A Systems Examination of Food Packaging and Other Single-Use Item Waste in School Nutrition Programs.

OBJECTIVE: Identify types of food packaging used in school nutrition programs and competing priorities, barriers, and facilitators for sustainable packaging waste use and recovery. DESIGN: Qualitative interviews (n = 20) and structured kitchen observations were conducted. SETTING: Data were collected from 3 school districts in Northern Colorado. PARTICIPANTS: Three nutrition program directors, 14 kitchen managers, and 3 sustainability staff. PHENOMENON OF INTEREST: Barriers and facilitators for sustainable food packaging waste practices among school nutrition programs. ANALYSIS: Interviews were recorded and transcribed, followed by inductive content analysis to identify themes. RESULTS: Commonly used food packaging included cardboard, aluminum, paper, plastic, and styrofoam. Four competing priorities were identified as impacting school nutrition programs' ability to reduce or recover food packaging: serving line speed, labor, food quality, and cost. One key barrier was that school staff had difficulty understanding the total system impact of their food packaging use and recovery decisions. CONCLUSIONS AND IMPLICATIONS: Food packaging is commonly used in school nutrition programs, and participants felt that its use offered key benefits, such as facilitating faster serving lines. More research is needed to quantify the direct and indirect impacts of packaging waste reduction and recovery in school nutrition programs.

Heat-related mortality under climate change and the impact of adaptation through air conditioning: A case study from Thessaloniki, Greece.

Climate change is expected to increase heat-related mortality across the world. Health Impact Assessment (HIA) studies are used to quantify the impact of higher temperatures, taking into account the effect of population adaptation. Although air-conditioning (AC) is one of the main drivers of technological adaptation to heat, the health impacts associated with AC-induced air pollution have not been examined in detail. This study uses the city of Thessaloniki, Greece as a case study and aims to estimate the future heat-related mortality, the residential cooling demand, and the adaptation trade-off between averted heat-related and increased air pollution cardiorespiratory mortality. Using temperature and population projections under different Coupled Model Intercomparison Project Phase 6 (CIMP6) Shared Socioeconomic Pathways scenarios (SSPs), a HIA model was developed for the future heat and air pollution cardiorespiratory mortality. Counterfactual scenarios of either black carbon (BC) or natural gas (NG) being the fuel source for electricity generation were included in the HIA. The results indicate that the heat-related cardiorespiratory mortality in Thessaloniki will increase and the excess of annual heat-related deaths in 2080-2099 will range from 2.4 (95% CI: 0.0-20.9) under SSP1-2.6 to 433.7 (95% CI: 66.9-1070) under SSP5-8.5. Population adaptation will attenuate the heat-related mortality, although the latter may be counterbalanced by the higher air pollution-related mortality due to increased AC, especially under moderate SSP scenarios and coal-fired power plants. Future studies examining the health effects of warmer temperatures need to account for the impact of both adaptation and increased penetration and use of AC.

Small targeted dietary changes can yield substantial gains for human health and the environment.

To identify environmentally sustainable foods that promote health, we combined nutritional health-based and 18 environmental indicators to evaluate, classify and prioritize individual foods. Specifically for nutrition, we developed the Health Nutritional Index to quantify marginal health effects in minutes of healthy life gained or lost of 5,853 foods in the US diet, ranging from 74 min lost to 80 min gained per serving. Environmental impacts showed large variations and were found to be correlated with global warming, except those related to water use. Our analysis also indicated that substituting only 10% of daily caloric intake from beef and processed meat for fruits, vegetables, nuts, legumes and selected seafood could offer substantial health improvements of 48 min gained per person per day and a 33% reduction in dietary carbon footprint.

Towards Win-Win Policies for Healthy and Sustainable Diets in Switzerland.

