Dear Ecologgers,
Regarding the discussion about diets, I submit Michael Pollan's article
from today's NY Times (below), which points out that not only what, but
HOW MUCH we eat is deeply problematic, placing this issue smack dab in
the middle of the health care debate. I would place it in the middle of
our ecological health thinking too (as he does in other writings).
Pollan also highlights here the irony of farming subsidies often
supporting our poor diets.
I paste the text below. Enjoy!
Teresa
--
Teresa M. Woods, M.S.
Ph.D. Candidate, Curriculum and Instruction
Kansas State University
913-269-8512
785-532-9834
two...@ksu.edu <mailto:two...@ksu.edu>
PlantingScience: http://www.plantingscience.org
<http://www.plantingscience.org/>
_______________________________________________________________
September 10, 2009
Op-Ed Contributor
Big Food vs. Big Insurance
By MICHAEL POLLAN
Berkeley, Calif.
TO listen to President Obama's speech on Wednesday night, or to just
about anyone else in the health care debate, you would think that the
biggest problem with health care in America is the system itself ---
perverse incentives, inefficiencies, unnecessary tests and procedures,
lack of competition, and greed.
No one disputes that the $2.3 trillion we devote to the health care
industry is often spent unwisely, but the fact that the United States
spends twice as much per person as most European countries on health
care can be substantially explained, as a study
<http://www.nber.org/papers/w15235.pdf?new_window=1> released last month
says, by our being fatter. Even the most efficient health care system
that the administration could hope to devise would still confront a
rising tide of chronic disease linked to diet.
That's why our success in bringing health care costs under control
ultimately depends on whether Washington can summon the political will
to take on and reform a second, even more powerful industry: the food
industry.
According to the Centers for Disease Control and Prevention
<http://www.cdc.gov/nccdphp/overview.htm#2>, three-quarters of health
care spending now goes to treat "preventable chronic diseases." Not all
of these diseases are linked to diet --- there's smoking, for instance
--- but many, if not most, of them are.
We're spending $147 billion
<http://content.healthaffairs.org/cgi/content/short/hlthaff.28.5.w822>
to treat obesity, $116 billion
<http://care.diabetesjournals.org/content/31/3/596.full> to treat
diabetes, and hundreds of billions more to treat cardiovascular disease
and the many types of cancer that have been linked to the so-called
Western diet. One recent study
<http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.480v1>
estimated that 30 percent of the increase in health care spending over
the past 20 years could be attributed to the soaring rate of obesity, a
condition that now accounts for nearly a tenth of all spending on health
care.
The American way of eating has become the elephant in the room in the
debate over health care. The president has made a few notable allusions
to it, and, by planting her vegetable garden on the South Lawn, Michelle
Obama has tried to focus our attention on it. Just last month, Mr. Obama
talked about putting a farmers' market in front of the White House, and
building new distribution networks to connect local farmers to public
schools so that student lunches might offer more fresh produce and fewer
Tater Tots. He's even floated the idea of taxing soda.
But so far, food system reform has not figured in the national
conversation about health care reform. And so the government is poised
to go on encouraging America's fast-food diet with its farm policies
even as it takes on added responsibilities for covering the medical
costs of that diet. To put it more bluntly, the government is putting
itself in the uncomfortable position of subsidizing both the costs of
treating Type 2 diabetes and the consumption of high-fructose corn syrup.
Why the disconnect? Probably because reforming the food system is
politically even more difficult than reforming the health care system.
At least in the health care battle, the administration can count some
powerful corporate interests on its side --- like the large segment of
the Fortune 500 that has concluded the current system is unsustainable.
That is hardly the case when it comes to challenging agribusiness. Cheap
food is going to be popular as long as the social and environmental
costs of that food are charged to the future. There's lots of money to
be made selling fast food and then treating the diseases that fast food
causes. One of the leading products of the American food industry has
become patients for the American health care industry.
