Home » A multi-problem solution – why hospitals are serving plant-based by default

A multi-problem solution – why hospitals are serving plant-based by default

The future of healthcare catering

Across the public catering sector, alternative proteins are on the rise. Whether in schools, prisons, or universities, the value of plant-based catering is becoming increasingly recognised. 

Given the well-known health benefits of a whole foods plant-based diet, plant-based catering is the obvious choice for hospital canteens and in-patient meals

How are hospitals transitioning to plant-based catering? In this article, the New Food Hub spotlights the case study of New York’s public hospitals. An effort spearheaded by New York Mayor and plant-based advocate Eric Adams, the initiative to default plant-based meals boasts impressive results

To name just one success: before defaulting, 1% of eligible patients chose a plant-based meal. Now, the figure is 50%

New York’s public hospitals provide a powerful proof of concept for embracing plant-based catering in healthcare institutions. Read on to discover how this was achieved, and what’s being done to replicate this success. 

Why are hospitals serving plant-based defaults?

Personal health

As health-centred institutions, plant-based food is the logical catering choice. 

Various animal-based foods are being increasingly recognized as harmful to human health. Processed meat is now classified by the WHO as a carcinogen, whilst red meat (i.e. mammalian meat) is classified as a probable carcinogen. 

why hospitals are serving plant-based by default
Source: Pexels/Cottonbro studio.

Given our evolving knowledge on the harms of these animal products, serving such foods in hospitals is becoming increasingly incongruous with the mission of healthcare providers. In an open letter to the British National Health Service, a group of doctors stated: “It’s the equivalent to distributing cigarettes in the pulmonary care unit.”1

In contrast, whole foods plant-based diets have consistently been found to reduce a variety of chronic diseases, which are major sources of strain for healthcare services with aging populations. As Shireen Kassam, Founder of Plant-Based Health Professionals UK, explains:

“Plant-based diets have been shown over and over to reduce the risk of chronic health conditions. Studies continue to show that vegans have lower rates of heart diseases, type 2 diabetes and certain cancers. With 42% of adults living with a chronic condition and most of us spending our last decade in ill health, supporting people to adopt a plant-based diet seems a simple solution.”

Dr. Shireen Kassam

Founder, Plant-Based Health Professionals UK

This speaks to the preventative potential of plant-based catering. Instead of providing patients with food that could increase their risk of a return visit, plant-based catering provides them with a diet proven to reduce the risk of chronic health conditions. 

Public health

From a public health perspective, plant-based catering also aligns with hospitals’ best interests. Given the risks we face from antibiotic resistance, the use of antibiotics in animal agriculture is a cause for concern. 

It still surprises many to learn that the majority – 66% – of antibiotics are given to farmed animals, where animals are routinely ‘mass-medicated’ in order to stave off diseases that naturally spread in intensive farming systems.2 Given how stringent many doctors now are with antibiotic use on their own patients, it seems counterintuitive to allow their excessive use in the food hospitals serve. 

Animal farming also increases the risk of future pandemics by creating an ideal breeding ground for the emergence and spread of zoonotic diseases. Farm animals have been linked to the outbreak of various pandemics in recent history, and zoonosis is one of the leading theories explaining the outbreak of COVID-19. 

Source: Pexels/Karolina Grabowska.

Given the severe impact COVID-19 had on our society (not least our healthcare sector), plant-based food has the potential to align hospital catering with increased pandemic preparedness and good public health practices.

“The last 100 years has shown us that pandemics will continue unless we change the way we eat. We need to learn from our mistakes.”

Dr. Shireen Kassam

Founder, Plant-Based Health Professionals UK

Collectively, the negative health outcomes associated with animal products exert a significant strain on healthcare systems, one that is expected to increase as our population ages. Plant-based hospital catering is not only a matter of nutritional preference, but also a strategic move aimed at reducing the prevalence of chronic illnesses that are a major burden for healthcare services.

By embracing plant-based menus, hospitals can improve patient and public health, and directly mitigate the chronic and public health risks they continually combat. 

But beyond the theory, can this work in reality? Enter New York’s public hospitals. 

The largest municipal system in the US, NYC Health + Hospitals have already received significant attention for their move to make plant-based the default for their inpatient meals. The transition was led by the New York Mayor’s Office, as part of Mayor Eric Adams’ efforts to promote plant-based diets in the city.3 

To understand all the details of the initiative, the New Food Hub sat down with Rachel Atcheson, Deputy Director of the NYC Mayor’s Office of Food Policy. 

The idea stemmed from a Meatless Mondays initiative that was rolled out by NYC Health + Hospitals in 2019. After some R&D to determine which recipes were most effective, default plant-based lunches launched in March 2022. Six months later, backed by positive data, plant-based defaults were extended to both lunch and dinner. 

The plant-based defaulting initiative is in essence, a simple one. Menus for in-patient meals have two initial options, both of which are vegan by default (although, in-line with a growing body of research on consumer perceptions of food labels, you won’t see the word vegan on the menu4). 

