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Hello and welcome to today's webinar on the climate crisis, food and lessons from New York City. I am delighted to welcome er two speakers with us here today. Ugh Montgomery is a professor of intensive care medicine at University College Hospital and co-chair of the lancet countdown on climate. It's an absolute delight to be able to welcome you here today. So thank you for joining us and we really look forward to hearing what you have to say about the latest updates in the climate crisis. Our second speaker is Heidi Fritz Heidi is a public health dietician based in Denver, Colorado and is the health program lead at Greener. By default, Greener by default is a nonprofit organization and was the organization that helped New York City and it's 11 public hospitals transfer to a predominantly plant based menu for all its inpatients earlier this year. So Heidi thank you so much for joining us this early in the morning and we really look forward to to hearing from you as well. So fur without further ado over to Professor Hugh. Good. Well, I've got 15 minutes. This is gonna be very quick because I need you to understand uh why this is really, really important. This isn't a nice to have. This isn't a little bit of an accessory to your day jobs. This is uh core business and it's about your survival now. So the reasons why straightforward these are greenhouse gasses, this is co2 steadily rising year on year inexorably at an ever increasing rate way above the 250 parts per million that we were at um pre industrially, that's trapping a lot of energy. Um You can measure it and rate it a forcing currently running at around 3.7 watts per square meter. But let's turn that into Hiroshima bombs. It's around eight Hiroshima bombs of energy per second that we're gaining to our atmosphere. 92% of that's been stored in our oceans and has been used in melting ice. And that's buffered us for a long time. It takes around if you think of the energy it takes to heat water from naught to 80 °C. So nearly boiling, that's the same amount of energy it takes to heat ice from naught degrees and turn it to water at naught degrees. So melting ice has buffered global energy uh temperature rises, but they are going through the roof. Indeed, sealer temperatures are rising steeply highest ever recorded in June. And actually, that's continued ever since. As we shall show you, atmospheric temperatures have been rising steadily as you all know. And indeed, we hit the highest temperature ever recorded in June and we've since exceeded it as I show you again shortly. And of course, it's not just averages. So, whilst average global surface temperatures have now risen, uh as of the 17th of November by two °C above normal, it's not evenly distributed. Um A lot of the very high rises are where we live. So average temperatures in a lot of the world have gone up by eight °C and these are average temperatures and you'll see very significant rises of the poles which we'll come back to as well. So one in a bit doesn't sound bad. Uh, eight sounds a lot worse and a lot of people are living with worse than that. That's melting the sea ice, which is steadily falling in extent. And melting land ice with thermal expansion of oceans, er, means that, er, er, sea level is rising ever more steeply as you can see here, we've gone up from 2.1 millimeters a year at the turn of the century to now ac a centimeter every two years. If you add energy to an atmosphere, you get weather, the more energy you add, the more extreme the weather is and the more extreme weather events you'll get and you'll see that those are also going up and going up ever more steeply as well as you would expect if you add a inherit of bombs of energy a second to the atmosphere. And let's remind ourselves of what we've seen in just the last three years. This was the northern hemisphere winter of 2020 massive fires in just the east of one province in just one country in just one season in just one year. Uh added 2.7% of global CO2 emissions from that one fire. But it wasn't the only fire. Indonesia was ablaze. Siberia was ablaze. Angola and Congo were ablaze. Amazon was ab blazed so it was California and then we moved through to 2000 and er er later in that year, the next year rather, Canada, Greece, Spain and the whole of Europe ablaze didn't stop there though, of course, in 2021 it wasn't just, everything was on fire, everything was flooding. So that summer, uh the Belt and German Border was flooding on the top left, top right. Germany was flooding middle there. Um The tens of thousands dying in China from floods bottom left, the three massive floods in August in London and the New York pictures that we all saw of the New York subway flooding that year too followed by Australia flooding British Columbia flooding and in the end, over 100 and 3000 people displaced in Malaysia following year, January highest temperatures ever recorded in South America, highest temperatures ever recorded in Australia. Highest temperatures in spring in Spain, highest temperatures ever recorded in Pakistan and India followed by highest temperatures ever recorded across Europe and in Japan, Korea and China by June followed by Great Britain in July. And yet the floods come back. Same year, causing the Tal in Africa saw the saw the highest density rainfall ever recorded. Spain saw the highest density ever recorded there in Valencia with massive flooding. Then Pakistan having been cooking with its highest temperature ever recorded was now underwater. A third of it underwater while Florida had the highest storm surge ever recorded there. Venezuela was bursting its banks twice in the year and over half a million people displaced in Nigeria in October of that year by January