A recent survey of German hospitals and nursing homes has found that the very institutions tasked with protecting human health may in fact be harming it—alongside the planet’s.
The new work is the first to do a deep-dive into the impacts of the catering at care institutions, and showed that they scored concerningly low on nutritional value, and strikingly high on environmental impact.
The Germany-based researchers carried out a survey on five institutions in the country: two hospitals, and three care homes. From each, they gathered detailed data on the meals prepared for nursing home and hospital residents.
To get a nutritional overview, the researchers analyzed a week’s worth of breakfasts, lunches, dinners, beverages and snacks from each institution, and used the 2020 Healthy Eating Index and the EAT-Lancet Planetary Health Diet to determine quality. To measure the environmental footprint, they gathered a year’s worth of food procurement data for each institution, then broke it down into 50 food groups—for example ‘chicken’, ‘milk’, ‘rice’—so that they could assess the lifecycle impacts of each one, including its greenhouse gas emissions, land and water use, and water-polluting effects.
The results showed an unmistakable overlap between poor nutrition and harm to the environment. None of the five institutions scored higher than 57 out of 100 on the Healthy Eating Index and most scored around 40. These low scores were tied to a higher planetary impact.
Nutritionally-speaking, the researchers found that institutional meals were low in the good stuff: fiber was lacking, and levels of micronutrients such as vitamin C, potassium, and several vitamin Bs were low across all institutions, while protein levels were insufficient in the three nursing homes. Conversely, sodium and chloride—which should be consumed in limited quantities—exceeded the recommended dietary intake, and meals were also noticeably high in saturated fats.
The poor nutritional performance of these institutional diets is such that the researchers fear that consuming them over the long-term would be harmful to human health.
Dietary guidelines say that a healthy diet should get 80% of its calories from wholesome plant-based food, and yet none of the five institutions derived more than 20% of their food from these sources. In fact, 60% of the protein in these institutional diets came from animal-based foods while just 1% came from plants. This partially explains the high fat- and salt-intake.
Meanwhile, this heavier meat and dairy intake is also linked to higher emissions. Meat consumption alone accounted for 38% of the greenhouse gas emissions, 45% of land-use impacts, and 40% of eutrophication associated with hospitals and care home catering. Animal-sourced foods in general were responsible for three-quarters of the environmental impacts overall, despite providing just one-third of the calories. Plant-sourced foods, meanwhile, contributed between just 13 and 20% of environmental impacts overall, yet contributed the large majority of consumed calories.
“I think everyone knows that food in these settings is not the healthiest; I’ve experienced this myself,” says Lisa Pörtner, a postdoctoral research at the Potsdam Institute for Climate Impact Research, and the study’s lead author. “But it was still surprising to have concrete numbers affirm this impression and see just how far away some institutions are from a diet that is healthy and sustainable.”
The takeaway from these striking figures is that what’s harmful to human health seems to also threaten the planet: it’s ironic that this trend was found to be so stark in healthcare institutions. And while the study focused on a small sample of five institutions in one country, it’s likely that the trends it identifies are repeated elsewhere, the researchers say, potentially making the health and environmental impact of care homes and hospital food one of considerable scale.
But these institutional settings also provide an opportunity to get to grips with the problem, as they are “expected to promote health” and “serve as role models” for society, the study authors write.
Hospitals and care homes can be helped to play this role through better government support, as poor quality catering is partially a symptom of financial strain, they note. “I hope that our research helps to put healthcare foodservice higher on the agenda, as it has received very little attention to date,” Pörtner says. “Ideally, concrete steps would be taken by both healthcare providers and policy-makers to improve the situation.”
With that, these institutions could start to align the health of their patients with that of the planet, through the powerful medium of food.
Pörtner et. al. “Dietary quality and environmental footprint of health-care foodservice: a quantitative analysis using dietary indices and lifecycle assessment data.” Lancet Planetary Health. 2025.
Image: Unsplash+