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Title: Embedding ecological public health in the hospital foodservice system : a case study in Wales
Author: McWilliam, Susannah
ISNI:       0000 0004 5352 3497
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2014
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Literature suggests that the public sector has a unique responsibility to promote sustainable practice from within. Food systems impact on planetary, social, economic and human health, and Ecological Public Health (EPH) is making these holistic connections explicit. This study developed a new methodological approach based on the principles of EPH, which for the first time are used to empirically investigate a complex foodservice system, the hospital foodservice system. In addition, Street Level Bureaucrat theory is used at the ward level for the first time deepening understanding of workers’ practices, particularly on the theme of choice. Using a case study based within one Welsh Health Board, this research considered the translation of a new Welsh policy into practice through an exploration of two key elements within the foodservice system: menu planning and food service at ward level. Following the systemic and interdisciplinary thinking promoted by EPH, a multi-methods approach was taken using documents and formal interviews with 28 key stakeholders in the case study Health Board. Ward based studies took place in three Health Board hospitals: lunch service on a total of nine wards was explored through observation, 33 informal interviews, 104 patient experience questionnaires, waste data and an in-depth study of one meal (lasagne) with 48 participants. The study showed mixed findings in the translation of policy into practice: aspirations to improve sustainability through procurement and waste reduction did not materialise in practice, and the individualised approaches of workers led to high levels of food waste and inconsistent approaches to choice. Patient satisfaction with choice increased under new menus, but a drop in satisfaction around menu changeability was found, particularly for longer stay patients. Finally, the lasagne study showed that patients had diverse responses to the same dish, and that liking the dish did not mean enough was eaten to meet nutritional needs. Such findings, in drawing the fields of nutrition and sustainability together, have multi-disciplinary impact, particularly for nutrition, environmental and hospitality management studies. In turn the findings demonstrate the value of research that draws on the principles of EPH.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: HT Communities. Classes. Races ; RA0421 Public health. Hygiene. Preventive Medicine