Above photo: ‘The health-care sector has a tremendous opportunity.’ Vancouver Coastal Health menu pilot project leads Ned Bell, Dr. Annie Lalande and Tiffany Chiang. Leila Kwok.
How health-care visionaries are creating tasty, culturally friendly menus.
While cutting waste and carbon emissions.
From Anchorage to Haida Gwaii to Vancouver and beyond, hospitals are reimagining their menus. Some seek to return Indigenous foodways to the healing process, while others aim to slash the big climate impacts of institutional food services. In both cases, chefs and medical staff are turning to more local and sustainable foods and attempting to tackle the difficult problem of food waste.
It’s not easy, but people are learning what works. Here are a few of their stories.
Alaska Native Medical Center, Anchorage, Alaska
As executive chef and director of traditional foods at the Alaska Native Medical Center in Anchorage, Amy Foote brightens patient menus with healthy Indigenous foods, including moose, salmon, fiddleheads and more.
“Traditional foods connect patients to their land and culture, which can help with healing,” says Foote amid the clattering pans and hissing pipes of the hospital’s large kitchen.
Incorporating traditional foods is no small task for a hospital serving over 5,000 meals daily to patients and their visiting families. But the Alaska Native Tribal Health Consortium, which runs the hospital, is investing in the cause. As part of that, says Foote, its food service recently went “self-op,” meaning it no longer contracts out. That clears the kitchen for a personal touch more fitting with traditional foods.
For Foote, partnerships are key, which means that when she’s not in the kitchen, she’s on the phone or on the road, finding new pathways for traditional foods to reach the hospital.
“I’ll talk with anyone who lets me talk about what we’re doing,” she laughs.
Last year, Foote worked with Copper River Seafoods to purchase 4,500 kilograms each of salmon heads and bellies, a traditional food now considered an industry byproduct. The heads are baked and roasted or cooked down into rich, velvety broths, while the bellies are smoked, baked or served in soups. Foote calls it all-Alaskan seafood that’s loaded with healthy fats and oils. It can also be loaded with soothing memories for Alaska Native patients in a foreign setting.
Foote also purchased 4,500 kilograms of reindeer from Cup’ig herders on Nunivak Island in the Bering Sea. She says it’s the closest she can get to the wild caribou familiar to patients arriving from Alaska’s interior. She bought the lower jaws and tongues, too, for traditional soups.
The hospital’s traditional foods donation program also brings in caribou, moose, seal and an array of seaweeds and plants. In a culinary crowdsourcing approach, its website hosts a “wish list” of over 100 donatable items. The wide net is possible because Alaska Native leaders and the Alaska Department of Environmental Conservation worked together in the 2010s to clarify and disseminate government safety rules surrounding traditional food donations.
The rules say seafood and meats — and the reindeer purchased from Nunivak herders, who are not U.S. Department of Agriculture-certified meat processors — must arrive unprocessed. Foote then processes them or sends them to processors.
“I can’t take seal oil,” she explains as an example, “but I can accept unprocessed seal and render it into traditional oil.”
The extra steps — like her constant work on partnerships — takes time, something other institutions cite as a challenge. In Sitka, Alaska, for instance, a spokesperson for the Mount Edgecumbe Medical Center said meeting food safety regulations was a reason that a 2018 traditional foods program there was discontinued. Southeast Alaska’s Ketchikan Medical Center blames regulations for its absence of traditional foods, too.
Foote also brings in locally grown produce such as carrots, potatoes and microgreens from university and tribal farms. She supports experimental efforts to grow fiddlehead ferns, nettles, fireweed and other traditional plants, too. And she happily buys the “scratch and dent” produce farmers discard.
“We can clean them up,” she says. “It just takes a little more work on the chef end.”
The fish heads, caribou jaws and misfit veggies reflect Foote’s aversion to food waste, a global sustainability issue that hospitals contribute to at high rates. She lacks numbers for her facility, but she’s eager for a food waste assessment, which experts say is the first step for tackling waste.
