Just what the doctor ordered: better access to healthy food

Before working at GRuB, I served as the founding director of the Washington Free Clinic Association. For five years, I dove into the deeply flawed health care system and worked alongside some of the most generous, innovative and dedicated medical professionals across the state.

At the height of the recession, in 2009, I was tasked by the Department of Health to conduct a study to find out what kind of care people were seeking at free clinics so that we could better understand gaps in the system and ultimately try to improve it.

Of the top 5 health conditions people were seeking care for, four of them had direct association with diet and food access. People were seeking care at a drop-in free clinic for complex issues like high blood pressure, high cholesterol, diabetes and depression/anxiety.

Many health conditions in the U.S. are described as “lifestyle diseases.” I would argue that they are actually cultural diseases. The concept of lifestyle implies personal choice, when in fact cultural trends are the driving force behind the enormous rise in these diseases over the past 50 years.

The interplay of U.S. farm bill subsidies on commodity crops like corn, wheat and soy (which, as staple foods, are calorie dense but nutritionally deficient), the profitability of the pharmaceutical industry, and the market forces behind the processed food industry has resulted in unprecedented access to flavorful high-calorie, low-nutrition, low-cost processed foods.

In addition to many families struggling to meet their basic needs financially — 11 percent of households in Thurston County were living in poverty in 2016, while another 25 percent were asset limited, income constrained, employed (ALICE) — time is a precious resource that is so scarce in our modern world that cooking and sharing meals is an exception rather than a rule. Scarcity of time drives the demand for processed convenience foods; their low price seals the deal.

According to the World Economic Forum, on average, Americans spend less on food than any other country, at just 6.4 percent of gross income. Conversely, we spend more per person on health care than any other country in the world, reaching a new peak of $10,348 per person per year in 2016, which is more than double most other developed nations’ spending, and is $2,400 more than the next highest spender, Switzerland.

In April of 1999, not even six months after the Tobacco Master Settlement Agreement was entered, 11 powerful men who controlled the major food companies in the U.S. convened at Pillsbury’s headquarters to discuss one key issue: the obesity epidemic, and what they might collectively do about it. Ultimately, they walked away without committing to take any collective action, or responsibility.

After my last piece in March, in which I asked the question, when did pleasure become a dirty word, and posited the belief that our culture is undervaluing pleasure as part of our health and happiness, someone bravely wrote me a succinct email response, “When so many of us cannot afford it.” Fair enough, and heard.

Without the subsidies that commodity crops receive, fresh produce is some of the most expensive, and eating healthfully costs at least $1.50 more per day than the average unhealthy American diet.

Again, this quagmire represents a cultural disease that cannot be simplified down to individual choices. A study of worldwide obesity conducted in 2017 revealed that childhood obesity has increased 10-fold over just 40 years. And to be clear, bodies most certainly are beautiful in many forms and obesity alone isn’t the real issue. The high correlation between “lifestyle” diseases like heart disease and diabetes and childhood obesity are undeniable.

Like the $206 billion tobacco settlement of 1998, someone is profiting off of the conditions of time scarcity and wealth disparity that are driving the demand for unhealthy foods, and we’re all paying for it. The health care industry, including pharmaceutical manufacturing and sales, and all of the hospitals and medical services in the U.S. reached $24.4 billion in revenues in 2017, making it the most profitable sector of the U.S. economy.

At a conference several years ago, I heard Dr. Adam Hoverman, faculty at the Pacific Northwest University of Health Sciences in Yakima, say that “the choices we have are the choices we make.” He exemplified this with an image of a vending machine filled with rows of bottled water and fruit juice, and a few soft drinks at the bottom, compared to one stocked 90 percent full of soft drinks.

If we want to see “lifestyle” diseases recede, or more importantly, if we want to see the health and well-being of our community improve, then we will have to work at the individual, community and policy level to make better options available, informed by those most affected. I look forward to a day when we are empowering doctors to prescribe fruits, veggies, gardens, and recreational activities freely and when insurance — or a major settlement — pays for it, so that we can ultimately spend less on health care and enjoy more well-being throughout our lives.