of this year. That was Bilbao on January the first where temperatures are normally 10 °C, they were 25 and people were out in swimming costumes playing beach volleyball whilst in France and Switzerland and Venice. Um everyone was drying up followed by massive heat waves and career highest temperatures again ever recorded the massive fires in Canada with the smoke coming down to New York and those with abuse in New York followed by massive flooding in New York, Spain, Oklahoma, Kansas, India and beyond as well as in Korea with record heats again this summer in China records broken again across Europe and in North America by August Hawaii was ablaze. China was flooding, Canada was on fire again and South American temperatures in their winter were higher than their normal summer temperatures. Whilst in September, Turkey, Greece and Bulgaria were under water and China was again suffering massive floods. As was Hong Kong in September, the dams burst in Libya killing 13,000 people and displacing 900,000 overall. The point being that 1.15 degrees of average global surface temperature rise is catastrophically unsafe and it's going to get worse because 1/5 of the CO2 we emit today will still be cooking our planet in 100,000 in, in 33,000 years and 7% in 100,000 years. Um We can't stop things accelerating from here. This paper in 2020 said we want target to 5.5 °C. Uh The latest data that we'll come to later say we are committed now to 3.4 °C this century with a plateau temperature of over 10, that will be a mass extinction event. The problem is that it's much, much worse than that emissions are going up exponentially not linearly. They look to us like linear because that's what the right hand of that graph, but they are actually going up exponentially. We added 1.1% of greenhouse gas emissions last year and it's worse also because we've triggered 10 positive feedback loops. Now, which mean that heating of the earth making is making the earth even hotter. Again, we're melting surface ice and snow, which is stopping light being reflected back into space. And that loss and the exposure of dark oceans and land has meant that we've doubled the rate of earth's energy gain. In only the last 14 years, fires are releasing carbon dioxide which is trapping more heat, which is causing more fires. And if we just think about the Canadian fires alone by the summer, that's the amount of CO2 that they've released. According to the Copernicus satellites, adding 6% to global greenhouse gas emissions. Just from those fires in Canada alone. Just in the summer, the fires are releasing carbon monoxide which mops up hydroxyl radicals and those hydroxyl radicals would normally clear methane 23 times as powerful. A greenhouse gas as is CO2 in its 1st 20 years. And we're releasing a lot of methane from carbonate rocks which are being heated from melting tundra and from fermenting wetlands. The result is that methane levels are rising, they were rising earlier on from fossil fuel use because natural gas is not in any way. A naturally nice thing. It's methane. We've reached a steady state uh in the last sort of eight or 10 years of the first part of the, of the century. But the positive feedback los now mean that we have an escalation in the rate of rise of methane from positive feedback. Rainforests are now net emitters because they're dry and desiccating and catching fire. We use 16 soccer pitches a minute fire in, in the Amazon alone. And meanwhile the massive storms are creating a sticking water vapor 19 kilometers up at the stratosphere troposphere border. Um And that acts as the greenhouse gas too. So we have got runaway climate change now. Um And we're still driving it because we're exponentially increasing the emissions. Um The smoke will also blanket um land which heats it up. The smoke from the fires in Australia raised land surface temperatures alone by three °C and the black soot in the stratosphere absorbed heat, raising its temperature by 0.7. And the pollutants also punch a hole in the ozone layer in Antarctica, which means that the ice melts even more quickly. You can see that we've triggered these positive feedback loops. Um If you look at temperatures, these are uh North Atlantic temperatures between 60 north and north and north to 80 west. Each little wiggly line going from January to December is a year, each year is getting hotter and hotter. The black line is this year. These are daily sea surface temperatures 60 north to 60 to globally. And each wiggly line as a previous year, the black line is this year. You can see it has gone way way, way beyond where it ought to be and this is not just the el nino effect and we're getting very big spikes. Um In June, the temperatures in the Baltic were 12 °C above normal causing a sort of extinction event of the snow crabs. There. Look at land surface temperatures, they've gone through the roof as well. Uh July saw the highest temperature on record on the planet. And in fact, if you look at the 30th warmest days were on record globally. Those are the ones from this year. Antarctic Sea Ice is collapsing. Same wiggly lines we talked about earlier on with the red line being this year, this sudden collapse in Antarctic Sea Ice because of these positive feedback loops. And we know the Arctic now could even be ice free by 2030. And that's the end of the Arctic ecosystem. And remember we sit on top of an ecological pyramid and when it collapses, we go with it, these are the latest data from temperature November the 17th, the first time in history that we've reached two °C above atmospheric averages, er preindustrial averages. And in November, another record broke and this was last week highest temperature ever recorded in Brazil at nearly 45 °C. It's worse still because weather states change