One third of our economy thrives on making people sick and fat. Big Farming grows 500 more calories per person per day than 25 years ago because they get paid to grow extra food even when it is not needed. The extra corn (sugar) and soy (fat) are turned into industrial processed food and sugar-sweetened beverages -- combinations of fat, sugar and salt that are proven to be addictive. These subsidized ($288 billion) cheap, low-quality foods are heavily marketed ($30 billion) and consumed by our ever-widening population with an obesity rate approaching three out of four Americans. The more they eat, the fatter they become. The fatter they become the more they develop heart disease, diabetes, cancer and a myriad of other chronic ailments.
Today, one in 10 Americans have diabetes. By 2050 one in three Americans will have diabetes. The sicker our population, the more medications are sold for high cholesterol, diabetes, high blood pressure, depression, and many other lifestyle-driven diseases. The Toxic Triad of Big Farming, Big Food, and Big Pharma profits from creating a nation of sick and fat citizens.
This structure is built into the very fabric of our economy and culture. It could be called the medical, agricultural, food industrial complex. It is what is known as "structural violence"--the social, political, economic and environmental conditions that foster and promote the development of disease.
But there is a way to turn the Toxic Triad into a Health Trinity. Through innovation and creativity we can create a new economy based on products and services that make people thin and healthy instead of sick and fat. Business can do well by doing good! We just have to change the default choices and behaviors both at a policy and a grass-roots level. I learned a few things about this in Haiti from my friend Paul Farmer.
Addressing Structural Violence
When I was in Haiti in January 2010, after the earthquake, I visited Zanmi Lansante, the health center started in the 1980's by Dr. Paul Farmer. Much to the world's amazement he showed how, in one of the poorest places on the planet, he could successfully treat complex infectious diseases such as tuberculosis and AIDS. The conventional wisdom was that poor people sleeping on mud floors would not take complex regimens of medication so we should essentially leave them to die. The problem wasn't that doctors didn't know what medications to prescribe, but that poverty and social conditions such as lack of access to health care, food, shelter, jobs, clean water and sanitation prevented effective treatment.
Paul Farmer didn't accept this. Through his foundation, Partners in Health, with the help of the Clinton Foundation and the Gates Foundation, he demonstrated the flaws in conventional wisdom and has successfully treated "impossible to treat patients in impossible conditions" around the world. He did it because he addressed one simple thing: Structural violence.
To successfully treat people in Haiti, Paul Farmer did not simply focus on what medication regimens were needed to cure tuberculosis or treat AIDS. He "accompanied" patients into their lives. By using local, trained community health workers he helped patients change the conditions of their lives, find shelter, food, jobs, clean water and sanitation--all necessary "structural" changes that allowed for effective treatment. He addressed the system, not just the symptom.
We must do the same if we are serious about addressing the wave of chronic illness sweeping across the world. We must focus, not only on the individual, but the system that has created 1.7 billion overweight citizens worldwide if we are to slow and reverse the national and global epidemic of obesity, diabetes, and heart disease threatening not only our health, but the survival of our economies.
Big Food, Farming And Pharma: How They Are Killing Us
The default condition of a human being in the 21st century is to be obese. Nearly 75 percent of Americans are overweight. This is not an accident. Specific, traceable forms of structural violence promoted by Big Food, Big Farming, Big Pharma (see my recent blog on "Dangerous Spin Doctors") and government polices is leading to the global spread of obesity, diabetes, heart disease and cancer.
Current food policies and subsidies encourage Big Farming to overproduce corn and soy which are then used to create sugary, fatty, factory-made, industrial food products sold as processed, fast, or junk food as I noted above. The government essentially stands in line next to you in fast food chains helping you buy cheeseburgers, fries, and cola. But in the produce isle of your supermarket you are on your own--the 2010 Farm Bill offers little support to farmers for growing fruits, vegetables, and healthy whole foods.
The resultant omnipresence of cheap, high-calorie, nutrient-poor processed foods (or "food like substances") in homes, schools, government institutions and food programs, and on every street corner creates default food choices that drive obesity. How can you eat fruits and vegetables when you can't buy them in your neighborhood convenience store or their price has increased five times as fast as sugar-sweetened beverages?
Big Food takes advantage of this glut of processed food to drive up profits through the use of mass media technologies. Other than drinking sugar-sweetened beverages, the number of hours of screen time or television watching is the single biggest factor correlating with obesity which, in turn, drives the diabetes epidemic. In addition to the metabolism-slowing, hypnotic effect of watching television, relentless food marketing focused on children is one of the major factors driving this problem. The average two year old can identify, by name, junk food brands in supermarkets, but many elementary school children can't readily differentiate between a potato and a tomato as Jaime Oliver recently demonstrated.
Big Food claims that the problem is one of personal responsibility-- that processed foods can be part of a healthy diet as long as they are eaten in moderation. But the more we delve into the research on food marketing practices, the impact of food deserts where healthy foods simply can't be found, and the biologically addictive properties of these overly available cheap, high-calorie, nutrient poor junk/processed foods, the clearer it becomes that environmental factors override our normal physical and psychological mechanisms that control weight.
As I explained in my recent blog on food addiction, it is not a failing of personal responsibility, moral fiber, or will power that drives people to over consume these unhealthy foods. Industrial, processed food has been found to be addictive. We are like rats in a cage with unrestricted access to processed sugar and fat. When given a choice between cocaine and sugar, rats always choose sugar. So do we.
Poverty and food scarcity also drive poor food choices and are linked to obesity, and diabetes. The poverty rate in 2009 was 14.3 percent, the highest since 1994. As I pointed out in my article "Not Having Enough Food Causes Diabetes" there is a correlation between the poverty rate and the obesity rate. The poorest states in the nation are the fattest.
