Food as Medicine (and Health Care Cost Control), Part I

Call me (still) crazy, but back about 10 years ago when people were fighting like cats and dogs over the  Affordable Care Act and political liberals and conservatives largely fell into nice, neat lines on either “side” of the debate, I, who consider myself to be largely a social liberal and a fiscal moderate, was trying to invent a completely different line whenever the issue came up in conversation. That line invoked my deep and pretty much unrelenting conviction that when you’re dealing with any significant, systemic issue, you do yourself (and any impacted constituents – in the case of healthcare, that’s more or less all of us who aren’t super-wealthy) a huge disservice by only addressing symptoms. Rather, analysis of, and solutions for, the root cause(s) of an issue are the path to a longer-term, more effective answer.In this case, the “symptom” was (is) the skyrocketing costs of healthcare (duh!), which, per the main focus of the ACA, would be addressed by a turning of the regulatory screws, mostly on providers and payers. My point (then, and still) was that we already knew at the time, and we have an even greater body of evidence now, that there are a few *significant* drivers behind healthcare costs in this country. One of those drivers is spending on chronic preventable diseases (which also impacts some of the other major levers of spending, including “service price and intensity,” a significant proportion of which is driven by increasing costs of pharmaceuticals and acute interventions to *treat* the chronic preventable diseases).My essential argument is this: we’ll *never* rein in the costs of healthcare if all we focus on is the cost of delivery of healthcare. We need to get serious (as serious as a heart attack, maybe?) about making the deeper changes we need to make as individuals, a country, and as a culture that will influence our collective health. And I’ll be the first to admit that diet isn’t the only issue, but it’s my soapbox, and I'll focus on food if I want to, because it's a big one.Here are some sobering statistics from the Centers for Disease Control and Prevention (a.k.a. the CDC – though this language is quoted from “The Nutrition Source” on the website of Harvard’s T.H. Chan School of Public Health):

• Chronic diseases are the leading causes of death and disability.
• 70% of annual deaths are due to chronic diseases.
• These *preventable* (emphasis added) conditions not only compromise quality of life, they add to rising health care costs—*75% of our health care dollars are devoted to treat these diseases* (emphasis added, again).
• Among adults ages 20 to 74, diabetes remains the leading cause of kidney failure, blindness, and non-traumatic lower-extremity amputations.

“Chronic diseases —*including heart disease, stroke, diabetes, and cancer* (emphasis added)— account for some of the most common health problems in the United States . . . yet many of these chronic diseases are preventable, as they’re linked to poor diet and lifestyle choices including tobacco use, excessive alcohol consumption, and inadequate physical activity.” Let me repeat: 75% of our health care dollars are devoted to treat these diseases.This isn’t simply about making changes to our diets, though. There’s an entire undercurrent (more like a riptide) of culture that needs to evolve as well, and I’ll be talking more about that in future entries, but allow me close this post with one simple example, as this particular policy is certain to whip up controversy wherever it’s proposed: a tax on beverages with added sugar. People invariably FREAK. OUT. over this (though I think it’s a freak-out that in large part is manufactured by political action/interest groups representing beverage manufacturers, whose “ads” on the horror of the idea are intended to sow discontent). But this is what I mean when I talk about the riptide of culture, and I’ll come back to that next time.Cheers for now, and happy (Food) Friday!