The McConnell Foundation and the development of sustainable food systems
Beth Hunter manages the Sustainable Food Systems program at the McConnell Foundation, a private philanthropic foundation based in Montreal, which seeks to build a more inclusive, sustainable and resilient Canada through social innovation.
For the past 25 years, Beth has worked at the cross-path of three dimensions: environment, economy and social change, and, more specifically, on questions of food systems. Co-founder of Équiterre, she has a Masters in Rural Economy from Université Laval focused on food security and diversity.
Can you present the different fields of action in which the McConnell Foundation intervenes regarding food systems?
Beth Hunter: Our work is both intersectional and targeted on a limited number of programs. We have programs on “Institutional Food,” on “Food security,” and one called the “Regional Value Chain Program.” Each one is at a different developmental stage. The one on local supply chains is not very active, with only one grant still active. We worked very hard on this program in the past. Now, we work on it indirectly through support investments to local economies. For the food security program, we are active partners through a project located in Northern Manitoba, which helps indigenous peoples amongst others. With a network of funders and members of communities, we help to support work on food systems within communities, be it by supporting gardens, livestock breeding, greenhouses, hunting or fishing.
However, regarding the initiative on sustainable food systems, we are most active with the institutional food program at the moment. It consists of using institutional purchasing power, most often public institutions – and thus funded by public funds – to lead them towards having positive impacts, be they social, environmental or economic. By doing this work in schools, on campuses and in Care centers (which include long-term care centers and hospitals), we realized that there was a particular opportunity in the healthcare system, for the simple reason that the purchasing power in healthcare institutions is such that it represents about half of food purchases. We thus developed a project that we call “Nourish” with which we can have an impact by encouraging purchases that are more eco-friendly, organic, local and contain fewer pesticides. This being said, we could also have an effect by incentivizing them to favour cooperatives or indigenous entrepreneurs, or those from other populations that we would like to offer more support. In this way, we could have a social impact on food systems by revisiting the way in which the healthcare system’s purchasing power is used. Also, in the healthcare sector, is it is particularly poignant to know how food can have a direct impact on health; even more so as it is supposed to be hospitals and the healthcare system’s mission to promote… health!
You’ve found that it wasn’t really the case for food in the healthcare sector?
Beth Hunter: As they say, “they don’t walk the talk.” In general, there isn’t much coherence between the food served in hospitals and their health mission. Too often, it is the lesser cost that is the main factor when choosing which foods to serve. Structurally, it is organized in the same way as the parking lots are, and they don’t see food as being part of healthcare on the same level as medications are. There is often a lack of consideration for nutrition…
So for that program, we sort of went against what we usually did: instead of financing projects and then creating some form of learning system after the grants, within the context of “Nourish,” we actually began by forming a network of people with decision-making power on nutrition matters within institutions. Often these individuals were directors, dietitians or nutritionists. We recruited 25 leaders for a leadership program that lasted two years and where each had to propose a project. They met three times in person – and much more often virtually – to create a community of practices together, by each bringing a project idea that they could implement in their establishment.
Sainte-Justine was part of the initiative. In their case, this institution had already undertaken a transition for the implementation of room service. Instead of having trays that are delivered to the rooms, where you might have a choice between chicken or beef for your meal, patients were offered a menu with healthy choices. They could then choose what they wanted, when they wanted. Once the order is placed, they receive their meal 45 minutes later, directly to their room. This practice has a positive impact on the level of food intake: the institution saw an increase in food intake, which is necessary to counter problems such as malnutrition. Also, it drastically reduced waste. While they used to throw away whole trays of food, I think the proportion of food waste has been reduced from 25% to 5%. The level of satisfaction of patients has significantly increased, and there were reductions in food costs.
This is an example of a project elaborated by our 25 innovators. Through the groups that were formed, we can see the impact of the exchange of ideas and knowledge. Following the experience at the Sainte-Justine Hospital, several hospitals are considering the possibility of implementing room service projects in their institution. We can thus see, concretely, how they can learn from each other and communicate their experience. We have several other similar collaborative projects, and it is in this spirit that we work.
If I understand correctly, the Foundation’s actions are no longer defined by or limited to the traditional role of philanthropy which was fundamentally defined as the management of donation redistribution?
