The Unspoken Trillion-Dollar Crisis in the Democratic Debates

By Nancy E. Roman, President and CEO, Partnership for a Healthier America

Date: February 27, 2020

When Mike Bloomberg was asked in Tuesday night’s debate about his soda tax in New York City, he replied, “What’s right for New York City isn’t necessarily right for all other cities,” made a joke about a naked cowboy, and the debate quickly moved on.

Bloomberg was wise to be cautious given the American love of freedom and disdain for taxes, which he experienced firsthand. The only other person on stage to touch the issue was Joe Biden. Yet, at some point we will have to grapple with the role of food as a driver of healthcare costs. We continue to bang our heads and talk in circles about the cost of healthcare in this country without addressing the root cause of those costs: Our nation’s broken food system.

While Medicare for All and Obamacare got lots of airtime, our nation’s true healthcare crisis received scant attention. Food holds the potential to build human health, prevent disease, slash the cost of Medicare and Medicaid–all while increasing productivity for business managers and owners.

The direct and indirect costs of diet-related disease in the U.S. are $1.72 trillion annually, equivalent to about 9.3 percent of US GDP, and twice what the U.S. spends on national defense.

We know that food is both a primary driver of poor health outcomes and a driver of health inequity. Food is an essential tool for preventing, slowing, or, in some cases, reversing the development of diet-related disease.

A mere ten foods–eating too much or too little of them–are found to be at the root of nearly half of U.S. deaths from heart disease, stroke, and Type 2 diabetes each year. Foods high in salt, sugar, and saturated fat or that are highly processed contribute to obesity, chronic inflammation, high cholesterol, and insulin resistance. Nutrient dense foods high in soluble fiber like fruits, vegetables, and whole grains can lower blood cholesterol levels, blood sugar, and body mass index.

Science shows this. Politicians know this. And yet, we aren’t acting on it.

Today, just one in ten American adults meet the federal recommendations for fruit and vegetable consumption. Men, young adults, and low-income individuals show the lowest rates of fruit and vegetable consumption overall. French fries remain the number one vegetable consumed by children as young as 12-14 months. We know that billions in federal funding for nutrition programs are spent on calorie-dense, nutrient-poor foods.

Government is in a strong position to leverage food as a tool for health in ways it has not.

Cities could set guidelines that drive purchase (and consumption) of more climate friendly vegetables, whole grains, nuts and seeds.

States could use food as medicine in Medicaid programs, with doctors able to write prescriptions for good food and pharmacists able to fill those prescriptions.

The U.S. Department of Agriculture could double subsidies for fruits and vegetables, both at the farm level and in federal nutrition programs. The Department could end subsidies for calorie dense and nutrient poor sodas and snacks through SNAP and school lunch guidelines so that the program not only meets people’s caloric needs, but is more likely to support beneficiaries’ health.

The Food and Drug Administration could require increased transparency around what is in food so consumers can make better choices. Just tell us “high in sodium,” “high in added sugar,” and/or “high in saturated fat,” and let us decide.

Food has immense power to build health, save medical costs, increase productivity, and prevent–sometimes even cure–disease. It simply lacks a champion who understands its power and is willing to champion it on stage. Will one step out from the crowd?