Date of Award

January 2022

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Leah M. Ferrucci

Second Advisor

Brooke M. Bell

Abstract

Interest in environmentally sustainable diets (i.e., diets beneficial for both human and planetary health) has increased as the role of food systems in climate change and population health has become better understood. Sustainable diet indices have been proposed as a holistic approach to assessing diets around the world with regards to human and planetary outcomes. The aim of this scoping review was to summarize and compare sustainable diet indices and their applicability to various populations.A literature search of three databases (Scopus, PubMed, and the Climate Change and Human Health Literature Search Portal) was conducted to identify articles that developed, validated, and/or applied a sustainable diet index. The search strategy included terms related to diet/food (e.g., food, dietary, eat), sustainability (e.g., sustainable, climate), and index/score (e.g., score, metric). The search was limited to articles published in English between January 1, 2010, and January 4, 2022. Two reviewers independently screened retrieved abstracts (N=4,188) and then eligible full-text articles (N=188) utilizing a priori inclusion and exclusion criteria. In total, we identified 51 sustainable diet indices in 61 articles. Six articles had a global or continental context rather than application to one specific country, while the remaining 55 articles were conducted in 33 different countries, 17 (51.5%) of which were low- or middle-income countries. Two types of approaches were used to construct the indices: impact calculated from food item-level consumption data (N=36, 70.6%) and impact calculated from adherence to a pre-defined diet or dietary pattern or dietary guideline (N=15, 29.4%). In addition to indicators related to environmental sustainability, the three most common indicators were related to human health (N=41, 80.4%), economic aspects (N=16, 39.0%), and sociocultural context (N=9, 17.6%). Scoring methodologies varied across indices, including calculating a composite score by weighing domains (N=9, 17.6%), scoring based directly on adherence to a pre-specified dietary pattern or guideline (N=7, 13.7%), and scoring of just a single domain (N=5, 5.8%). Our review noted a wealth of sustainable indices in the literature developed in a wide range of countries and locations. The most comprehensive indices covered at least the four most common sustainability domains (environmental sustainability, human health, economic aspects, and sociocultural context) and multiple indicators per domain. Comparability across studies is challenging as many existing indices included domains and measures tailored to geographic locations or populations. To advance research in this area of study, sustainable diet indices should capture the most important sectors food systems impact, including agriculture, energy, and healthcare, have easily understood scoring or rating systems, and strive to have targeted applicability for specific end-users, such as individuals, organizations, populations, and policymakers.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/19/2024

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