The first Swiss national dietary survey (MenuCH) was used to screen disease burdens and greenhouse gas emissions (GHG) of Swiss diets (vegan, vegetarian, gluten-free, slimming), with a focus on gender and education level. The Health Nutritional Index (HENI), a novel disease burden-based nutritional index built on the Global Burden of Disease studies, was used to indicate healthiness using comparable, relative disease burden scores. Low whole grain consumption and high processed meat consumption are priority risk factors. Non-processed red meat and dairy make a nearly negligible contribution to disease burden scores, yet are key drivers of diet-related GHGs. Swiss diets, including vegetarian, ranged between 1.1-2.6 tons of CO2e/person/year, above the Swiss federal recommendation 0.6 ton CO2e/person/year for all consumption categories. This suggests that only changing food consumption practices will not suffice towards achieving carbon reduction targets: Systemic changes to food provisioning processes are also necessary. Finally, men with higher education had the highest dietary GHG emissions per gram of food, and the highest disease burden scores. Win-win policies to improve health and sustainability of Swiss diets would increase whole grain consumption for all, and decrease alcohol and processed meat consumption especially for men of higher education levels.

Human Health Benefits from Fish Consumption vs. Risks from Inhalation Exposures Associated with Contaminated Sediment Remediation: Dredging of the Hudson River.

BACKGROUND: Billions of dollars are spent on environmental dredging (ED) to remediate contaminated sediments, with one goal being reduced human health risks. However, ED may increase health risks in unanticipated ways, thus potentially reducing net benefits. OBJECTIVES: To assess the ways that ED may increase health risks in unanticipated ways, thus potentially reducing net benefits, we quantitatively assessed a subset of population health benefits and risks of ED, using the 2009-2015 remediation of the Hudson River Polychlorinated Biphenyls (PCBs) Superfund Site as a case study. Three remediation scenarios were evaluated: No Action (NA), Source Control (SC), and ED. METHODS: We quantified health benefits for each scenario from reduced PCB levels in Hudson River fish, and health risks from ED operations due to increased inhalation exposures to PCBs and fine particulate matter (PM2.5), using disability-adjusted life years (DALYs) as a common metric. Occupational health risks were also considered in a separate sensitivity analysis. Estimates of population-level benefits and risks included Monte Carlo simulation-based uncertainty analysis. RESULTS: Under NA, fish consumption would result in an estimated health burden of 112 DALYs, and ED would lead to a reduction of 15 DALYs in excess of SC. ED operations were estimated to induce a total burden of 33 DALYs, dominated by PM2.5 impacts from rail transport emissions (32 DALYs). Including uncertainty, the net health benefit of ED ranged from -138 to +1,326 avoided DALYs (90% confidence), with a median of -11 avoided DALYs. CONCLUSIONS: For the considered impacts, ED in the Hudson River might not have led to an overall net positive human health impact. The benefits and risks of ED, however, have different degrees of uncertainty and involve different populations. Reducing long-distance transport of dredged sediment is a priority. This comparative approach could be used prospectively to better determine trade-offs involved in different remediation scenarios and to improve remediation design to maximize benefits while minimizing risks. https://doi.org/10.1289/EHP5034.

Global Effect Factors for Exposure to Fine Particulate Matter.

We evaluate fine particulate matter (PM2.5) exposure-response models to propose a consistent set of global effect factors for product and policy assessments across spatial scales and across urban and rural environments. Relationships among exposure concentrations and PM2.5-attributable health effects largely depend on location, population density, and mortality rates. Existing effect factors build mostly on an essentially linear exposure-response function with coefficients from the American Cancer Society study. In contrast, the Global Burden of Disease analysis offers a nonlinear integrated exposure-response (IER) model with coefficients derived from numerous epidemiological studies covering a wide range of exposure concentrations. We explore the IER, additionally provide a simplified regression as a function of PM2.5 level, mortality rates, and severity, and compare results with effect factors derived from the recently published global exposure mortality model (GEMM). Uncertainty in effect factors is dominated by the exposure-response shape, background mortality, and geographic variability. Our central IER-based effect factor estimates for different regions do not differ substantially from previous estimates. However, IER estimates exhibit significant variability between locations as well as between urban and rural environments, driven primarily by variability in PM2.5 concentrations and mortality rates. Using the IER as the basis for effect factors presents a consistent picture of global PM2.5-related effects for use in product and policy assessment frameworks.