in a binary fashion. Uh The polls are warming four times quicker than the global average and that can accelerate in what is known as Dans Osler Evens. And there's one there at 38,000 years ago when temperatures drop 12 °C within a decade or so on. The right is what was predicted for us that we've triggered such an event. And if you measure it, it because if we have because on March, the 21st, last year, temperature in Antarctica were 40 °C above normal and those in the Arctic 30 °C above normal the following day though it was worse still on the 22nd, it was 47 °C above normal, accelerating massive ice melt there. Whilst in the June of last year, average temperatures in the Arctic circle were 32.5 °C against the normal average of 13. Again, we're triggering these big feedback loops in terms of melt rates. Now, Greenland in September of last year, that red line is the sudden spike against the gray, which is the decay averages from before just that weekend, 20 Celss above normal, 20 billion tons of ice loss. 7% of an annual ice loss lost in 40 hours, the second year in a row that that had happened. And we are resetting Arctic ice when you tip things over, they suddenly melt. And to do that abrupt ice sheet collapse, that's triggered at around 1.7 to 2.3 of average temperatures. But remember we're at two °C as of November last year of this year. Uh Even temporary overshoots means that we have massive and sudden sea level rise to which we're now committed. Um And we've seen these binary state changes happening the first of um over 10 years ago, ocean circulations are going to collapse. We know the Atlantic abysmal circulation will collapse. These carry heat or cold water. We know the Atlantic r overturn circulation will collapse. Leading severe global weather changes. These two papers saying when, well, we're close to a critical transition now and it will happen within the next 30 or so years, perhaps 25 years. This paper coming out in March of this year saying it, er, we're into 95% confidence or intervals of this happening within 13 months of now. If that does happen, it will switch off the SM OC and the Atlantic circulation and the, that's the end of global food production and it's the end of human civilization. The jet stream is moving north at the boundary between cold north air and warmer southern there. And as the Arctic heat is moving south, that's gonna produce a massive drought in Spain, which we've already got water supplies in Spain and Portugal, southern iffy, France, North Africa will cease, er, they will become an inhabitable and the water will dumper on northern Europe's massive flooding. And we're also seeing those flips. That was the, er, flip in the jet stream causing the whole cold heat dome. Um, a cold dome rather in, um, North America at the beginning of the year. And it's bifurcating in the summer months, trapping heat in the middle as a ring of fire, which is why the world's been incinerating for the last two summers. We were just on the edge of that in Britain, uh, this year, which is why we were wet and cold and not so good where everyone else was very hot indeed. And we're talking about food today. Food supplies are going to be very, very badly affected. Let's just look at that. That's the Po River in July 2022. It dried up essentially that normally supplies 20% of Italian agriculture with the heat. That meant that c crop production, there was badly hit with massive economic costs to the Judo. Over €6 billion. In fact, it was probably nearer, nearer 11. The Rine in Germany couldn't ship food because it was down to 36 centimeters at carb and you needed four barges instead of one to get food through substantially adding to the cost of transport. And we're seeing this with the Panama Canal now which was running dry. And in May this year added $500 per container, not per ship per container to a surcharge to try to limit shipping that didn't work. So they actually had to put in restrictions into the Panama Canal, driving up food and commodity prices. As a result, Spain suffered massive food shortages earlier in this year. Um spent €2.2 billion already by May in trying to alleviate drought. And Italy is facing um a 32 plus billion loss 1 billion this year um from crop production and 32 billion, 33 billion near enough coming down the pipeline in coming years. That's the collapse of European economies as is happening in America. Um This event just the southern plains drought costing $9.4 billion. In 2022 15 confirmed extreme weather events due to climate change in America in 2023 each costing more than a billion Florida. The floods there costing 20 billion and that's attributable to climate change too. And this, this month only last week, in fact, the US National Climate assessment, uh pointing out that we're getting a a severe climate related weather event in the United States. Now every three weeks uh are costing around 100 and 50 billion to the US economy. And remember it's not going to stop there. This is just the start of it collapsing the world Meteorological organization pointing this out in May. Um We've already lost 4 to 5 trillion from the world economy from these climate related extreme weather events, Lloyds of London last month saying they're expecting around five trillion to go out of the world economy within five years. And they're also saying there's a one in 300 chance of a single extreme weather event hitting the food economy to the tune of $17.6 trillion. That's 1/5 of the global economy wiped out in one food event. Um With catastrophic societal impacts. We're already losing 4.5 $1000 a second to such events even now in the States alone, the impacts will be severe. This is what the IPCC said. We're expecting pigs extinction, widespread disease, unlivable heat and ecosystem