Until then, she and medical staff co-ordinate to better understand individual patient needs, which she says are often made fickle by illness, fatigue and medications, leading to trayfuls of uneaten food destined for the dumpster. One approach, says Foote, is more “batch cooking,” where kitchens stagger smaller portions over time to meet personal preferences, a tactic some hospitals are adopting. Foote also diverts some waste to the zoo and hopes to begin composting.
“We’re just scratching the surface,” she says, acknowledging that food waste carries a big environmental impact.
Foote says avoidance of waste, traditional meals and the communal effort represented in her many partnerships all reflect the hospital’s Indigenous values. But she knows challenges remain, including single-use plastics, excess packaging and the need for more energy-intensive freezer space for storage, a problem she says is common among efforts to improve food security.
Still, Foote and her partners are moving local and traditional foods across the landscape to the hospital. It may come by truck or plane, but it’s never far from the routes that Indigenous foods have always followed.
Haida Gwaii Hospital and Health Centre, Haida Gwaii, BC
Over 1,500 kilometres away, Elizabeth Moore and Shelly Crack bring traditional foods into hospitals on the islands of Haida Gwaii. Moore is a Haida knowledge keeper who teaches traditional foodways through a Local Foods to School program. Crack is a 20-year registered dietitian at Northern Health, which runs two hospitals on Haida Gwaii, with a total of 22 beds.
The pair worked with the hospital and food contractors to add locally sourced halibut soufflé, venison stew, salmon and other traditional meals to hospital menus. They also partner with local harvesters, cooks and families to serve additional Haida foods outside of the menu. These have included fresh prawns, ginger crab and herring eggs on kelp, among others. Crack uses grants to pay harvesters for their foods, and the hospital accepts donations ranging from fish to meat to berries.
“Eating in our culture is creating memories and bonding,” says Moore, adding that it is how recipes and cultural practices pass between generations. Echoing chef Foote, she says the tastes and smells of traditional foods conjure memories for patients, providing physical and psychological benefits.
Crack adds that when families visit to serve patients traditional meals, which may also include speaking Haida, it shows how “precious” Elders are to the community. She calls it “beautiful role modelling” for non-Indigenous staff.
“It shows how to approach care in a culturally sensitive way,” she says.
Both women say food contracts and government regulations are barriers to integrating more traditional foods. The menus, for instance, generally offer non-Indigenous and processed meals that are sourced from afar. And food safety rules prevent preparing certain locally harvested foods at the hospitals.
“It’s like the legislation hasn’t caught up with the Truth and Reconciliation Commission’s recommendations,” says Crack.
The commission’s 2015 final report presents recommendations for national healing from Canada’s residential school system. Items 18 to 24 call for the health-care system to recognize and incorporate Indigenous healing practices.
Paying harvesters for local foods and welcoming community members to serve traditional meals align with the recommendations. But the onus, including applying for grants, falls on community members or concerned staff like Crack, rather than being permanently incorporated into the system.
The hospital’s acceptance of traditional food donations also helps. To comply with laws, harvesters must certify that they used approved food-handling methods.
Similar requirements are part of a traditional foods program at Whitehorse General Hospital in Yukon. There, First Nations harvesters fill out forms showing they used “best practices” for gathering, cleaning and preserving foods. The hospital supports the program by funding an Indigenous liaison position, something not currently done at Haida Gwaii.
Crack bristles at some of the legalese, which can create barriers for local harvesters. She prefers that the law recognize that Indigenous people developed their own safe food-handling techniques over millennia. But she’s also grateful to Northern Health.
“I feel like the hospital administration works hard to remove barriers and buy local and traditional foods,” she says. “But we have more work to do.”
Moore points out that engaging harvesters benefits local communities, too. It gets families and youth onto the land to perpetuate traditions and track environmental conditions — all part of building a sustainable food economy. And she isn’t bothered by paying harvesters, which she says mirrors the blended cash and subsistence economies long present on Haida Gwaii.
For both women, embracing traditional foodways is good environmental stewardship. Sourcing from Haida Gwaii’s rich bounty of fish, berries and other foods carries only a fraction of the transportation and environmental costs of the food contracts. And avoiding food waste is inherent in Indigenous foodways.