The market for prescription drugs and medical devices to manage Type 2
diabetes, which the Centers for Disease Control estimates will afflict
one in three Americans born after 2000, is one of the brighter spots in
the American economy. As things stand, the health care industry finds it
more profitable to treat chronic diseases than to prevent them. There's
more money in amputating the limbs of diabetics than in counseling them
on diet and exercise.
As for the insurers, you would think preventing chronic diseases would
be good business, but, at least under the current rules, it's much
better business simply to keep patients at risk for chronic disease out
of your pool of customers, whether through lifetime caps on coverage or
rules against pre-existing conditions or by figuring out ways to toss
patients overboard when they become ill.
But these rules may well be about to change --- and, when it comes to
reforming the American diet and food system, that step alone could be a
game changer. Even under the weaker versions of health care reform now
on offer, health insurers would be required to take everyone at the same
rates, provide a standard level of coverage and keep people on their
rolls regardless of their health. Terms like "pre-existing conditions"
and "underwriting" would vanish from the health insurance rulebook ---
and, when they do, the relationship between the health insurance
industry and the food industry will undergo a sea change.
The moment these new rules take effect, health insurance companies will
promptly discover they have a powerful interest in reducing rates of
obesity and chronic diseases linked to diet. A patient with Type 2
diabetes incurs additional health care costs of more than $6,600 a year;
over a lifetime, that can come to more than $400,000. Insurers will
quickly figure out that every case of Type 2 diabetes they can prevent
adds $400,000 to their bottom line. Suddenly, every can of soda or Happy
Meal or chicken nugget on a school lunch menu will look like a threat to
future profits.
When health insurers can no longer evade much of the cost of treating
the collateral damage of the American diet, the movement to reform the
food system --- everything from farm policy to food marketing and school
lunches --- will acquire a powerful and wealthy ally, something it
hasn't really ever had before.
AGRIBUSINESS dominates the agriculture committees of Congress, and has
swatted away most efforts at reform. But what happens when the health
insurance industry realizes that our system of farm subsidies makes junk
food cheap, and fresh produce dear, and thus contributes to obesity and
Type 2 diabetes? It will promptly get involved in the fight over the
farm bill --- which is to say, the industry will begin buying seats on
those agriculture committees and demanding that the next bill be written
with the interests of the public health more firmly in mind.
In the same way much of the health insurance industry threw its weight
behind the campaign against smoking, we can expect it to support, and
perhaps even help pay for, public education efforts like New York City's
bold new ad campaign
<http://cityroom.blogs.nytimes.com/2009/08/31/new-salvo-in-citys-war-on-sugary-drinks/?scp=1&sq=soda%20fat%20sewell&st=cse>
against drinking soda. At the moment, a federal campaign to discourage
the consumption of sweetened soft drinks is a political nonstarter, but
few things could do more to slow the rise of Type 2 diabetes among
adolescents than to reduce their soda consumption, which represents 15
percent of their caloric intake.
That's why it's easy to imagine the industry throwing its weight behind
a soda tax. School lunch reform would become its cause, too, and in time
the industry would come to see that the development of regional food
systems, which make fresh produce more available and reduce dependence
on heavily processed food from far away, could help prevent chronic
disease and reduce their costs.
Recently a team of designers from M.I.T. and Columbia was asked by the
foundation of the insurer UnitedHealthcare to develop an innovative
systems approach to tackling childhood obesity in America. Their
conclusion surprised the designers as much as their sponsor: they
determined that promoting the concept of a "foodshed" --- a diversified,
regional food economy --- could be the key to improving the American diet.
All of which suggests that passing a health care reform bill, no matter
how ambitious, is only the first step in solving our health care crisis.
To keep from bankrupting ourselves, we will then have to get to work on
improving our health --- which means going to work on the American way
of eating.
But even if we get a health care bill that does little more than require
insurers to cover everyone on the same basis, it could put us on that
course.
For it will force the industry, and the government, to take a good hard
look at the elephant in the room and galvanize a movement to slim it down.
Michael Pollan, a contributing writer for The Times Magazine and a
professor of journalism at the University of California, Berkeley, is
the author of "In Defense of Food: An Eater's Manifesto."
<http://www.plantingscience.org/>