers, and community organizations to weigh in on these recommendations through the Nourish Commons or by contacting the Nourish team. The strongest national framework will be shaped by the people who must implement it and by those whose health, cultures, livelihoods, and lands it should serve.
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references 1.World Health Organization (2021). Action Framework for Developing and Implementing Public Food Procurement and Service Policies for a Healthy Diet. Provides a framework for establishing, implementing, monitoring and evaluating public food procurement policies in settings including hospitals and long-term care. https://www.who.int/publications/i/item/9789240018341 2.Health Canada. Canada’s Dietary Guidelines. Guidance for health professionals and policymakers, including the use of healthy eating recommendations in procurement policies for hospitals and long-term-care facilities. https://www.canada.ca/en/health-canada/services/food-guide/explore/dietary-guidelines/what.html 3.EAT–Lancet Commission (2025). The 2025 EAT–Lancet Commission on Healthy, Sustainable and Just Food Systems: Summary for and with Policymakers. 2025. Establishes the scientific basis for healthy, sustainable and just dietary patterns within planetary boundaries. https://eatforum.org/wp-content/uploads/2026/03/2025-EATLancet_Summary-forand-with-Policymakers.pdf 4.Nourish Leadership and Team Six Nations. Ogyǫhsraniyǫ́hsdǫh: Growing Partnerships for Food Sovereignty and Sustainability in Six Nations. Team Six Nations Impact Report, 2026. Documents an Indigenous-led approach to strengthening food sovereignty, community well-being and access to original Haudenosaunee foods through relationships with growers, harvesters and food knowledge keepers. https://nourishleadership.ca/knowledge-hub/team-six-nationsimpact-report/ 5.World Resources Institute (2019). Cool Food Pledge: Food-Related Greenhouse-Gas Reduction Target. The initiative established a collective target of reducing food-related greenhouse-gas emissions by 25% by 2030. https://www.wri.org/news/release-companies-serving-800-million-meals-give-menus-climate-friendly-makeover 6.Treasury Board of Canada Secretariat (2025). Guide to Best Practices and Green Criteria for Low-Carbon Food Procurement. Developed in collaboration with Nourish Leadership. Provides practical criteria and strategies for using public procurement to reduce food-related emissions and influence suppliers. https://www.canada.ca/en/treasury-boardsecretariat/services/innovation/greening-government/green-procurement/buyers-climate-action.html 7.Nourish Leadership (2026). Estimating Annual Food-Service Spending in Canadian Health Care: Updating the 2012 Sector Estimate to 2026 Dollars. Updates the original $4 billion estimate using inflation while distinguishing total food-service spending from ingredient-procurement expenditures. https://nourishleadership.ca/knowledge-hub/methodology-memo2026/ 8.Hsu, Cheryl and Hayley Lapalme. ‘Hospitals as Anchor Institutions: Eco-systemic Leadership to Nourish Patient, Community, and Planetary Health.’ Proceedings of the Relating Systems Thinking and Design 8 Symposium, Chicago, October 13–15, 2019. Examines how hospitals can leverage their purchasing power, institutional assets and public leadership to strengthen community well-being and advance systemic change beyond hospital walls. https://openresearch.ocadu.ca/id/eprint/3201/1/Hsu_Lapalme_AnchorInstitutions_2019.pdf 9.Health Canada. About Canada’s Health Care System. Describes federal, provincial and territorial roles, including provincial and territorial responsibility for delivering healthcare services and the federal government’s funding and standard-setting responsibilities. https://www.canada.ca/en/health-canada/services/canada-health-care-system.html 10.Reynolds, Jennifer (2019). Nourishing the Future of Food in Health Care: A Pan-Canadian Policy Scan 2018. Key Findings and Discussion. Food Secure Canada, commissioned by the McConnell Foundation for Nourish. Maps Canadian health, agriculture and procurement policies affecting food in health care and identifies opportunities for policy innovation. https://20441233.fs1.hubspotusercontentna1.net/hubfs/20441233/Knowledge%20Hub%20(new%20website)/2019_Policy%20Scan%20Report_Print.pdf 11.Nourish Leadership. 100 Million Better Bites. A Canadian implementation framework for improving health, sustainability and cultural connection through food in health care. https://nourishleadership.ca/impact/100-million-better-bites/ 12.Lapalme, Hayley. ‘Public Sector Purchasers as Curators and Value Creators in the Food System.’ Relating Systems Thinking and Design 4 Working Paper, Banff, September 1–3, 2015. Documents how networked public institutions and communities of practice can use procurement to create public value, reconfigure supply-chain relationships and strengthen resilient regional food systems. https://openresearch.ocadu.ca/id/eprint/2035/1/Lapalme_%20Public_RSD4_2015.pdf 13.Sumner, Jennifer and Hayley Lapalme. ‘The Public Plate in the Transnational City: Tensions among Food Procurement, Global Trade and Local Legislation.’ Canadian Food Studies / La Revue canadienne des études sur l’alimentation 6, no. 1 (2019): 22–42. Examines the regulatory and trade-related barriers public institutions face when attempting to direct procurement toward local and resilient food systems. https://canadianfoodstudies.uwaterloo.ca/index.php/cfs/article/view/268 14.Curtis, L., P. Bernier, K. Jeejeebhoy, J.P. Allard, D. Duerksen, L. Gramlich, M. Laporte and H. Keller. “Costs of Hospital Malnutrition.” Clinical Nutrition 36, no. 5 (2017): 1391–1396. Examines the clinical and economic burden associated with hospital malnutrition in Canada. https://nutritioncareincanada.ca/about-us/malnutrition-overview
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Food Is Health Infrastructure: A Policy Framework
August 2026