Only if the patient doesn’t want both plant-based options – such as a Garden Bolognese with Rotini and Spinach or a Vegetable Paella with Yellow Rice – will a meat option then be offered.   

And the results of this simple defaulting design are truly impressive. 

Before the initiative, just 1% of patients were choosing plant-based hospital meals. With the plant-based defaults in place, that figure has risen to 50%.5

As a result, NYC Health + Hospitals have recorded a 36% decrease in food related emissions, cost savings of around 59 cents per meal, and a patient satisfaction rate above 95%.6 In 2023, they served roughly one million plant-based meals to patients. 

Source: Pexels/Lukas Kloeppel.

The New York case study demonstrates that plant-based catering in hospitals is a multi-problem solution: reducing carbon emissions, lowering costs, and maintaining exceptional patient satisfaction simultaneously. And all thanks to the relatively simple and achievable method of menu defaults

Beyond New York

Of course, not everyone has the leverage that the New York Mayor’s Office has. But now that the proof of concept is set, there is hope that more hospitals could make similar changes. 

“This case study demonstrates the value of implementing plant-based defaults in hospitals. We now have the data to show that this cuts carbon emissions and reduces costs, all while retaining patient satisfaction. It’s simple and effective.”

Rachel Atcheson

Deputy Director of the NYC Mayor’s Office of Food Policy

One American organization, Greener By Default, specializes in defaulting plant-based offerings in various foodservice settings, including hospitals. They currently work across the US to help hospitals implement default plant-based menus. 

“We create custom interventions based on the foodservice environment and patient demographics. For those seeking to increase the sustainability and cost-effectiveness of their catering whilst retaining patient satisfaction, contact Greener By Default so that we can conduct a menu audit and offer customized suggestions that will be easiest to implement and have the biggest impact.”

Katie Cantrell

Co-Founder and CEO of Greener By Default

Actionable insights

Institutional catering changes like this don’t happen overnight – they require careful planning, successful pilots, and buy-in from stakeholders. However, success stories like New York’s public hospitals act as a powerful proof of concept that this strategy is a viable and impactful way to accelerate the protein transition

Moreover, organizations like Greener By Default provide tailored services to aid healthcare institutions in this transition. Beyond defaulting, organizations like the World Resources Institute provide a host of research-backed behavioral nudges from menu design to interpersonal strategies that can be even simpler to implement. 

To effectively promote plant-based catering in hospitals, the New Food Hub recommends:

Especially given that their implementation can often be as easy as re-structuring pre-existing offerings, plant-based defaults offer an impressively high return on investment as a method of food system change. They don’t compromise patient choice, and so are often a more politically palatable option. New York’s hospitals are testament to the truly remarkable benefits that come from simply making the most sustainable food the default choice. 

From the New York team’s experience, the first default is by far the most important. Whilst they expected the second default to catch patients who rejected the first option due to taste preference, that’s not what the data showed. In reality, the vast majority of patients chose the first default, with the second proving only marginally effective. If resources are limited, having at least one default plant-based option on the menu seems most important. 

It can be challenging to convince strained healthcare systems with limited resources to change. A key learning from the New York case study was that the support of stakeholders is key. The team behind the initiative visited all 11 of the city’s public hospitals to deliver a presentation and taste-testing session demonstrating the benefits of their proposal. Once the key decision makers were on board, there was little resistance or backlash. So, wherever possible, target those in power, and use the growing authority of the research and organizations promoting vegan food in hospitals to your advantage. Their success to date is a powerful and convincing tool demonstrating the success of sustainable, delicious, plant-based food. 

If you’d like more support on your plant-based strategy, please visit the New Food Hub and contact ProVeg’s experts at [email protected]

Billy Nicholles 


  1. Scottish Doctors Tell NHS Serving Meat in Hospitals is like Distributing Cigarettes (2022). Vegan First. Available at: https://www.veganfirst.com/article/scottish-doctors-tell-nhs-serving-meat-in-hospitals-is-like-distributing-cigarettes. Accessed 2024-01-11
  2. Antibiotic Overuse in Livestock Farming. Available at: https://www.saveourantibiotics.org/the-issue/antibiotic-overuse-in-livestock-farming/. Accessed 2024-01-11
  3.  8 ways NYC mayor Eric Adams is creating a plant-based city, 2023). Available at: https://plantbasedtreaty.org/eric-adams-plant-based-city/. Accessed 2024-01-11
  4. See Vegan: the product label which shall not be named, (2023). Food Dive. Available at:  https://www.fooddive.com/news/vegan-the-product-label-which-shall-not-be-named. Accessed 2023-10-11
  5. Note that this figure is for eligible patients only. Non-eligible patients included those with prescribed medical diets.
  6.  Note that the cost-savings were initially recorded that 59 cents, although this does vary depending on fluctuations in supply chain prices.

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