More broadly, Northern Health uses regular audits to identify frequently uneaten items and will soon let acute care patients indicate verbally or by app what they want to eat. Long-term care patients have also been given greater choice, indicating a shift toward the more personalized service described by Foote.
Vancouver General Hospital, Vancouver, BC
On the British Columbia mainland, Vancouver General Hospital is also improving its food services, but in an urban setting home to over a million people. And while Vancouver Coastal Health, which runs the hospital, lists “Indigenous cultural safety” as a principle, its menu reform program is most immediately focused on responding to climate change and improving staff and patient health.
“The health-care sector has a tremendous opportunity to align with its core tenet of ‘do no harm’ by taking bold climate leadership and addressing its current footprint,” three of the program’s leaders, Dr. Annie Lalande, Ned Bell and Lana Brandt, recently wrote in the Vancouver Sun.
In March, the hospital concluded its six-month Planetary Health Menu Pilot, which temporarily served patients over 20 new plant-rich meals. Hospital staff developed the meals alongside noted chef and sustainability advocate Ned Bell. Dishes included steelhead trout with tomato miso dressing, creamy coconut chickpea curry with cauliflower and cashews, and a Korean gochujang bowl.
The dishes placed less emphasis on carbon-intensive meats. In an email, Vancouver Coastal Health communications leader April Penney says they included locally sourced fruits, vegetables and seafood and were meant to be diverse, flavourful and comforting for patients.
The meals were paired with patient surveys and monitored for rates of waste. Now, says Penney, the most-liked meals will be incorporated into menus across VCH’s facilities, which include 13 hospitals, 55 long-term care and assisted living sites and 17 community health centres.
Myriad partners contributed to the project, including Nourish, which seeks to reform hospital foods across Canada. A 2023 Nourish report describes additional Vancouver General efforts, including educational programs that “nudge” staff toward making plant-rich meals the norm, which the report says could reduce the menu’s carbon emissions by 10 to 15 per cent.
Future goals include developing Indigenous food options for long-term care patients. Already, Vancouver Coastal Health, among other Canadian health providers, offers an Elders in Residence program at several long-term facilities. The program embeds First Nations Elders at care units to inform individualized and culturally sensitive healing methods, which can include traditional foods.
Vancouver General is in the early stages of assessing food waste, too. In a pilot that used patient surveys and adjusted the portions and timing of meals, much the way chef Foote promotes in Anchorage, food waste dropped by 50 per cent.
‘Wonderful stories of hope’
The examples show overlap among efforts to restore Indigenous practices, improve patient health and fight climate change. Common among them are staff champions like Amy Foote and Shelly Crack, who are personally committed to change, paired with Indigenous knowledge keepers and hospital administrations willing to invest in reform. Common approaches include increasing individualized care and sourcing local ingredients. And partnerships are key.
“These are huge systemic problems that no one can solve alone,” says Lana Brandt, communications manager for Nourish.
Brandt says Nourish, which also collaborated at Haida Gwaii, connects and supports people working toward hospital food reform. Their goal is a more sustainable and equitable health-care system.
Nourish also provides programs like Food Is Our Medicine, an online course for health officials that explores the complex interplay between Indigenous foodways, reconciliation and healing.
Nourish reports also describe common challenges, including inflexibility within legislation or food contracts and misunderstanding or bias against Indigenous foodways. But sometimes change is hampered by limited resources, too. A spokesperson for Bartlett Regional Hospital in Juneau, Alaska, for instance, says serving Indigenous foods and reducing waste are desired, but rebuilding a post-pandemic workforce is the current priority.
Other efforts are more modest. In Ketchikan, activity staff drive long-term care patients to traditional food luncheons at the Ketchikan Indian Community.
In Sitka, the regional health consortium produced a 55-page traditional foods guide.
The B.C. First Nations Health Authority also produced traditional foods fact sheets with tips and recipes.
Brandt acknowledges that it’s all challenging work. But she also sees “wonderful stories of hope” at hospitals pursuing change.