collapse as a consequence within 30 years. And as I pointed out, the confidence in sort of that are much lower Lloyds are saying we have a one in 300 chance of that within five years. And we know the AM OC might switch off within 30 months. Um When these things happen, there will be a mass extinction. As this paper in science points out that's the end of, of life on earth as we know it. If we don't act now, then as the IPCC said, um we miss a rapidly closing window to secure a livable future. And yet last year we removed a cop 27 a target to reduce emissions. And that's off the table for this year. It's worse than that too because Jim Hansen's group at NASA Goddard, er, this paper was an archive expert. It's just come out actually, um, last week in Oxford climate. Um looking at the fact we've underestimated global heating, which is probably why it's run away so much more quickly than anyone had told you that it would. Um, as he points out 1.5 degrees is as dead as a doornail and that we're looking at a rise around 3.5 degrees um, this century and look where we're now with 1.15 uh but 1.5 degrees a century with a plat uh sorry, 3.5 with a plateau of 10 °C. So the solution is user and that is the good news part of this and it's what we're gonna talk about now, we can change this. There is time for us if we're very, very, very aggressive and you are here because you want to make that difference so well done, you healthcare can do it. Not because we're just 5% of emissions, but because we're 11.7% of global domestic product. And if we change what we do, um the Bank of England tell us that we only got to move between 10 and 12% of global domestic product for everything else to follow. So if we do this in health care, we save the world, which is quite good and we are starting today with food because methane accounts for 27% of global heating. Um We've got to get rid of natural gas, but a huge amount comes from fermenting rice fields and most of it from belching ruminant, local vegetable, seasonal and vegetable based products are very low carbon in general because they have very limited transport costs, very limited cooling costs during transportation, no refrigeration. If you buy an apple, for instance, in March, in England, it's been refrigerated for six months. If it's an English apple and if it's a vegetable, it's got a very low carbon cost for production and we can displace the belching cows as a process. It's also happened to be of course, very, very, very healthy as a white male at lower my risk of bowel cancer, coronary disease, dementia and a bunch of other things too. So it's good for health. It's good for planet. What we need to do, working with Nathan Victoria and those of you that are on this call is to produce a rapid exemplar which the rest of this country and then the rest of the world can follow. We are a little bit behind New York and we have a speaker who will tell us about that shortly. But together we can light the brush fire that we will make the change. And indeed, it's been a Touchstone for us because we can point to New York and say, come on, if New York can do this, then surely we can over here. So that's where I'm gonna stop. That was 17 minutes and we, I apologize for overrunning slightly. We can save the world, but we have to do it now. That's my message. Um There won't be time for questions on that. So Nathan back to you. Fantastic. Thank you. Thank you very much for a a whirlwind tour of all the latest updates in climate change, which I must say are are pretty terrifying and anxiety inducing to say the least. Um But it's a a nice message of hope to leave us with this. So thank you very much. And with that, I will hand over to Heidi Fritz who is a public health dietician and the healthcare program lead at um Green by the fault. Who are the team that helps New York City with their changes they introduced earlier this year? So Heidi, thank you very much for joining us from Colorado. I believe it is and over to you. All right, just get myself unmutated. Thank you so much, Nathan and uh Professor Montgomery as well. Um Yes, I'm hoping that I can offer a little bit more of a solution today and something more tangible to um think about uh as we look at um all the climate change statistics that were just presented as well. So um as as Nathan mentioned, I'm the healthcare program director with Greener by default, which is a US based consultancy. And today, I'll be sharing evidence based strategies for cultivating sustainability by default. Um As mentioned, I am a public health registered dietitian with a background in chronic disease prevention along with organizational and public policy change. So our mission at Greener by default is really simple. We are flipping the norm to make plant based the default whilst giving people the choice to opt in to meat and dairy. So before I explain how this works, I do wanna spend just a couple of minutes explaining why we're focused on plant based foods in particular. And this is really related to both uh planetary health and human health, which of course are closely uh linked and and very urgent issues. So as do Doctor Jonathan Foley from National Geographic explained when we think about threats to the environment. We tend to picture cars and smoke sacks, not dinner. But the truth is our need for food poses one of the biggest dangers to the planet. Many of those dangers come from one part of the agricultural sector. Globally. Animal agriculture uses 77% of all farmland and pro produces 57% of all food associated greenhouse gas emissions, but only produces 37% of the world's protein plants provide most of the protein while animals produce most of the emissions. In addition, much of the world's antibiotic supply is being used to promote growth in