Want to Fix Health Care? Focus on Food First

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A group enjoys assorted foods in front of a stand. Photo by Scott Ball.

Scott Ball / Rivard Report

Food is the number one cause of poor health in the United States.

The national debate on health care is moving into a new, hopefully bipartisan phase.

The fundamental underlying challenge is cost – the massive and ever-rising price of care which drives nearly all disputes, from access to benefit levels to Medicaid expansion.

So far, policymakers have tried to reduce costs by tinkering with how care is delivered. But focusing on care delivery to save money is like trying to reduce the costs of house fires by focusing on firefighters and fire stations.

A more natural question should be: What drives poor health in the United States, and what can be done about it?

We know the answer. Food is the number one cause of poor health in the U.S. As a cardiologist and public health scientist, I have studied nutrition science and policy for 20 years. Poor diet is not just about individual choice, but about the systems that make eating poorly the default for most Americans.

If we want to cut down on disease and achieve meaningful health care reform, we should make it a top nonpartisan priority to address our nation’s nutrition crisis.

Food and health

Our dietary habits are the leading driver of death and disability, causing an estimated 700,000 deaths each year. Heart disease, stroke, obesity, Type 2 diabetes, cancers, immune function, brain health – all are influenced by what we eat.

For example, our recent research estimated that poor diet causes nearly half of all U.S. deaths due to heart disease, stroke, and diabetes. Every day there are almost 1,000 deaths from these causes alone.

By combining national data on demographics, eating habits, and disease rates with empirical evidence on how specific foods are linked to health, we found that most problems are caused by too few healthy foods like fruits and vegetables and too much salt, processed meats, red meats, and sugary drinks.

To put this in perspective, about twice as many Americans are estimated to die each year from eating hot dogs and other processed meats (around 58,000 deaths per year) than from car accidents (about 35,000 deaths per year).

Poor eating also contributes to U.S. disparities. People with lower incomes and who are otherwise disadvantaged often have the worst diets. This causes a vicious cycle of poor health, lost productivity, increased health costs, and poverty.

What a poor diet costs

It’s hard to fathom how much our country actually spends on health care: currently $3.2 trillion per year, or nearly one in five dollars in the entire U.S. economy. That’s almost $1,000 each month for every man, woman, and child in the country, exceeding most people’s budgets for food, gas, housing, or other common necessities.

Diet-related conditions account for vast health expenditures. Each year, cardiovascular diseases alone result in about $200 billion in direct health care spending and another $125 billion in lost productivity and other indirect costs.

At the same time, health care costs cripple the productivity and profits of American businesses. From small to large companies, crushing health care expenditures are a major obstacle to growth and success. Warren Buffet recently called rising medical costs the “tapeworm of American economic competitiveness.” Our food system is feeding the tapeworm.

Yet, remarkably, nutrition is virtually ignored by our health care system and in the health care debates – both now and a decade ago before the Affordable Care Act was passed. Traveling around the country, I find that dietary habits are not included in the electronic medical record, and doctors receive scant training on healthy eating and other lifestyle priorities. Reimbursement standards and quality metrics rarely cover nutrition.

Meanwhile, total federal spending for nutrition research across all agencies is only about $1.5 billion per year. Compare that with more than $60 billion spent per year for industry research on drugs, biotechnology, and medical devices.

With the top cause of poor health largely ignored, is it any mystery that obesity, diabetes and related conditions are at epidemic levels, while health care costs and premiums skyrocket?

Moving forward

Advances in nutrition science highlight the most important dietary targets, including foods that should be encouraged or avoided. Policy science provides a road map for successfully addressing our country’s nutrition crisis.

For example, according to our calculations, a national program to subsidize the cost of fruits and vegetables by 10% could save 150,000 lives over 15 years, while a national 10% soda tax could save 30,000 lives.

Similarly, a government-led initiative to reduce salt in packaged foods by about three grams per day could prevent tens of thousands of cardiovascular deaths each year, while saving between $10 billion to $24 billion in health care costs annually.

Companies across the country have been rethinking their approach to employee health, providing a range of financial and other benefits for healthier lifestyles. Life insurance has also realized the return on the investment, rewarding clients for healthier living with fitness tracking devices, lower premiums, and healthy food benefits which pay back up to $600 each year for nutritious grocery purchases. Every dollar spent on wellness programs generates about $3.27 in lower medical costs and $2.73 in less absenteeism.

Similar technology-based incentive platforms could be offered to Americans on Medicare, Medicaid, and SNAP (formerly known as Food Stamps) – together reaching one in three adults nationally. In 2012, U.S. Sen. Rob Portman (R-Ohio) proposed a Medicare “Better Health Rewards” program to reward seniors for not smoking and for achieving lower weight, blood pressure, glucose, and cholesterol. This program should be reintroduced, with updated technology platforms and financial incentives for healthier eating and physical activity.

