By Paul Terry, PhD
Editor, The Art of Health Promotion
CEO and President, Health Enhancement Research Organization
The articles offered in this month’s journal issue explained how our relationships with food have been disrupted and how we can restore a healthy communion with eating through better informed choices. Dr. Kevin Walker writes about how our disengagement with food production and the cavalier individual choices we now make about food purchases has disassociated us from the collective consequences of our new eating habits.
Dr. David Katz argues that we need to coalesce more deliberately around the many points of agreement experts have about what constitutes a healthy diet if we are to counter the confusion that comes with the daily delivery of blog abetted nutritional nonsense. We reference Katz’ “True Health Initiative” and his colleague Susan Benigas expands on this work in the following Blog Post interview:
An Interview with Susan Benigas, The American College of Lifestyle Medicine
Susan, you’re passionate about the work of The American College of Lifestyle Medicine. Where does the “True Health Initiative” fit in the strategic scheme of things for your organization?
Susan Benigas: The American College of Lifestyle Medicine (ACLM) is the nation’s professional medical association for physicians, allied health professionals, healthcare executives and others who are dedicated to a lifestyle medicine-first approach to true ‘health’ care. But even more so, ACLM is a convening of healthcare professionals who share a passion for the urgent need to transform health and healthcare, understanding that simply prescribing more pills and procedures is not in the best interest of patients, nor will it create sustainable human health or a sustainable healthcare system.
As president of ACLM, David has expanded the focus of the College emphasizing “lifestyle in medicine,” as well as “lifestyle as medicine.” The former has been the primary focus of ACLM since its inception: lifestyle used as a therapeutic intervention to prevent, and, more importantly, to treat and, often, reverse the lifestyle-related chronic conditions that are all too prevalent both in the U.S. and in many other nations around the world. The latter speaks to our culture: the need to create cultures and communities that bring clarity to and support healthful lifestyle choices that clinicians ‘prescribe’ and we as citizens self-prescribe as we take far more personal responsibility for our health.
ACLM has been a springboard for the launch of the True Health Initiative—with David’s vision being to ignite a global movement focusing on “lifestyle as medicine.” The True Health Initiative Council of Directors, assembled via David’s personal invitations, serves as the unified, authoritative global voice to espouse the foundational principles of healthy living.
Thinking long term, what is your vision for the True Health Initiative, especially with respect to impacts you may be able to quantify?
We’re in the midst of a seismic shift in healthcare, as we move from a fee-for-service to a value and outcome-based healthcare delivery system. How is value delivered? How are improved outcomes delivered? The answer: Through lifestyle medicine! Lifestyle medicine is about identifying and eradicating the cause of disease. When we consider that 80% or more of all dollars spent on healthcare in this country pay or the treatment of conditions rooted in poor lifestyle choices, it goes without saying that educating, equipping and empowering people to protect their health and fight disease through the power of their lifestyle choices is essential. This is the focus of the American College of Lifestyle Medicine: lifestyle in medicine. Our vision is a nation and world in which every healthcare executive and medical practitioner commits to a lifestyle medicine-first approach to care. We like to say that Lifestyle medicine is the medicine with only positive side effects.
Coupled with this is the vision for a nation and world of ‘Blue Zones’—communities built and designed, at every level, to support healthful lifestyle choices. From pedestrian-friendly design to restaurants of all kinds that offer a plethora of selections that support an optimal dietary lifestyle.
The ultimate vision for the True Health Initiative is that it will be looked to as the ‘Consumer Reports’ of health information, whereby misinformation, misinterpreted research, and the deluge of conflicting and confusing health-related reporting can be clarified once and for all by the True Health Initiative Council of Directors—the global, unified, authoritative voice espousing the foundational principles of healthy living and healthy eating.
How can our Journal readers get involved, show their support and advance “True Health?”
On the True Health Initiative home page (www.truehealthinitiative.org), all who have a shared passion for creating a culture of health are invited to register to become part of the campaign. As the initiative builds and grows, it will provide tools and resources that can be used by members to help promote the foundational principles of healthy living and healthy eating in their own communities.
On the home page of the American College of Lifestyle Medicine (www.lifestylemedicine.org), we encourage all who are interested in joining with us to transform health and healthcare to sign-up to receive the ACLM newsletter and to consider joining. ACLM offers an outstanding array of member benefits for our physician, doctoral, healthcare executive, clinician and non-clinician members. Plans are already underway for Lifestyle Medicine 2016, set for October 23-26 in Naples, FL. David will be a featured keynote reporting on the progress and impact of the True Health Initiative, as we marry lifestyle in medicine with lifestyle as medicine. As David likes to say, “Feet, forks, fingers, sleep, stress and love” are key—each representing a foundational pillar of health and a transformed and sustainable ‘health’ care system.