healthy livestock, which is really contributing to antibiotic resistance. According to the World Health Organization here, you can see how different protein sources compare in terms of greenhouse gas emissions. So the most carbon intensive foods are the animal products that you see on the left of the crap with beef, lamb and cheese, contributing the most emissions per kilogram of food and plant based foods on the right with the smallest carbon footprint, sometimes chicken is promoted as a sustainable choice as well. However, while its carbon footprint is much lower than beef, it's still seven times greater than those of plant based proteins like lentils and beans. Leading scientists of course, are increasingly alarmed about our food systems, environmental impacts. There are many peer-reviewed studies that have found that we can't keep climate change under control if we continue our diets as usual. And even if the food system were to remain as it is. While every other sector including energy, transportation and buildings became completely carbon neutral by 2050. Um As we've just heard, emissions from the food system alone would still take us over. Uh The now surpassed perhaps 1.5 degrees of warming in the Paris Agreement. The food system and modern diets are also at the heart of many public health issues. We know that half the risk factors associated with the highest number of deaths worldwide in 2019 were directly related to dietary choices. Uh There's also another study in the lens that that noted that poor diets effects on mortality. Now now also surpassed that of smoking and much of this diet related illness hits historically marginalized groups, the hardest poor dietary choices are also incredibly expensive. Accounting for a very large portion of health care costs and government spending. So there's a substantial amount of high quality observational and experimental evidence that links high consumption of processed meats, sodium and refined grains and cereals with low consumption of fruits, vegetables, legumes, nuts and seeds, with cardio metabolic diseases and different cancers. So that that's contributing to this as well. But there is some good news and that is that eating and serving more plant based meals is a critical strategy for reducing emissions while improving health outcomes. And according to the British dietetic association. It's estimated that well planned completely plant based diets need just one third of the fertile land, fresh water and energy of the typical British meat and dairy based diet. Um although the research varies on the magnitude of the environmental impact of meat in the diet versus plant foods. Um based on where people are on that spectrum of uh meat to uh to plants healthy plant based diets have at least a 30% lower carbon footprint. Um and as high as 75% less than an animal based diet, and they are also associated with significantly lower risk of many chronic diseases. So, plant based diets of course, have encouraging health benefits. Um Meta analyses have found that higher adherence to a plant based eating pattern is associated with lower risk of several diseases. As you can see here, research also suggests that there's a dose response effect. So the more plant based a person's eating pattern, the greater the reduction in health risks, especially when including plenty of whole plant foods. But even when they did include some processed foods in people's diets. Plant based diet is also low in saturated and trans fats while being rich in antioxidants, folate and Vitamin E, which may offer a protective effect against Alzheimer's and other dementias. According to the Physician's Committee for Responsible Medicine and the Lancet Commission on De on dementia. In addition, the World Health Organization also recommends a Mediterranean diet pattern rich in plant based foods and low in meats and saturated fats for the prevention of dementia. So really the main takeaway here is that you don't have to be completely vegan to reduce your risk of chronic diseases. But you do see more benefits as you eat more plants and fewer animal products. Now, for individuals looking to improve existing chronic conditions and risk factors. Controlled trials with plant based eating patterns also show significant reductions in key indicators like BP, LDL cholesterol, triglyceride concentrations, C reactor protein hemoglobin A1C and insulin resistance. And these are an interventions just as short as 1 to 2 months. So it's pretty impactful plant-based eating patterns were also found to be more effective in improving those measures than disease specific tailored eating plans within healthcare settings. There's good evidence suggesting that plant based eating patterns can reduce short and long term healthcare costs, decrease medication use and health care utilization. In one paper on vegetarians, they found they had 15% lower medical expenses compared to omnivores from the same population. Well, another paper on vegans found that they took 58% fewer prescribed and over the counter medications compared to omnivores from the same catchment area. And there's also emerging evidence that plant based eating patterns can reduce hospital readmission rates. So that's encouraging. So in case there's any doubt, I wanted to just touch on the nutritional adequacy of plant based eating patterns. Um And I'll mention that according to the British Dietetic Association. Well planned plant based diets can improve health outcomes and support healthy living at every stage and or every age and every life stage plant based diets can also be higher quality than that of standard diets. Uh plant based foods provide plenty of protein fiber phytonutrients and they're often higher in nutrients that many people are considered deficient