In a recent study published in the journal Nutrients, researchers conducted interviews and online surveys with hospital café employees to investigate support and implementation variables towards the Meat-Free Mondays (MFMs) movement. More than half of the 194 participants in the survey were actively contributing to the movement, and nearly 60% supported the movement. Study findings revealed proof of the benefits of MFMs, and greater inclusion and consultation with café employees were the most influential variables in making the movement successful.

Study: Meat-Free Mondays in Hospital Cafés in Aotearoa, New Zealand. Image Credit: Created with the assistance of DALL·E 3

The qualms of a non-vegetarian diet

Unprecedented anthropogenic greenhouse gas emissions find the Earth at the tipping point of sustainable environmental health. The resultant climate change already presents severe threats to public safety, affecting weather (increased sporadic floods and droughts), diseases (increased pathogen load), and food availability (reduced soil fertility and an overreliance on chemical growth enhancers and genetically modified crops).

Surprisingly, the food system is a crucial driver of climate change – the agricultural industry represented one of the most significant contributors to climate change, with methane and nitrous oxide emissions from livestock rearing (14.5%) being the single largest greenhouse gas source globally. Meat production requires greater land, water, and feed availability than crop production. Alarmingly, a growing body of research identifies livestock rearing in combination with excessive antibiotic use as central to the recent risk of diseases, both infectious and noncommunicable, worldwide.

Noncommunicable diseases (NCDs) are the primary cause of global mortality, responsible for an estimated 89% of all human deaths. NCDs are associated with a complex interplay between genetics, socioeconomics, and individual health behaviors. These health behaviors are modifiable, with diet at the forefront of interventions to combat NCDs and improve public health. The New Zealand (NZ) Adult Nutrition Survey (2008/09) has identified critical deficits in the average NZ citizen's dietary composition, with only 32.8% of NZ adults meeting prescribed food and vegetable requirements and almost all NZ adults failing to meet recommended fiber intakes.

Alarmingly, NZ has been identified as the 6^th largest meat-consuming nation in the world (per capita) per the findings of the Organisation for Economic and Development (OECD). Research has associated prolonged red meat consumption with increasing NCD risk, including type 2 diabetes (T2D), cancers, coronary artery disease, cardiovascular disease (CVD), and total mortality.

"In 2019, the EAT-Lancet Commission recommended a largely plant-based diet, advising that profound changes must be made to the global food system to feed the world's population of 10 billion within planetary boundaries by 2050."

A potential answer to the growing concerns of meat overconsumption is the Meatless Mondays (MMs) campaign. Initiated in the US, the MMs campaign encourages individuals to forgo meat on all Mondays and also attempts to substitute 15% of current meat consumption with equivalent vegetarian intake. It has gained global popularity, with numerous cafés, hospitals, restaurants, and even schools partaking in and advertising the benefits of the movement. However, insufficient work has documented the impacts of MM compliance on public and environmental health.

About the study

The present study investigates the enablers and barriers to implementing the Meat-Free Mondays (MFMs) policy, a policy characterized by the free or subsidized provisions of vegetarian diets across District Health Boards (DHBs) across NZ. The study was conducted to identify and provide recommendations to facilitate future policy implementations.

Three of the 20 DHBs in NZ were selected based on their different stages of contemplation/implementation of MFMs. DHB1 (Nelson Marlborough DBH) had been implementing the policy for over two years at study initiation, DHB2 (Northland DBH) was in the process of trialing the policy, and DHB3 (Auckland DHB) was not implementing the policy.

This study comprised a 12-question online staff survey, semi-structured interviews of crucial job representatives, and an open-ended survey open to both DHB staff and the NZ public. The surveys and interviews were formulated based on inputs from a seven-member team comprising three nutrition experts, a DHB manager, and three lay people. The surveys additionally collected participant demographics, eating habits, and general attitudes toward MFMs.

The χ² (Chi-squared) test was used for statistical analyses. More extensive studies could not be conducted due to insufficient sample sizes.

Study findings

The online survey sample cohort comprised 194 respondents from DHB1 (54.1%) and DHB3 (45.9%). Most participants were female (76.3%) and belonged to the Pākehā (72.7%) ethnicity. Allied health or other health professionals (28.9%) comprised the majority of respondents. More than 60% of respondents were meat eaters (63.4%), with flexitarian (18.6%), pescatarian (7.2%), vegetarian (6.7%), and vegan (4.1%) representing the dietary minorities.

Encouragingly, more than 50% of meat-eating respondents reported taking active measures to substitute meat-based foods with vegetarian alternatives.

"Approximately one and a half times as many respondents were vegan at DHB3 (12.4%) compared with DHB1 (8.9%). There were approximately twice as many flexitarians at DHB1 (25.8%) than at DHB3 (12.4%)."

Health, environmental concerns, and an affinity for plant-based dishes were identified as the significant enablers of MFMs policy implementation. Concerns towards animal welfare and economic savings represented minor, yet significant, enablers towards reduced meat consumption. In contrast, knowledge (30.1%), taste (26.3%), and familiarity (16%) were identified as the primary barriers against policy subscription.

Awareness was found to be high across DHBs, with 65.5% of all respondents aware of the movement. However, inter-DBH understanding was found to vary greatly – DHB1 depicted 79.8% awareness versus DHB3, which described only 53.3%. Surprisingly, awareness in MZ hospitals was observed to be lower than that of the general populace. Statistical analyses of support revealed that 58.8% of all participants supported the movement and were taking an active role in its implementation.

Interview results identified (in contrast to previous surveys) that environmental concerns and not health benefits were the most critical enablers of the movement among café managers.

"A proportion of respondents did not feel that reducing meat would positively impact the environment. Some felt other sustainable actions would have more benefits, such as packaging, recycling, reducing food transportation and regenerative agriculture. This sentiment was echoed in the interviews and is aligned with other research in this area.

Conclusions

The present study investigates the enablers and barriers to implementing the MFMs campaign across three NZ DHBs at different stages of their policy implementation. It identifies misconceptions and lack of sufficient knowledge as significant barriers to the ongoing success of the policy. It recommends outreach to key movement players, including café managers, café staff, and medical personnel, as the best possible intervention for the policy's rapid and successful future deployment.

Written by

Hugo Francisco de Souza

Hugo Francisco de Souza is a scientific writer based in Bangalore, Karnataka, India. His academic passions lie in biogeography, evolutionary biology, and herpetology. He is currently pursuing his Ph.D. from the Centre for Ecological Sciences, Indian Institute of Science, where he studies the origins, dispersal, and speciation of wetland-associated snakes. Hugo has received, amongst others, the DST-INSPIRE fellowship for his doctoral research and the Gold Medal from Pondicherry University for academic excellence during his Masters. His research has been published in high-impact peer-reviewed journals, including PLOS Neglected Tropical Diseases and Systematic Biology. When not working or writing, Hugo can be found consuming copious amounts of anime and manga, composing and making music with his bass guitar, shredding trails on his MTB, playing video games (he prefers the term ‘gaming’), or tinkering with all things tech.