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Dr. Dariush Mozaffarian: Want to fix America’s health care? First, focus on food

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 U.S., and what can be done about it?

We know the answer. Food is the number one cause of poor health in America. 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. There are almost 1,000 deaths from these causes alone, every day.

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 of 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 (~58,000 deaths/year) than from car accidents (~35,000 deaths/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 US$3.2 trillion per year, or nearly 1 in 5 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 when Obamacare 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 percent could save 150,000 lives over 15 years, while a national 10 percent 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 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, Ohio Senator Rob Portman 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.

By 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.

First published in The Conversation

Dariush Mozaffarian is Dean of the Tufts Friedman School of Nutrition Science & Policy, and the Jean Mayer Chair and Professor of Nutrition. The only graduate school of nutrition in North America, the Friedman School produces trusted science and real-world impact in nutrition. A board-certified cardiologist and epidemiologist, Dr. Mozaffarian’s research focuses on how diet and lifestyle influence cardiometabolic health and how effective policies can reduce these burdens.

4 comments on “Dr. Dariush Mozaffarian: Want to fix America’s health care? First, focus on food

  1. Jean Antonello
    February 25, 2018

    Dr. Mozaffarian’s article is entirely correct. But in order to make the changes he proposes,we must compel the public at large through scientific evidence, that there is a practical approach to eating that works and is sustainable for a lifetime. Such a workable and sustainable approach exists. It costs nothing, requires no supervision and involves no type of traditional eat-less diet. It does, however require food—plenty of good quality, nutrient-rich food. And it requires time. Time for the body to adapt to a brand new systematic, high quality food supply. And it requires a new understanding of the human body as far as fat accumulation and fat utilization are concerned.


  2. AmeriBev
    October 4, 2017

    Beverages can be part of a balanced lifestyle, and it’s important to keep sugar intake in perspective. As CDC data confirms, food, not beverages, is actually the top source of sugars in the American diet. Moreover, soft drink intake has declined dramatically in recent decades, and beverages with sugar make up a relatively small percentage of the calories Americans are taking in.

    It’s also important to point out that taxing any single food, beverage or ingredient as a means of combating obesity is wholly misguided. While soda taxes boost revenue, they don’t make an impact on waistlines.

    In fact, the editorial board of USA Today came out against soda taxes, stating “[s]oda taxes are heavy on intrusion and light on impact…Most important, soda taxes haven’t been shown to work.”

    With that said, beverage companies are committed to being part of real solutions to public health challenges with initiatives like Balance Calories. This effort aims to reduce sugar and calories consumed from beverages by offering more low- and no-calorie choices and smaller sizes and then finding ways to get people to try them. We also have voluntarily placed clear calorie labels on the front of every bottle, can and pack we produce.


  3. johnlawsonpoet
    September 30, 2017

    I completely endorse Dean Mozaffarian’s basic points–that 1) Americans’ quality of life would vastly improve if we ate a healthier diet and 2) business and government policy changes should more effectively promote healthier eating. But I fear that the dean is wrong to promise that the healthcare system will save money–even if we succeed in getting people to eat healthier, get more exercise, and stop smoking.

    When I worked in health promotion twenty years ago, researchers were trying to prove that healthy lifestyle changes would produce significant healthcare savings. They couldn’t do it, and I doubt they ever will. Why? Because no matter how many years healthy lifestyles add to our lives, even healthy bodies eventually wear out; even active, non-smoking, careful eaters reach the phase that health mavens refer to as “morbidity and mortality”: we’re all going to get sick and die, and the bulk of us are going to need healthcare, regardless of how long we may delay that need.

    Arguably, healthier lifestyles might save some money around the edges: the dean mentions that absenteeism may be reduced; researchers in my day were trying to show what they called “compression of morbidity”–meaning that healthy people would die more promptly than their sicker counterparts. I doubt that they’ve proven that, but I haven’t tracked the literature for a while. Overall, though, it’s very unlikely that lifestyle changes are going to provide enough savings to, in Dean Mozaffarian’s words, allow significantly “expanded coverage for all.”

    I remember my boss, the head of a university office for health promotion, summing up the research with an ironic observation–that from a managerial point of view, smoking is the ideal habit for the industrial working class: it actually induces higher sensory acuity for the first couple of years, and it kills workers just around the time they’re ready to retire and start drawing pensions and benefits.

    No one would seriously put forward such an argument, of course (though who knows what darkness hides behind the heavy oaken doors of corporate boardrooms?).
    Again, I entirely support the dean’s recommended policy changes, which would improve Americans’ quality and quantity of life. But we should be careful not to base those changes on unsubstantiated promises.

    Liked by 1 person

  4. anisioluiz2008
    September 30, 2017

    Reblogged this on O LADO ESCURO DA LUA.


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