Improving American nutrition would make the
biggest impact on our health care.
Aug. 26, 2019 By Dariush Mozaffarian and Dan Glickman Dr. Mozaffarian is dean of the Tufts
Friedman School of Nutrition Science and Policy. Mr. Glickman was the secretary
of agriculture from 1995 to 2001.
The Democratic debate
on health care has to date centered around who should be covered and who should
pay the bill. That debate, which has been going on for decades, has no clear
answers and cannot be easily resolved because of two fundamental realities:
Health care is expensive, and Americans are sick.
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.
Dariush
Mozaffarian (@Dmozaffarian) is a cardiologist and dean of the Tufts
Friedman School of Nutrition Science & Policy. Dan Glickman (@DanRGlickman) was the secretary of agriculture from
1995 to 2001.
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