in like magnesium or potassium and Vitamin C. There's data from a study of almost 1500 people found that those that were following a vegan diet had the highest values on the healthy eating index and the Mediterranean diet score while omnivores had the lowest scores on both of those indices. Um And in 2021 there was a review of 100 and 41 different studies that compared diets of vegetarians and vegans with meat eaters. They found that the, well, the protein intake was a little bit lower in people following plant based diets compared to meat eaters, but it was still well within the recommended intake levels for protein. Um And the researchers in this uh analysis found that there were some nutrient inadequate uh inadequacies across all of the dietary patterns. Um but they concluded that since plant based diets are generally better for health and the environment, public health strategies should facilitate the transition to a balanced diet with more diverse nutrient dense plant foods. Although plant based meals, uh someone might have during their hospital stay is not gonna convert them to a vegetarian or vegan diet while they're there. That's, that's not our objective, but it is good exposure and having more plant based menu items can offer patients a variety of foods that are good for their long term health as well as being fully nourishing, appetizing and culturally appropriate while they're ill and recovering. There's also a common misconception that plants don't stack up to animal proteins and I just wanna address that. Um In fact, all plants have all nine essential amino acids. Uh Those being the ones that the body can't make on its own along with con containing all the remainder of all 20 amino acids, which are the building blocks of protein. The key differences are that grains or cereals tend to be lower in lysine and beans tend to be a little bit lower in methionine. Otherwise, the distribution of amino acids is almost the same in plants as in animal foods. In particular, soya foods are considered complete proteins with an amino acid distribution, very similar to animal proteins. Um soy protein is also easily and quickly digested, making it a very high quality protein. So, dieticians used to be taught that combining certain plant based foods within a meal was important, like for example, combining uh beans and rice together to have a, the amino acids fit together. But we know now there's really no need to have complementary proteins in any one meal and then eating a variety of foods, even solely plant foods throughout the day. And in the overall diet ensures adequate essential amino acid intake. All right. So the core of our work at greener by default is making it easier and more appealing for omnivores to choose plant based options. And really changing the paradigm that says the plant based food is just for vegetarians. So how do we encourage that shift? Our program was inspired by behavioral economics. Specifically, this book Nudge, which examines the profound impacts of defaults and nudges on human behavior. A default is just the option that people end up with. If they don't make an active choice. For instance, many people's phone ring tone is still the default tone it came with because they just didn't bother to go through the settings and change it. It was just something else to do and then uh it didn't uh take that time to do it as the authors. Uh Baylor and Sunstein explain, people tend to stick with those defaults or the status quo, partly because it's just one less decision to make and partly because defaults are often seen as more socially acceptable. We have a subconscious assumption that if most people are doing something, it must be the right thing to do. We're social creatures we like to fit in and the surest way to do that is to mirror our peers and stick with the default when you combine plant based foods with defaults and nudges you get greener by default. Our concept is simple, facilitate healthy sustainable choices by flipping the norm right now, almost everywhere, meet and Darier than norm. People have to opt to plant based foods which usually only vegetarians and vegans would put in the time to do. And we're working to change that by making plant based the default and giving people the choice to opt in to meat and dairy. This way, everyone still has complete freedom of choice. Meat and dairy are still on the menu. But the more sustainable health promoting option is the default. The strategy is also flexible and can be implemented in any environment where food is served across a range of cuisines and dietary preferences. It's also cost neutral and can even save money. Our approach is also more inclusive for people with specific dietary needs, having to request special accommodations rather than just enjoying a meal can be alienating and it could take extra time serving plant based foods with the option to add meat and dairy includes everyone by default. It includes those with food allergies, problems of which has been increasing. And the roughly two thirds of the global population who are lactose intolerant, the majority of whom are people of color. It includes those practicing religions that encourage vegetarianism and those that keep kosher or donate pork, for example. And it also includes many communities of color uh with a global prevalence of vegetarianism estimated at 1.5 billion people. These defaults are also an extremely effective intervention greener by default, partnered with researchers at Harvard UCLA and other universities to study the impacts of a plant based default on meal choice that catered events. So in the control condition which you see on the part, on the left side of the slide, it was found that when meat was the default and people could request a plant based