Calculating Intake of Dietary Risk Components Used in the Global Burden of Disease Studies from the What We Eat in America/National Health and Nutrition Examination Surveys.

Disability adjusted life years (DALYs) is a health burden metric that combines years of life lost due to disease disability and premature mortality. The Global Burden of Disease (GBD) has been using DALYs to determine the health burden associated with numerous health risks, including risks associated with dietary intakes, at the global and national level. To translate such information at the food level in the U.S., variables in What We Eat in America (WWEIA) need to be aligned with those in the GBD. In this paper, we develop the necessary new variables needed to account for differences in definitions and units between WWEIA and the GBD. We use the Food Patterns Equivalents Database, Food Patterns Equivalents Ingredient Database, Food and Nutrient Database for Dietary Studies, and Standard Reference databases that provide data for WWEIA to develop food group and nutrient variables that align with definitions and units used in the GBD. Considerable effort was needed to disaggregate mixed dishes to GBD components. We also developed a new "non-starchy" vegetable variable, since the GBD vegetables do not include potatoes and corn, and we report fruits and vegetables in grams instead of household measures. New fiber variables were created to avoid double counting of fiber from legumes, whole grains, fruits, and vegetables. Regression analyses were used to predict trans-fat content for foods in WWEIA with missing or incomplete information. The majority of foods in various U.S. Department of Agriculture (USDA) categories contain multiple GBD food groups (e.g., vegetables, whole grains, and processed meat). For most nutrients considered in the GBD, composition is more evenly distributed across the main food categories; however, seafood omega-3 fats were predominantly from either protein foods or mixed dishes and sugar sweetened beverages were from a single category. Dietary intakes in the U.S. fall short of recommendations for all food groups/nutrients with established theoretical minimum-risk targets in GBD. To our knowledge, this is the first approach that aligns WWEIA intake variables with those used in the health burden-based GBD reports. These methods will facilitate researchers to begin comparing data from the U.S. with that from other countries, as well as assess food sustainability performances by concomitantly evaluating DALYs for environmental and nutritional impacts.

Characterizing Aggregated Exposure to Primary Particulate Matter: Recommended Intake Fractions for Indoor and Outdoor Sources.

Exposure to fine particulate matter (PM2.5) from indoor and outdoor sources is a leading environmental contributor to global disease burden. In response, we established under the auspices of the UNEP/SETAC Life Cycle Initiative a coupled indoor-outdoor emission-to-exposure framework to provide a set of consistent primary PM2.5 aggregated exposure factors. We followed a matrix-based mass balance approach for quantifying exposure from indoor and ground-level urban and rural outdoor sources using an effective indoor-outdoor population intake fraction and a system of archetypes to represent different levels of spatial detail. Emission-to-exposure archetypes range from global indoor and outdoor averages, via archetypal urban and indoor settings, to 3646 real-world cities in 16 parametrized subcontinental regions. Population intake fractions from urban and rural outdoor sources are lowest in Northern regions and Oceania and highest in Southeast Asia with population-weighted means across 3646 cities and 16 subcontinental regions of, respectively, 39 ppm (95% confidence interval: 4.3-160 ppm) and 2 ppm (95% confidence interval: 0.2-6.3 ppm). Intake fractions from residential and occupational indoor sources range from 470 ppm to 62 000 ppm, mainly as a function of air exchange rate and occupancy. Indoor exposure typically contributes 80-90% to overall exposure from outdoor sources. Our framework facilitates improvements in air pollution reduction strategies and life cycle impact assessments.