Beth Hunter: Exactly. With “Nourish,” we offer grants, but only to support collaborative projects. We have asked the leaders to indicate issues that interest them, which brought them to determine together which projects were the most intersectional and could have systemic effects within their health center and/or hospital. It is within this perspective that we offered funding. In fact, even the decisions on the way in which funds would be distributed were made in a very collaborative fashion. We told them: “We have 100 000$ for collaborative projects and we will decide together how to spend it, by obtaining the approval of our board of course”. They identified projects where they would have to be at least three people working together. Then, they would “pitch” their ideas amongst themselves to present their projects. Finally, through a funnel selection process, we ended up with five projects. These latter were all financed, but not precisely at the same level. The financing was established based on the needs of the project and according to what was considered most important.
However, “Nourish” is broader than that. I just mentioned the “supply and demand” aspect, where it’s a question of empowering people who are in important decision-making positions, meaning people responsible for the purchases of food in healthcare institutions. Yet, our network of leaders is also invested in other dimensions, be they educational or community programs. Basically, it surpasses the question of food purchases, even if we quickly use the term demand building to talk about it. We also work on other levels as we know that “building the demand” doesn’t solve everything.
For instance, we need policies that support demand-building efforts. For example, we need policies with adequate budgets. At the moment, there are budget cuts or shortages that make the work we want to accomplish very difficult. For instance, in the current hospital conditions, if it is not impossible to innovate and do a good job, it remains that it is challenging as long as the available budgets are limited. It is a question of working with a food budget that is approximately 8$ a day per patient. It becomes difficult to buy local or organic foods.
Other than the financial dimension, it is also essential to change the policies regarding the procurement regulations, which are only thought up around the question of the price of the merchandise. It would be ideal to add other criteria, such as the economic or environmental benefits that local purchases represent for communities. In this direction, the work consists of figuring out how we can integrate other criteria. To do so, we have developed a strategy based on communication: we’re talking about changing the narrative. We know that even if the person who takes the nutrition decisions has a very holistic view on the way of making good choices, if the doctors, nurses, upper public officials, and directors don’t agree, it won’t work. So we also look at how we can change the situation through a narrative where nutrition is fundamental for health, and where everyone values mealtime and the quality of what people are eating. It is crucial that this narrative is transmitted within the community, that the food experience within a hospital or long-term care center marks their life habits once they leave the institutions in question. That a doctor gives importance to what we eat while we’re in the hospital is one thing, but we can not neglect what is eaten once back at home, and that can reduce the chances of being rehospitalized. We are thus working on changing the narrative among professionals within the institutions in the hopes that “good habits taken, good habits adopted” for health will then spread to the community.
I would like to hear more on the Foundation’s systemic approach, which allows, for instance, to work on the development of sustainable food systems
Beth Hunter:I would say that the systemic approach has brought us to focus on the question of sustainability, in the sense that we seek to support actors for projects that will persist through time. To do so, we recognize the need, for the Foundation and the people/organizations with whom we work, to be profoundly committed, in the long-term and not to have a superficial commitment.
It is vital that we have the time to understand the dynamics of the system to act where we believe we can have a lasting impact. I think that we try to have this vision overall at the Foundation, be it for the funding of an organization or the financing of an entire program. However, regarding the initiative of sustainable food systems, we opted to act on healthcare institutions as they offer specific leverage for change. Within such institutions, we see the presence of a shortfall and of an opportunity, as much regarding health as nutrition. It is not the only opportunity, but by moving forward with this approach, making our way through it, our understanding of the situation allowed us to notice that there was a much larger space for improvement available. We then realized that we could bring several of the Foundation’s tools to generate significant change. We bring our convening power to the table, a form of the Foundation’s reputation that acts symbolically in the mobilization of actors and getting them to work together around one same schedule. Once this mobilization takes place, we use our economic power, through our grants, and work towards getting the projects to have an influence on public policy. This also requires us to work among/with different levels of government. We believe that this form of approach is essential for the Foundation to generate systemic change.
If we are taking action to build a demand geared more towards health, for example, this brings us, in a systemic approach, to work on the transformation of supply. Even if we work on it more indirectly, we recognized from the very beginning of our work on nutrition that we cannot make a change without working with the private sector. There is thus this intention, within the Foundation, to engage the private sector. This is why we’ve organized meetings with food service companies to better understand their constraints, their perspectives, and the dynamic together. This is also why, for example, we are in contact with farmers for another program on local nutrition. We have worked a lot towards favouring more local food, by accompanying farmers or fishermen. In sum, our approach makes it so that we mobilize all of the resources and contacts that we have.
