Improving American nutrition would make the biggest impact
on our health care.
By Dariush Mozaffarian and Dan Glickman
Mr. Mozaffarian is dean of the Tufts Friedman School of Nutrition Science and Policy. Mr.
Glickman was the secretary of agriculture from 1995 to 2001.
Americans benefit from highly trained personnel, remarkable facilities and access to the newest drugs and technologies. Unless we eliminate some of these benefits, our health care will remain costly. We can trim around the edges — for example, with changes in drug pricing, lower administrative costs, reductions in payments to hospitals and providers, and fewer defensive and unnecessary procedures. These actions may slow the rise in health care spending, but costs will keep rising as the population ages and technology advances.
And Americans are sick — much sicker than many realize. More than 100 million adults — almost half the entire adult population — have pre-diabetes or diabetes. Cardiovascular disease afflicts about 122 million people and causes roughly 840,000 deaths each year, or about 2,300 deaths each day. Three in four adults are overweight or obese. More Americans are sick, in other words, than are healthy.
Instead of debating who should pay for all this, no one is asking the far more simple and imperative question: What is making us so sick, and how can we reverse this so we need less health care? The answer is staring us in the face, on average three times a day: our food.
Poor diet is the leading cause of mortality in the United States, causing more than half a million deaths per year. Just 10 dietary factors are estimated to cause nearly 1,000 deaths every day from heart disease, stroke and diabetes alone. These conditions are dizzyingly expensive. Cardiovascular disease costs $351 billion annually in health care spending and lost productivity, while diabetes costs $327 billion annually. The total economic cost of obesity is estimated at $1.72 trillion per year, or 9.3 percent of gross domestic product.
These human and economic costs are leading drivers of ever-rising health care spending, strangled government budgets, diminished competitiveness of American business and reduced military readiness.
Fortunately, advances in nutrition science and policy now provide a road map for addressing this national nutrition crisis. The “Food Is Medicine” solutions are win-win, promoting better well-being, lower health care costs, greater sustainability, reduced disparities among population groups, improved economic competitiveness and greater national security.
Some simple, measurable improvements can be made in several health and related areas. For example, Medicare, Medicaid, private insurers and hospitals should include nutrition in any electronic health record; update medical training, licensing and continuing education guidelines to put an emphasis on nutrition; offer patient prescription programs for healthy produce; and, for the sickest patients, cover home-delivered, medically tailored meals. Just the last action, for example, can save a net $9,000 in health care costs per patient per year.
Taxes on sugary beverages and junk food can be paired with subsidies on protective foods like fruits, nuts, vegetables, beans, plant oils, whole grains, yogurt and fish. Emphasizing protective foods represents an important positive message for the public and food industry that celebrates and rewards good nutrition. Levels of harmful additives like sodium, added sugar and trans fat can be lowered through voluntary industry targets or regulatory safety standards.
Nutrition standards in schools, which have improved the quality of school meals by 41 percent, should be strengthened; the national Fresh Fruit and Vegetable Program should be extended beyond elementary schools to middle and high schools; and school garden programs should be expanded. And the Supplemental Nutrition Assistance Program, which supports grocery purchases for nearly one in eight Americans, should be leveraged to help improve diet quality and health.
The private sector can also play a key role. Changes in shareholder criteria (e.g., B-Corps, in which a corporation can balance profit versus purpose with high social and environmental standards) and new investor coalitions should financially reward companies for tackling obesity, diabetes and other diet related illness. Public-private partnerships should emphasize research and development on best agricultural and food-processing practices. All work sites should demand healthy food when negotiating with cafeteria vendors and include incentives for healthy eating in their wellness benefits.
Coordinated federal leadership and funding for research is also essential. This could include, for example, a new National Institute of Nutrition at the National Institutes of Health. Without such an effort, it could take many decades to understand and utilize exciting new areas, including related to food processing, the gut microbiome, allergies and autoimmune disorders, cancer, brain health, treatment of battlefield injuries and effects of nonnutritive sweeteners and personalized nutrition.
Government plays a crucial role. The significant impacts of the food system on well-being, health care spending, the economy and the environment — together with mounting public and industry awareness of these issues — have created an opportunity for government leaders to champion real solutions.
Yet with rare exceptions, the current presidential candidates are not being asked about these critical national issues. Every candidate should have a food platform, and every debate should explore these positions. A new emphasis on the problems and promise of nutrition to improve health and lower health care costs is long overdue for the presidential primary debates and should be prominent in the 2020 general election and the next administration.
The article is great, but there is a glaring omission...the primary reason we have such a hard time getting this message out to the public, never mind all the good suggestions in the article. How bout we just start by getting this information out there? Why can't we even do that???
It's called big pharma folks, one of the primary sources and purveyors of the mountains of misinformation on diet and health we, mostly unaware, wade through everyday. And why do they do that? Well first of all this industry is making a bloody fortune that depends on lots of sick people. Second of all, so called Health Care ("disease management" is more accurate) has, according to the article at the link below, become the primary contributor to US GDP. Which is a very big deal with all sorts of political ramification:
https://www.investopedia.com/articles/investing/042915/5-industries-driving-us-economy.asp
And why do I say why are we mostly unaware of all this misinformation? Because it comes to us through primary media sources. The New York Times is definitely taking the lead on bucking this trend. Good for them.
The other reason is because we hear so many half-truths that appeal to our pre-existing habits and biases. A good example of this is the so-called Paleo Diet. The range of diets possible under this name is huge. (To be fair the term "Vegan" has the same problem.) The all bacon all the time contingent is not healthy. The rate of heart attack in the paleo movement is reason enough to see this. The rate of digestive/congestive issues is another marker. And there are many others. There is a healthier contingent in the paleo world, these are the folks that consume mostly plants. You can measure this by volume or calories. Let's measure by calories: as "calories consumed" as a percent of total gets closer to the low fat plant based whole food prescription Paleos get healthier. Imagine that.
OK I'm coming off my soapbox now, for the time being at least:) The original blog below:
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Unfortunately for me the New York Times has instituted a hard paywall for online viewers, so unless you are paying the $8/mo subscription fee this link will not let you read the article.
I say unfortunately for "me" because the NYT has been taking a lead recently against the "foods" (toxic substances really) that are killing us prematurely by the millions (leading cause of death by far), and the NYT is a major voice in the US and developed world in general. I like to feature this kind of story in my blog to reinforce the idea that I'm not "off the deep end" over here :)
Oh well, I'm making this a blog anyway just to note the fact increasingly prominent voices are in effect saying "enough is enough" and calling for greater awareness of this clear and present danger to our country and our fellow sisters, cousins, and brothers.
I will however quote the sub heading (which we can see), and provide the link for digital subscribers to the Times.
"Improving American nutrition would make the biggest impact on our health care."
GREAT!
ReplyDeleteReally good, all candidates need to read this, including Mr. T.
ReplyDelete