At first, San Francisco Dr. Daphne Miller got funny looks when she told colleagues she was pursuing continuing education on sustainable farms. “The moment I began working as a family physician, it became clear to me that much of the chronic disease I was treating in my office was directly traced to our system of agriculture,” Miller explains. The ecologically managed farms Miller visited gave her hope for a better way — and inspired her to get involved in how we grow our food. For Miller and an increasing share of the medical community, the imperative to change the food system is a matter of health care economics.
When the Supreme Court upheld the Affordable Care Act’s federal health insurance subsidies in June, the 6.4 million Americans who rely on these subsidies breathed a sigh of relief. Joining them were emergency room nurses, social service providers and everyone else with a front-row seat on the inhumanity and short-sightedness of denying low-income Americans access to routine health care. Since the 2010 passage of Obamacare, more than 17 million uninsured people have enrolled in a plan.
But Obamacare also offers another opportunity. The law requires private hospitals to spend 3 percent of profits on community chronic disease prevention programs and, as Miller explains, “That’s a lot of dollars that could potentially go to supporting a healthier agricultural system. We just need to connect the dots and start seeing the way we grow our food as a public health concern.”
We can begin with the American diet. According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese, and it’s costing us $147 billion a year. First lady Michelle Obama has responded by trying to increase children’s physical activity, improve school lunch and get kids in the garden — all important and laudable goals. Cities such as New York and San Francisco have attempted to introduce taxes on sugary beverages to discourage consumption; Berkeley’s soda tax passed last year and will provide an interesting test case for this policy approach.
But our unhealthy national diet is just a symptom. It’s our food system that is the disease. Agricultural policy — mostly within the federal Farm Bill — continues to prop up a food sector structured to produce the very fare associated with our most common causes of death and ill health. Because we effectively subsidize unhealthy foods, they are artificially cheap; hence, the health burden of their consumption falls disproportionately on low-income communities. As Miller says, “Primary prevention is offering everyone a healthful, affordable selection of foods; whereas secondary prevention is screening for diabetes and heart disease.”
In other words, if we really want to improve American health, we need to change the structure of this food system, from the ground up. We need to rebuild infrastructure to support diverse rotation crops, distribution of local produce, and farm-to-institution partnerships for schools, hospitals and child care facilities. We need to support our public agricultural research and agricultural extension system and direct its activities toward biologically diversified farming systems and agriculture in the public interest. Absent such changes, attempts to curb diet-related ill health merely will treat symptoms, not the disease.
Liz Carlisle is a fellow at the Center for Diversified Farming Systems at UC Berkeley and the author of “Lentil Underground,” (Gotham/Penguin Random House, 2015).