An Interview with Kevin Walker, Ph.D., Professor, Michigan State University, The College of Veterinary Medicine, Department of Large Animal Clinical Sciences.
Most of what we read about food is compartmentalized such as the effect of dieting, emerging food-related diseases, or calories versus nutrition. You’re looking at food in a much broader context, why?
Kevin Walker, Ph.D. I’ve always been drawn towards the connections of seemingly distinct topics. For example, when I came to Michigan State University I was asked to participate in meetings linking food manufacturing, employment opportunities, and desired lifestyles. That led to further collaboration with various multinational food companies and diverse faculty from different colleges across campus. My interest was linking together different expertise on contemporary food-related challenges.
Dr. Kevin Walker
I’ve identified fifteen decision points that determine how the modern food system operates. As mentioned in the article, they comprise the intersections of six important elements: consumers, food uncertainty, resources, governance, science, and food providers. Any one decision affects others, so it’s hard to prioritize which ones are most important.
But as examples, decisions regarding “public safety nets” (the intersection of food uncertainty and governance) dramatically affect access to food as population grows and faces increasing structural income disparity. Behind “science a la carte” (the intersection of consumers and science) are decisions that say science and technology that make food less expensive are acceptable, but so also are ignoring threats to the environment that threaten comfortable lifestyles. “Resource stewardship” (the intersection of resources and food providers) entails decisions of whether or not to deplete finite petroleum reserves by shipping food overseas for processing and back, because the labor costs make it more profitable.
If I can jump ahead to food-related health decision points that I’m working on as a result of unintended consequences they are: “fraudulent or adulterated foods,” “fight over transparency,” “dilution of science,” “deficient health safeguards,” “rampant energy misuse,” “calories over nutrition,” and “culture against genetics.”
Some of what you’re saying strikes me as failure of government to act. Is it not the responsibility of government to do more?
Ideally, yes. But traditional government with its laws and regulations is just one way individuals pursue collective interests. Another way is through culture with its norms and behaviors. Common courtesies, not littering, helping others in distress are acceptable norms and behaviors we practice that help define our culture. If we think about, acceptable norms and behaviors such as cooking practices, hygiene, use of utensils are ways to ensure better health and food safety.
Perhaps the person who best illustrated how norms and behaviors apply to governance such as sharing resources like water was Elinor Ostrom. In 2009, she received the Nobel prize in economics for her work that documented examples around the world. Prior to her death, the World Bank commissioned her to prepare a white paper on global warming. Part of the reason for the lack of action, she pointed out, was that global warming was framed at such a high level, individuals didn’t believe their actions were part of the bigger problem.
It’s the same with food. Because of the modern food system, the role of consumers and food-related health appears isolated from the production of food. In fact, some address nutrition policy as separate from agriculture policy. I would contend they’re linked as both are steered by the same modern food system.
I recently read an article of young professionals wanting to eat more healthy food while insisting it be convenient and not take time away from their busy schedules. It sounds like a good idea, but whether they recognize it or not, behind their decisions centered on better health are acceptable norms and behaviors that say time is more important than food waste that happens as a result. Food waste translates into resource depletion and environmental loss. When the societal norms and behaviors shift around food-related health and food production, then traditional government will follow behind.
What would you say is the biggest food-related challenge we face?
Not asking questions. At one time, people were responsible for producing the food they consumed. They were personally vested in how food tied to health that sustained life. The advantage of the modern food system is it made calories consumed almost free. All we had to do was show up, choose what foods we wanted, possibly prepare something, and eat.
When food requires so little, we don’t ask whether it’s reasonable to believe that access to food requires having money? When questions like this are never asked, we start to think that money offsets any need to consider biological and geophysical forces that make food possible.
There are other questions worth asking as well such as what can food teach me as it relates to health? Or what am I willing to learn from food? These are very different questions then asking what can food do for me?
What can we do at the individual level?
I suggest starting with increased awareness about how we connect to food. By stepping back, observing, and listening one realizes just how much our culture and identity is wrapped around abundance and convenience without commitment. Sure, we still laugh when children say milk comes from the refrigerator, but then we live as if food originates from supermarkets and restaurants. Historically, food always required more time and effort than what modern society has been willing to invest.