option, less than 20% of people requested that plant based meal. But when plant based was the default, and people could request a meat meal. On average two thirds of people stuck with a plant based default and one third requested a meat meal. This is an almost 50% point increase in the number of people eating plant based meals simply by switching the default better yet. This doesn't upset people in the way that a fully plant based menu could because the people that uh really want meat, they still have that option available to them. It's just no longer the default for everyone. So another strategy uh that we suggest when it's not possible to make the base of the meal entirely plant based is that you can create the perception of a plant based default by offering a minimum ratio of 2 to 1 veg to me options. A recent study found that when menus shift from having two thirds meat options to two thirds veg options, selection of the veg meals increases by 56% overall. And this is really just because when there's only one vegetarian or plant based option, the omnivores might perceive it as the special option. That's just for vegans or vegetarians. So if I don't follow those diets, I might think that's not the food for me. But when we shift the ratios and provide an abundance of veg options, we also shift the decision making process. So now people are thinking about, do I want those black bean enchiladas or the Chickpea curry or the pasta primavera? They're thinking more about the flavors and what sounds good today, what they're in the mood for rather than whether they identify as a vegetarian who would go out of their way to not eat meat. So greener by default has a few other menu engineering strategies we recommend. But just for time purposes, I'm not gonna go into those right now. I know that you also wanted to hear about New York City. Uh Greener by default, worked with New York City health and hospitals to pilot plant based defaults for patient lunches at one of their hospitals. Um And the way they do this in their operation is to have their food service associates first offer patients to plant based chef specials. And then if the patients decline those um they're offered the rest of the menu including animal based dishes in the pilot. They found that more than half of patients selected one of the plant based meals and 95% of those patients were satisfied with their, with their meal choice. So the pilot was so successful that they are now implementing the defaults at lunch and dinner at all. 11 of their hospitals across New York City saving an estimated half a million US dollars annually. Um They also cut their carbon footprint by about a third, which is amazing. All right, what's especially powerful about New York's program is that they're really serving cuisines that reflect the cultural diversity and preferences of their patient population. And these are just a few of the dishes that they serve, which really illustrate how delicious plant based meals can be and why this program has been really successful for them. So, um I do also have a short video that I'd like to share about New York City's program uh which sums up why we are doing this work. And I just realized, I don't think I shared my sound uh when I initially shared my screen here. So let me stop sharing for just a second and try this one more time. So I can share my sound and hopefully that will work and you'll have to just let me know if, yeah. Can you all hear the sound good? All good. Most communities of color we suffer from high levels of diabetes. We're dying from hypertension. We're dying from so many cardiovascular diseases when it comes to a meat based diet. We typically will see an increase in blood cholesterol in high BP and overall weight management. What we really ought to be doing as health care systems is to address some of the root causes of these chronic diseases. Our mission at health and hospitals is to leverage one of the most powerful tools we have and that's nutrition. And so what we're planning to do is incorporate nutrition into the fabric of the care that we provide. No one likes having something forced onto them or feeling like they're having their choice taken away from them. So in New York City, health and hospitals, they have initiated a really groundbreaking new program where patients choose from different meals. But the two chefs special of the day are now always plant based and then if they don't want those and they have a variety of meat options to choose from. So with the default approach, you keep everyone happy because everyone has the options that they want or need. But again, it's nudging people towards the more sustainable plant based options. Food is good. I like the vegetable and the vegetable is good for health. So when we're developing menus, what we look at, number one is the cultures that we feed. We look into our communities, the foods that they've grown up on things that they might make at home. And we take that approach, we just make them healthier meat, proteins have fat, they have that umami flavor. So we try to do that with vegetables. So by roasting them and, and getting the natural sugars out of the vegetables and caramelizing them. It really makes it exciting as a retro dietician being able to provide that patient with the amount of calories that they need the amount of protein and making sure that we're meeting all their micronutrient needs through a plant based diet has really been eye opening. It's not as hard as it appears to be. I thought it was gonna be more difficult. We get a really good feedback from our patients. Some of the people actually said to me, this reminds me of my mom sent coo I know there's no meat, meat but it was really delicious. Eating healthy is not just for the