It is disgraceful that in the United States, which our politicians insist on telling us is the best at everything, people need to drive hundreds of miles to line up in the middle of the night for battlefield medicine. Here is a 60 Minutes clip from last year’s version; this year had just under twice the turnout:
I have tried to outline a few ideas about the health care system, and there is no shortage of academic interest in the area. But I can’t help but notice something else in the coverage: we have a food problem.
I am not a nutritionist. I have been cut off at a Burger King. But surely we do ourselves no favors as a nation if we fail to acknowledge the amazing correlation between poverty and obesity, and between obesity and all manner of chronic conditions. It even holds up within small geographic areas:
More than 62 percent of Bronx residents are overweight or obese, higher than the rate in any of New York City’s other four boroughs, while strikingly, the comparable figure for Manhattan was just over 42 percent — the lowest of any of New York State’s 62 counties.
Michael Pollan and Jill Richardson have written about diets and the health benefits of moving towards an organic future. In fact, Pollan describes this as a move back in time, to a food world that someone from the 1800s would recognize. I disagree about the retro thing; food, for those who can afford it, has never been better.
Just think of something as basic as coffee: fifteen years ago, if you took a long drive and stopped somewhere to get a cup of coffee along the way, you poured it from a pitcher of Maxwell House that had been sitting there God knows how long. Not only did no one know how bad it tasted, no one even knew it was supposed to taste good; it was as functional as the gas in the tanks. I’m not talking about centuries; you could find traffic information on the Internet before Starbucks finally broke away from cities with alternative bookstores and hit the mainstream. It isn’t Rome, but it’s a big change for this country.
Richardson advocates organic food, which I support, and buying local, which I most certainly do not. If I want blueberries in January, waiting several months is a poor substitute for Chilean berries. I don’t have any great desire to know the farmer who raise the beef on my plate, just as I don’t feel the need to see the factory that assembled my television. In fact, I don’t care if my produce comes from a sole proprietorship or a giant corporation. Farmers, for reasons that escape me, are like doctors and teachers, classes of workers whose tug on the American heartstring and pursestring seem endless. Farmers are not on my side; they are on their side, which would be fine if they did not keep asking for my money. If declines in farm prices force families off the land, so be it, and if we are to have a death tax, there is no reason to treat $10mm in agricultural land any differently from $10mm in cash. Hell, they can be exchanged for each other.
Over the past century we have developed a system of maximizing the amount of calories. Not surprisingly, such a strategy leads to a very low price/calorie. It is a popular strategy, because we buy food by the item (actually, quite a bit like the way we buy health care) and people are attuned to “price of beef has gone up.” It is also completely inappropriate for a society where our major problem is too much food, not too little.
Here are three ideas and one not-quite-idea that come to mind for national methods of improving the food system. Any comments would be appreciated.
- Cut the commodity food programs. I have been flogging this for a long time, and it should be done purely for fiscal solvency purposes; at their heart, the programs are simply transfers of wealth from the cities and suburbs to rural areas, and there is absolutely no justification for this. Rural poverty quite clearly still exists…but so does urban poverty, and neither the rural poor nor the urban poor are net producers of food; if the rural poor had the capital to run their own land and herd, they wouldn’t be poor. The commodity food programs have a negative public health effect in that they crowd out pretty much everything else. The enormous supply of corn and soy create the economic environment for feedlot animals; it would not make sense to keep hundreds of thousands of animals cheek by jowl were it not for the ability to fatten them cheaply. A much broader range of plants, many edible by humans directly, would be grown on land currently used for the commodities.
- Bar the use of any drug on any animal without a specific prescription from a veterinarian. This isn’t strictly about the food system, it’s about antibiotic resistance. If hen #ABC1234 needs an antibiotic, let someone come out and say “hen #ABC1234 needs XYZ antibiotic.” This would force an entire redesign of industrial agriculture; it would no longer be cheaper to inoculate animals than to keep the animals from getting sick in the first place.
- Bar soft drinks from food stamp and school lunch programs. I know it’s paternalistic, and I am OK with that, just as I am OK with including requirements for unemployment insurance. There is absolutely no reason for the government to pay for unhealthy foods with money from a program designed to ensure a modicum of health for the most vulnerable Americans. The WIC program has a very specific list of products that can be purchased; I would expand that list somewhat (it is designed as a supplement to food stamps), but keep to the basic idea that it only applies to fresh non-processed foods. Surely Kraft and Frito-Lay can survive the loss of the indigent market.
I am confident the above will work, even if the entrenched opposition will be difficult. If we are going to sacrifice to fix our health, the food industry should be expected to do its part; it’s the least it can do for eighty years of farming the taxpayer. But I also have one fractional idea, half-baked at best:
- Teach students to cook in school. There are some obvious problems with bringing back home economics, not the least that we struggle to teach the few subjects that are still in the schools and might not be ready to add one. English, math, science, history, a foreign language – that’s a full academic schedule right there, and I would prefer students take each of these for each one of the four years of high school than drop a term to sit in a room while someone makes a roast. On the other hand, when you look at countries with very high restaurant food costs – northern Europe, for example – the reason the entire population is able to eat is that they can cook for themselves. There is some evidence, albeit limited, that the total amount of time to prepare a meal from processed foods isn’t that different from the amount of time to cook from whole ingredients (not clear if this is measuring elapsed time or active time – does putting something in the microwave for nine minutes count as ten seconds or nine minutes). We cannot very well try to move people to healthier foods if they have no way of eating them.
Good to see Kathleen Sebelius following up on my posts:
“We’re spending just under 150 billion dollars a year on health conditions related to obesity,” Sebelius told the first-ever national conference on obesity to be organized by the federal Centers for Disease Control and Prevention (CDC).
“We have a situation where health conditions related to obesity have nearly twice the cost-impact on the health system as all the cancers combined in this country.”