Several other key strategies should be added, together forming a core for modern healthcare reform. Incorporating such sensible initiatives for better eating will actually improve well-being while lowering costs, allowing expanded coverage for all.

The ConversationBy any measure, fixing our nation’s nutrition crisis should be a nonpartisan priority. Policy leaders should learn from past successes such as tobacco reduction and car safety. Through modest steps, we can achieve real reform that makes healthier eating the new normal, improves health and actually reduces costs.


8 thoughts on “Want to Fix Health Care? Focus on Food First

  1. Perfectly beautiful article. Though I still have a penchant for sweet stuff, I’ve been following this diet since the sixties. Forget bi-partisan government intervention and fight the companies selling the offending foods.

  2. Sounds really good, but it will be very difficult to convince most people to eat more broccoli and less burgers or tacos. Realistically it’s just not going to happen. Soda taxes don’t work, people just drive elsewhere to buy. There’s a reason it’s called Comfort Food.

  3. Amazing article by Dariush! Absolute truth and wisdom! Thank you so much, Wonder Man!
    I wish you were in our paper’s HEADLINES!!! Health is 99% what passes our lips.

    Thank you!

  4. Actually, sugared soda taxes do seem to work. See this from April 2017 http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002283

    This is the first time in the US that this was tried and the one evaluation supports the effectiveness of sugared soda taxes at the local level. Further evaluation should continue in this location and the other US local communities with more recent implementation of these taxes: Philadelphia (Pennsylvania), San Francisco (California), and Oakland (California)—and Cook County (Illinois), Boulder (Colorado) and Albany (California).

    Nudges can also help people eat healthier (e.g., placement of food in cafeteria lines) and also lowering barriers of cost and convenience for healthier foods also works (fruits and vegetables).

  5. actually the number one predictor of life expectancy is where one lives, their zipcode. This is largely dependent on income and educational attainment. If you truly want to provide people with better abilities to improve their health then help them gain economic mobility and higher education attainment. Food is important, too, but without focusing income and education, this sort of thinking will do little to change things for many.

  6. The issue of food in our culture is actually a problem with freedom.

    If you’ll look at it from a particular angle, some of the freedoms are really only entitlements.

    To me, the moment that one person gains at the expense of another is the moment that a freedom becomes an entitlement. From there, an impenetrable power structure is required to maintain the status quo, to protect the behaviors of those who are getting over on others, and the tools that are use for all of this are very familiar words to us.

    Those tools are called rights and laws. Everyone knows at least something about them. But elites really know how to use them to maintain a balance of inequality; a way of life that is characterized by atrocities that elites use in order to stay among the elite.

    Look at it this way: in our society it is perfectly acceptable for one person (a corporation) to sell something that will actually harm others. Let me re-phrase so that this sinks in: it is legal to invent or create and then give or sell to others food or food-like substances that over time lead to premature death (and major financial gains for the medical industry).

    This is something that we allow in our culture.

    Is this nuts?

    Take a look around people. Look at all this from a new or different lens for once. This is not what healthy communities and societies did long ago. It is so ubiquitous on the planet today that looking at it from this angle is no longer an option, well except for a few of us.

    Practice looking at things from the perspective of truth.

    The real premise that our society lives by is Adam Smith’s framework of capitalism, but we have forgotten about the morality clause that Smith had written so near the invisible hand line. Within capitalism morality can exist, but it hasn’t been happening with us, and it has become ingrained in us to overlook the obvious, and the elites wouldn’t have it any other way.

    Look out and wake up readers. The era of blaming the victim can soon end. In history, blame can always be placed toward one place: a ‘civilized’ power structure.

    If our society were healthy and moral it would be illegal to produce and sell anything that is destructive to land or people. Work that out with simple logic and you will find our core way of living.


    Why are we so quick to love and celebrate and to guard this behavior?

    If you like this, then you will share and foment.
    If you don’t like this, then you deny truth (likely because you are well paid to continue to deny that truth, or likely because the idea incites fear and you just don’t know what to do).

    If you like this but don’t know what to do, just keep thinking. Light comes to those who seek truth, and darkness resides within those who keep it from surfacing, including writers and reporters. John Brown knew this. Harriet Tubman knew this. Frederick Douglas knew this. I know this, which means that you can know this too.

    We have a really skewed sense of freedom. Freedoms to commit violence against others. But we can tease this out. Just think on it. And then act on it with whatever gifts you have.

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