In this way, the Foundation is able to intervene at nearly every level, be it on demand, supply or even public policy.
Beth Hunter: Yes, exactly. This isn’t to say that we are trying to control everything and be everywhere, but, if we want to work systemically, we can’t favour one field of intervention over another or ignore a sector. We must at least be in contact and be aware of what is going on. Sometimes, we can play a role by organizing meetings or conversations between governments or between different sectors. For example, we planned a retreat two weeks ago on nutrition, and there were nutritionists, dietitians, researchers, farmers, people from indigenous communities, governments and environmentalists. It was a big mix of individuals from a variety of sectors. The objective was to, together, see how we could change our perspective on nutrition, notably to recognize the importance of the source and production method of food, without forgetting how we eat and prepare them. We maintain that it is too narrow a focus to only look at the nutritional value and price. It’s important, yes, but there are many other things to consider. In consequence, as a Foundation, we can act as a turntable by bringing together the actors to think and to listen to us talk about the issues upon which we need to work together. We can then further our involvement, either by giving out grants, organizing meetings, supporting research activities, etc.
The implementation of such a sophisticated approach must pose considerable challenges. What is the main difficulty that you have encountered with the “Nourish” program, which has as an objective to produce systemic change by transforming the relationship healthcare institutions have with nutrition?
Beth Hunter: When we defend a holistic approach to agriculture, it signifies being preventive through and for diversity. We want to have diversity in the seeds, in the type of agriculture, in the way the soils are managed so that the ecosystem is in balance and, in the long term, we prevent the emergence of diseases that invade and kill crops. We are aiming for the same thing in health. We are looking for a preventative approach, and nutrition is a big part of it. If we had a healthy diet and a healthcare system, an education system and living areas that make the promotion of health a priority, in the end, we will collectively pay a lot less for healthcare. However, the main problem is that the incentives in our system are hard to evaluate. Let me explain. If a hospital decides to serve sustainable, healthy and local foods, they do it because they know it’s the right thing to do. Yet, it won’t be the institution that will necessarily reap the immediate benefits of this decision with patients who are less sick. The results are often too indirect and deferred, which renders the recognition of the advantages of this strategy quite complicated and the integration of meaningful results into their reports quite tricky…
We thus question ourselves in ways that will allow us to highlight existing incentives. We see that it is possible for certain things such as malnutrition. There is research that shows how malnourished patients stay in the hospital two to three days longer than well-fed patients. So that is an institutional incentive for people to eat well, as the hospital will keep said patients for shorter periods of time. We try to use this type of research to convince hospitals through interventions where screening for malnutrition is done, meaning we identify those who are at risk for malnutrition and give them special attention regarding their nutrition, be it by putting a positive emphasis on their mealtimes or by helping them eat.
Another example that would be more on the long-term comes from studies that show that hospitals should procure meat without antibiotics as, in the long run, the overuse of antibiotics in animal farming contributes to the problem of antibiotic resistance. Currently, hospitals are very concerned with antibiotic resistance, but they aren’t doing anything to use their purchasing power for meat without antibiotics…
They don’t do it because the incentives are not emphasized enough for them to become influential when it comes to making decisions. They would need to do it because it’s the right thing to do and not only to help reduce short-term clinical problems. To summarize, the lack of incentives is in large part connected to the inability of integrating the long-term benefits of good practices and behaviours into the analyses, and thus, into making good decisions.
In conclusion, how do you view the role of private philanthropy in a system that is mainly funded by the government?
Beth Hunter: This is precisely the last point I wanted to cover with you. Regarding the philanthropic perspective, I feel there is an interesting and important role to play. As I was explaining, we intend to change the system by acting on the incentives within the healthcare systems, for example, to progressively bring them to recognizing the fundamental fact that nutrition is an integral part to health and the healing process. It is evident that governments, who pay over three-fourths of health budgets on the national scale, are principal actors; they represent a considerable weight to shift. However, historically, philanthropy has shown its capacity to do things on a smaller scale, to test solutions and to prove that they work. Once this proof is found, we need to incentivize, rally and convince so that these experiences are taken up by governments on a larger scale.