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New Allies For Food Reform


I think Tom Laskawy is way too hard on the American Medical Association here. If they're saying the right things on food -- namely, that

"the current US food system is highly industrialized, focusing on the production of animal products and federally subsidized commodity crops, such as corn and soybeans. This has resulted in a highly processed, calorie-dense food supply, instead of one rich in a variety of fruits vegetables, and whole grains ... The poor quality diets supported by this system contributes to four of the six leading causes of death in the United States: heart disease, stroke, diabetes and some cancers."

-- then they're saying the right things on food. That's good! They don't need to devote lobbying dollars to the effort to be judged "serious." Indeed, I'd think food reformers would welcome the AMA's statement: It allows them to say that the country's leading doctor organization has officially found that our food system is oriented toward making us fatter, sicker and poorer and that reform is needed.

One of the issues I tackle in my article on the difference between health and health-care reform is the difficulty of expanding health-care reform to include things that would make us healthier but that don't happen in a hospital. One of those things is making it more affordable for low-income Americans to eat well.

In the movie Food Inc. -- which I'll have more to say about soon -- there's a segment in which a poor family (pictured above) goes through a fast food drive-through. The mother admits that she knows better. They shouldn't eat like this. Her husband, in fact, has diabetes, and they spend more than a hundred dollars a month to purchase his medications. But they have no choice. They can't afford anything else.

This gets to an important point about cheap food: It's not necessarily cheap. It's cheap now. But given the health costs associated with obesity and diabetes -- and given their stunning prevalence in low-income communities -- it's really a way of borrowing money from your future self. No one thinks about it that way, but for this family that bought fast food because it was affordable and now spends thousands of dollars out-of-pocket on diabetes medication, that's been the overall impact.

So if the AMA wants to help make that point, then great! For better or worse, they have the credibility to make it. People trust doctors. And you have to admit: there's something weird about a country where it's very common to say that every American should have guaranteed access to extremely expensive, cutting edge medical care but it's weird to say that every American should have guaranteed access to a variety of affordable, fresh, healthful foods.

Photo credit: Magnolia Pictures Photo.

By Ezra Klein  |  June 19, 2009; 5:33 PM ET
Categories:  Food , Health  
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i dont understand people saying that they eat unhealthy foods because they cant afford healthy foods.
yams, bananas, oranges, apples, russet potatoes, carrots,rice,beans,cabbage.....and other fruits and vegetables in season. these are not expensive foods, but they are very good for us.
i think it is not always an economic choice....people just enjoy eating things that are not good for them.
in another post, i wrote about attending a lunch event for seniors. sadly, the people around me were almost all suffering from severe medical conditions, including diabetes and different kinds of heart disease....and yet, although not everyone chose salad on their plates, everyone at the table finished their coconut cake with artificial frosting on the top.
no-one is perfect, but much of the time, we are conscious of what we are doing, and responsible for the choices we make.
the consequences of our choices often affect everyone else.
almost everyone at that table was being treated for serious, chronic illnesses, and the choice to eat nutritiously, often plays an important role in that.
illness is hard enough, without eating poorly and encouraging it along.

Posted by: jkaren | June 19, 2009 6:07 PM | Report abuse

I also don't understand the cheap vs. healthy dichotomy. Is it more expensive to make a ham sandwich at home than it is to drive to a fast food place and buy a hamburger? If you take the time to cook at home, it is almost always cheaper than eating out - even at fast food joints.

Posted by: vespaden | June 19, 2009 6:35 PM | Report abuse

That was exactly the point I was making in my post that Tom was responding to and why I took Atul Gawande to task for not exploring the social health cost angle in his otherwise great New Yorker article. See:

Posted by: samfromartz | June 19, 2009 7:03 PM | Report abuse

There's no way that fast food is cheaper than beans and rice or potatoes and cabbage or liver and onions or split pea soup. The thing is, these things are considered poor people's food and ordinary Americans won't eat them - even though they are much healthier than the salt, sugar, and fat that's sold to them.

Posted by: Bloix | June 19, 2009 7:03 PM | Report abuse

Just a story. I have a cousin, a physician, who is well up in his eighties and very healthy whose mother died at 110 and her sister died at 108. He is part of a study that examines children of long lived parents.

One day he was in line at the cafeteria at his hospital and took a doughnut. One of his colleagues said that he didn't think his mother would have taken the doughnut. My cousin said that his mother's diet was atrocious. If the meal was diary, she smeared butter over everything; if it was meat, she put smaltz on everything.

We shouldn't assume we know all the answers in nutrition.

Posted by: lensch | June 19, 2009 7:11 PM | Report abuse

I think some of you are mostly right about the cheap v. healthy dichotomy, but it's not necessarily the cost that is the only factor. There's an educational gap. Being able to just buy better food will do no good if you don't know how to prepare those foods. Plus, for this family in particular, there is also a time factor. This is a family, like many working class families, that lives paycheck to paycheck and often has little time to devote to making the nutritious meals.

It's going to take a cultural shift for real change to happen.

Posted by: davidcastilloiii | June 21, 2009 9:18 PM | Report abuse

You have to take all the costs into account when you model cheap vs healthy. Buying, storing and preparing cheap healthy food takes time and cognitive energy that poor people may not have. It takes education in what to buy and how to prepare it. It takes access to stores where the cheap healthy stuff is available at good quality.

Those of us who eat cheap healthy food that we prepare are looking at the costs from the vantage point of 10 or 20 years of practice, usually going back to early childhood. So sure I can throw some flour in a bowl with some salt and sourdough starter and knead up a loaf that tastes better than most store-bought at a quarter the cost. It only took me half a lifetime to learn how.

How do we support people in getting and using the knowledge they need to eat better while they work two or three jobs and take care of their kids? I don't know the answer, but as a nation we'd better figure it out.

Posted by: paul314 | June 22, 2009 11:24 AM | Report abuse

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