How one health system increased plant-forward options and saw its climate impact drop

Health Care Without Harm
7 min readJun 23, 2021


“ I don’t sell plant-based, I sell delicious looking and tasting food that just happens to be plant-based.” — Dan Henroid, University of California San Francisco Medical Center

San Francisco is known for its great food. Walk a few blocks in almost any direction and you are likely to find something delicious, creative, and satisfying. In an atmosphere of such stiff competition, one might think a hospital cafe doesn’t stand a chance, but University of California San Francisco Health (UCSF Health) is defying expectations, attracting customers, and increasing sales.

UCSF Health operates three sites in San Francisco, Calif. The Department of Nutrition and Food Services is responsible for all UCSF Health food operations, including patient dining, retail food outlets, inpatient and outpatient nutrition services, catering, and gift shops. They serve approximately 2.3 million meals annually comprising 537,000 patient meals and 1.7 million retail transactions to faculty, staff, students, and visitors.

Walking into the hospital’s Moffitt Café you are greeted with a beautiful deli case displaying the immensely popular “roots and shoots” menu items. Roots and shoots, described as “lots of veggies and a little meat,” combine root vegetables with other vegetables and plant proteins and sometimes a small amount of animal protein. The vibrant red beet salad is a favorite. If you are in the mood for classic American you can choose the Fresh Burger, a blended 70% beef, 30% mushroom patty that outsells its 100% beef predecessor. Or diners can take a culinary trip beyond their borders and try the Sitaw Kalabasa, a Filipino vegetable stew of kabocha squash and green beans simmered in coconut milk.

“We earned $49,774 more on our fresh mushroom blended burger compared to our original burger by marketing it simply as a ‘better burger.’ We also reduced our CO2 emissions and made our customers happy.”

The hospital’s patients, visitors, and staff love the expanded variety of foods available that are inspired by cultures near and far, and they can count on getting a tasty and satisfying meal at a fair price. What they may not realize is that the food they are eating is also helping to reduce greenhouse gas emissions and fight climate change.

Culinary Institute of America

The Cool Food Pledge

“We recognized the need to evolve our menu to move towards more climate-friendly food while still providing great looking and tasting menu items. We automatically make new menu concepts with plant-based options and avoid climate impactful ingredients in their design.”

About five years ago UCSF Health’s food service director, Dan Henroid began working with his culinary team to increase plant-forward menu items and decrease animal proteins. The hospital had already met and exceeded its environmental sustainability goals for food service and Henroid wanted to take it to the next level. Also, it was not lost on him that consumer trends were showing increased interest and demand for plant-forward eating. Henroid knew that by reducing his cafes’ use of animal proteins and creating delicious foods that celebrate plants he could both reduce the hospital’s climate impact and stay on-trend.

We have been using third-party certifications to measure sustainability and surpassed our goal of 20% sustainable pretty quickly. We wanted to take our work to the next level and utilize something science-based that could help us quantify our impact on the climate and the Cool Food Pledge met those specifications. We were also up for a new challenge.

When UCSF Health joined the Cool Food Pledge Henroid discovered his work was paying off. The Cool Food Pledge is a cross-sector, international effort led by the World Resources Institute to achieve a science-based collective target of reducing emissions from food by 25% by 2030. Signatories submit data on plant and animal protein purchases and receive a report on their emissions by food category. Participating hospitals receive technical assistance and support from Health Care Without Harm and Practice Greenhealth as they implement plant-forward strategies to meet the pledge goal.

Four years of GHG emission reductions

“The Cool Food Pledge helps us identify “hot spots” in our food purchasing to focus on reducing our GHG emissions.”

After submitting four years of data spanning from 2017–2020, Henroid learned that the health system’s plant-forward efforts had reduced the climate impact of the food they serve by 12.5% overall, translating to an 8% reduction in GHG emissions per meal. This was driven by a reduction of beef procurement by 28%, an increase in legumes by 13%, and an increase of almost 70% of plant-based milk in this period. Three main drivers helped UCSF Health achieve this result:

  • Replacing their 100% beef burger with 70/30 mushroom blended burger for all three campuses.
  • Conducting a menu analysis and reducing the number of dishes with beef from approximately 20 menu items in 2017 down to just three by 2020 on the patient menu.
  • Launching the “roots and shoots” menu concept which made the plant proteins the center of the plate.

The health system’s achievements translate to some real world outcomes. By reducing highly impactful foods, it reduced the land used to grow its food by 13% or 264 acres, the equivalent of about 200 football fields. Its 12.5% reduction in GHG emissions is the annual equivalent of taking 455 cars off the road, or the carbon sequestered by 2,749 acres of U.S. forests, or the energy required to power 243 homes, or charge a smartphone more than 268,455,328 times.

Climate-friendly food is easier than we think

“Members were able to collectively reduce emissions by 4.6% overall and by 12% per plate in just four years. Some members have reduced emissions even more quickly, showing big changes are possible within a short time.”

— Richard Waite, World Resources Institute

Henroid also learned that the health system was on track to meet the pledge goal of a 25% reduction in greenhouse gases by 2030, contributing significantly to the collective effort of the international cohort which includes 36 other hospitals, several universities and a variety of private sector entities such as Ikea and Panera.

The first Cool Food progress report released in September 2020 showed that the cohort as a whole was on track to meet the goal with a 3% absolute reduction in GHG emissions or a 6% reduction per calorie, the equivalent of taking 700,000 cars off the road and preserving 30,000 hectares of land — land which could be forested and sequestering carbon.

A Plant-Forward Future

Looking ahead, Henroid admits that continued progress will be challenging as they have already tackled the “low hanging fruit.” It will require more creativity and menu analysis in order to continue the trajectory they are currently on. However, friendly competition with three other health systems (also Cool Food signatories) in the larger UC system and the feeling of being part of a collective cross-sector effort keeps the team motivated. Henroid keeps his eye out for new opportunities to meet his goals whether it be a new product or a new initiative to engage in.

What would you say to a food service director in another part of the country that may have doubts about plant-centered dishes selling in their facility?

Just try it. Learn about the cultures represented in your region and what is currently popular and come up with dishes that will meet your goals.

And resilience is what this is all about. As we experience the realities of a changing climate and we begin to emerge from a pandemic caused by a zoonotic disease, hospitals and health systems are thinking more about how to be more prepared and how to make their communities stronger and able to bounce back from shocks. Part of that work is to invest in their regional food system, ensuring that the soils are healthy and drought resistant and able to grow food into the future — regenerative farming of plant proteins contributes to that.

Another essential aspect of this work toward a more resilient future involves leading a culture shift around diet. In order to feed a growing population within environmental limits, health care professionals understand that, globally, we need to reduce our consumption of animal proteins but particularly in higher-income countries like the United States that consume greater amounts. The production of animal proteins consumes 83% of the available agricultural land and generates only 18% of the total calories consumed by humans, and 37% of the protein consumed. Collectively moving towards a plant-forward diet will better position us to feed 10 billion people by 2050 without clearing forests for food production, thereby preserving the ability of those natural areas to sequester carbon.

Your future starts today

Join Henroid, UCSF Health, and Practice Greenhealth in creating a Plant-Forward Future for us all. Visit our Plant-Forward Future webpages to access the latest resources in the areas of plant-forward implementation, marketing, and tracking and to join the Cool Food Pledge.



Health Care Without Harm

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.