Abstract
BACKGROUND: High consumption of red meat is an important cause of burden of disease and environmental degradation globally. To motivate changes in food consumption and production, policymakers need evidence on the overall impact of such changes on the health of citizens, and on all aspects of sustainability: environment, socioeconomics, and culture. METHODS: Using three different approaches, we compared the impact of four scenarios of replacement of beef consumption with pulses (a well-established plant protein source) in two EU countries, Portugal and Denmark. First, health impacts were quantified in disability-adjusted life years (DALY); second, sustainability impact was measured using various social, economic and environmental indicators. Finally, we used MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique), an interactive, iterative, multicriteria decision analysis approach, to create a quantitative value model. RESULTS: We estimated positive health impacts for all substitution scenarios in the two populations. Positive impacts were larger for Denmark and ranged from 5,9 DALYs (25% substitution of beef by pulses in Portugal) to 39,7 DALYs averted/100,000 people (100% substitution, Denmark). The two countries had positive economic impacts, but beef production was more resilient than pulses. Environmental and social impacts of beef production were consistently higher than pulses. The MCDA model included a set of 15 criteria within the four dimensions of analysis to assess the overall value of implementing each scenario. CONCLUSIONS: Individually, each approach allowed us to compare health, sustainability and integrated impacts of different options for food substitutions relevant to the sustainability agenda. Together, they allowed us to create a platform for discussing the co-benefits of dietary changes in different contexts. Expanding this work to other dietary changes and countries will support further development of public health policies. KEY MESSAGES: • Different possible scenarios of substitution of beef consumption by pulses, an alternative plant-based protein source, will lead to overall positive health and sustainability impacts. • Quantitative measurements of the integrated health, environmental and socioeconomic impacts of dietary transitions will support development of public health policies towards sustainable diets.