The government's approach to these issues echoes Big Food. Government interventions like industry initiatives are predicated on education and encouraging personal responsibility. The rhetoric is that regulating the food industry strips away our right to choose, and that the market should be self-regulating.
It's true that market-driven forces often do effectively control commerce. Companies can produce and sell poor-quality products, and if consumers choose to not buy them, the market regulates itself--companies begin supplying what consumers demand instead. This model works in our society unless those products affect our health, safety, or the greater social good. In this case, we expect our government to step in and take action.
Consider cars or medication. The government has mandated the production of safer, less polluting cars and protects us from harmful medication. In cases like these, government regulation is accepted. Poor diet causes many more deaths than auto accidents, yet as a society we resist government regulation over Big Food. Why?
If our normal protective biological mechanisms don't work in this toxic food environment--and they don't--it is lack of government oversight that erodes personal freedom. Big Food may make the right "noises," but it will not self-regulate just as Big Tobacco wouldn't.
Perhaps more to the point, there is an element of blaming the victim in all of this that misses the structural violence--the environmental conditions--that drive obesity and disease and lead to what is not being called an "obesogenic" environment. The main factors of which are:
1. Industrial processed, fast, and junk food is addictive. Processed food full of sugar, fat, and salt is neurochemically, biologically addictive in the same way cocaine, heroin, nictoine and caffeine are addictive, and it increases food and calorie consumption and obesity as a result.
2. Big Farming's influence over the global increase in obesity. Agricultural practices and government subsidies promote the growing of cheap corn and soy which is turned into the sugar, fat, and processed food that drives disease and fosters the spread of this cheap, calorie-dense, nutrient-poor food across the globe.
3. Unethical, manipulative food marketing that drives eating habits. There is very little government control over Big Food's marketing practices which shape behavior in insidious ways, especially in children.
4. Poverty's relationship to obesity and disease. Poverty promotes obesity, diabetes, and chronic disease because processed food is cheap while being high in calories and low in nutrients.
5. The destruction of the family kitchen and home cooked meals. The family meal, and family and local food culture, has been replaced with convenience or fast foods. This has led to a generation of Americans who can't recognize any vegetable or fruit in its original form and can't cook except in a microwave.
6. Obesity is contagious. You are more likely to be obese if you have fat friends, than if you have fat relatives. Social norms promote weight gain.
7. Environmental toxins. These contribute to weight gain, obesity, and diabetes. Not only do we have to worry about what we eat, but also the burden of plastics, metals, and pollutants which have been shown to poison and slow our metabolism leading to weight gain.
Important initiatives have been created by the Obama administration within the health care bill and Michelle Obama's "Let's Move" program that mark a beginning of a shift that needs to happen in our food climate, but to really change our obesogenic environment we need to create healthier default choices for citizens. We must focus on specific actions we can take personally and politically to alter our food landscape.
Ending Structural Violence: What We Can Do to Create a Healthier Nation and World
What can be done to change the social and economic conditions that fuel the fattening of America and the world? The public can vote with its fork and with the ballot! Here are some choices we can start making individually and as a society today:
1. Eliminate unhealthy foods from all schools, child-care and health care facilities, and all government institutions. The government must establish rigorous standards for school nutrition consistent with current science (through the USDA). Similarly, we need to create nutrition programs for other public and government-run institutions.
2. Stop food advertising to children. Food marketing directed at children should be banned (through the FTC). This has been done in over 50 countries across the globe including Australia, the Netherlands, and Sweden. We should follow suit. The FDA should also restrict unproven health claims on labels.
3. Develop more funding for nutritional science. Congress should mandate greater funding of nutritional science and place guidance for dietary policy with an independent group such as the Institute of Medicine.
4. Change the Farm Bill. Agricultural policies should support public health and encourage the production of fruits and vegetables, not commodity products like corn and soy.
5. Lobby reform. We must change campaign finance laws so that corporate political donations from entities like Big Food, Big Farming, and Big Pharma can no longer control the political process.
6. Tax sugar. Scientists suggest a penny an ounce tax on sugar-sweetened beverages. This would reduce consumption, obesity, health care costs, and provide revenue to support programs for the prevention and treatment of obesity.
7. End irresponsible relationships between medicine and industry. Public health organizations like the American Heart Association and the American Dietetic Association should avoid partnerships, endorsements, or financial ties with industry that compromises their independence and credibility. Coca-Cola sponsoring events at the American Dietetic Association, or the American Heart Association promoting chocolate sugary cereals as heart healthy because they have a few grains of whole wheat--is this credible?
Perhaps the most important initiative we could enact is the creation of a "Health Corps for the nation--a workforce of community health workers to educate and support sustainable change by addressing structural violence in homes, schools, the workplace and most institutions. By following Paul Farmer's model in Haiti, we would create jobs, improve health, and lower health care costs.
My friend, Dr. Memhet Oz, has started working on this. He created HealthCorps, an organization that trains college students in lifestyle change and then provides them with the infrastructure to go into schools and communities around the country and share what they have learned. We should follow this model on the national level.
If pushed, Big Farming can start growing healthy food to feed the nation and Big Food can come up with innovative solutions that satisfy consumers and supply healthful, economical, convenient, and delicious foods for our world. However, these industries will not police themselves.
With appropriate checks and balances put in place by government, it can become profitable to create products and foods that create and promote health. When this happens the Toxic Triad can become the Healthy Trinity!
To your good health,
Mark Hyman, M.D.
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