wealthy, it's not for the well educated only. It's also for me and you and our community, right? So what's in it for guys in Saint Thomas? Uh Here's just a few of the potential benefits of implementing green or by default strategies. Um plant based meals can certainly allow for more streamlined menus and reduce the need to stock specialty ingredients and ready made meals that satisfy a number of diverse dietary needs, which could also reduce food waste. And just thinking about recent price fluctuations in foods like poultry and eggs due to avian flu outbreaks, reducing the purchase of those items could help protect the catering department budget from large and unpredictable changes. Uh foodborne illness is another one. And I recognized that food safety practices of, of course, are critical for all foods including plant based foods. But if you reduce the amount of high risk foods like raw or undercooked meat, poultry, fish, seafood and eggs, that could help your uh lower your risk of foodborne illness. Um We also know that plant based foods may have lower risk of cross contamination and harmful pathogens like listeria, which are commonly associated with animal foods in terms of emissions reductions. Greener by default, strategies are easier to implement and more cost effective in reducing emissions compared to many other sustainability interventions. Far more even than using local suppliers. It's really more about of what you're buying instead of where it's coming from in terms of the emissions when it comes to food. Um If you are making changes to menus for hospital staff, plant based foods can also improve the quality of calories that staff are consuming there and help manage obesity and chronic diseases among staff, which may reduce overall staff healthcare challenges as well as the use of sick days. And finally, I'll just explain briefly how we could work together to bring greener by default to guys in Saint Thomas. Um Our concepts really work in any food service setting um whether it's patient dining catered meetings, staff cafeterias, as well as coffee bar, bars, and cafes. And so what we would do is just help you determine where greener by default, can make the greatest impact for you and where it would be easiest to implement a pilot. Um just like New York City Health and hospitals, they started with just patient lunches. You could also start with just one meal a day. You can start with one or two wards, whatever makes sense. Um You know, we're, we're very flexible with that and here's just a bit about our process. So once we work together with you to identify a pilot site, we would complete an audit of your existing menus and propose a range of different strategies like the climate friendly ratios and the plant based defaults that I mentioned along with a few others that we didn't get to talk about today. And then once you have selected the strategies that you want to test, we would work with your team to design a pilot to fit your specific goals and your food service environment. We typically recommend pilots in multiple phases so that you can collect baseline data and then gradually shift the menu and ease diners into more plant based dishes over a bit of time. Um We would help you implement the pilot which usually runs about three months and support your team with menu design and project management throughout. Um Other things that we can provide are communication, toolkits, um kickoff presentations for staff, any um consul consultation on um things like training materials and culinary guidance as needed after the pilot concludes, we would help analyze your purchasing and production data or sales data as well as diner satisfaction data to calculate changes in emissions, water use and diner satisfaction. And then if you're interested, we also can help you publicize the results of the pilot because this is a great pr opportunity as well. Um And best of all our services are completely free of charge. We are a nonprofit consultancy and our work uh with the health care sector in particular is funded by foundations and donors who believe in our mission. And so we don't have to charge for um any of our work with health care. Uh If you do work with us, you would be in good company and joining a growing number of institutions that are implementing plant based defaults. And I would really love to collaborate with you. Um This is just our website and my contact information here. I'd be happy to answer any questions about our process and uh and next steps, thank you so much for everything you've just s shared. It's really fantastic to hear this, a sense of optimism and give us a really tangible action that we can take as healthcare professionals and healthcare organizations that will make a truly important er difference, not only to the health of our planet, but also to the health of our, our patients. So thank you once again, so much for sharing your time and your expertise on this topic. Um And of course, thank you to Professor Hugh as as well for sharing all of your expertise on this topic and for joining us here today um with a really quite stark warning about what is to come if we don't take any action. So, on this last screen, er, we have the feedback survey QR code. So please do fill that out. It will give us the opportunity to collect your views. Um, you can either fill it in as a name respondent or anonymously. And of course, if anybody's got any questions, then please do feel free to email me on Nathan J HP at doctors.org dot UK. So once again, a massive thank you to Hugh and Heidi for joining us today and sharing all of your thoughts and a huge thank you to you as well for joining us live today or for watching, back on catch up. Um I look forward to hearing from you in the survey and that's it for now.