Next is conscious awareness of how food-related decisions we make align with the way we want to live. Besides the decisions I mentioned earlier, there are a host of others we can’t ignore that relate to unintended consequences. As examples, for food-related health, our decisions determine how much society tolerates adulterated or fraudulent foods like fish and imported honey. For food safety, science can inform but we decide what’s safe. And for the environment, our decisions ultimately determine how much we value nature which obviously has ramifications for personal health.
At a minimum, we can stop wasting food, thereby preserving resources and the environment. We can practice breaking the mindset that our only role as consumers is at the tail end of the food system. Or that the main tool to better food-related health options is through choices we make at supermarkets and restaurants. Instead of looking at food as a means of entertainment or recreation, we can look at it as a path to build community and teach connection to one another and other living species. We can challenge politicians who say the almost ~$1 trillion farm bill is in consumers best interests by asking how it improves consumers health?
Finally, can you give some simple examples of how increased awareness has changed how you live?
The more I learn, the less complicated decisions become. It’s easier to see the connection to health and resist the formula behind many processed foods (the decision point I call “culture against genetics”). I’m also more aware of where food originates and make personal decisions accordingly. I’m more mindful of the compromises being made between business profit and personal health that plays out everyday in product labels, advertising, and manufacturing standards.
When I eat, food is more than what I put into my mouth. Instead of reaching for more dressing to boost kale or spinach palatability, I’m more grateful for the marvelous events that brought together energy and fiber my body needs and that I’m about to consume. I’m less needful of foods designed to stimulate sensory pleasures like taste; I’m more appreciative of simpler foods that promote health.
Could a Broader Social and Educational Diagnosis Inform Fairer Food Policies?
By Anna Terry, M.N., R.N., P.H.N. and Paul E. Terry, Ph.D.
This Blog Post adds additional detail to the closing commentary from this month’s Art of Health Promotion section: “The Food Issue” and offers references used throughout the full commentary.
The articles offered in this journal issue explained how our relationships with food have been disrupted and how we can restore a healthy communion with eating through better informed choices. In the full closing commentary, we built on these themes by examining how nutrition science and food policies are linked to issues of individual justice, economic fairness and environmental preservation.
We proposed that changing consumer attitudes and awareness about both local and global food chain realities is needed if we are to overcome the natural resistance to food policy changes that are focused primarily on individual health and are commonly felt as merely about limiting freedoms and choices. Successful tobacco policy reform took decades. Unless we increase consumer awareness about the health consequences of our current food distribution system as well as the economic, individual and social justice issues fostered by our current food supply, it may take even longer to affect policies that change food demand and make healthy eating the easy choice, particularly in economically disadvantaged communities.
The Difference between Food Policy and Tobacco Policy
Those who have even a modicum of schooling in nutrition understand the health benefits of policies that limit intake of sugar, salt and fat. Nevertheless, thousands of health care organizations worldwide, with a mission to protect health, continue to make sickening levels (literally) of sugar, salt and fat the easy choices for patients and their employees every day. This restraint about limiting choices, where tobacco free buildings and grounds are now common place, bespeaks the fundamental difference between food and tobacco policy making. There is no health benefit to tobacco but we need food. Hence, unlike the long road that led to policy reforms in tobacco, changing food policy may start with the case for protecting health, but the case for limiting access to bad for your foods will also benefit from a deeper appreciation of how our choices about foods can also be bad for other people, their communities and our planet.
How would worksite and/or school based food policy changes be decided, communicated and sustained using such a holistic paradigm? We would begin by assessing how our food consumption patterns are affecting individual and population health across the global food system.
Food Workers Deciding between Paying for Food or Rent
A nurse learns if someone is hypothermic a related factor may have been exposure to cold. In the case of an impaired food distribution system, a primary related factor is the prevalence of poor working conditions. A “flexible labor” force has become endemic to agriculture and when a worker does not have guaranteed hours they often cannot afford food if they are still working to pay for rent. In the case of tomato production in Mexico, for example, vulnerable populations are recruited for flexible labor to maximize profits during harvest. Their story, as told by Deborah Barndt in Women Working the NAFTA Food Chain, explains how “hundreds of poor Indigenous workers, brought in by trucks and housed in conditions of squalor in makeshift camps, do much of the picking during the three-to-five month harvest season.” (1999, p. 71). Ironically, cheap labor and the related low prices for foods results in small changes in market supply or demand resulting in outsized impacts on the poor. After one recent change in commodity demand, the World Bank estimated 44 million people fell below the poverty line due to rising food prices (Knaup et al, 2011).
An even more ironic example of good intentions producing bad outcomes come from The Green Revolution and the introduction of ‘western’ style farming techniques to developing countries. In her book “Staying Alive,” Vandana Shiva explains how these techniques displaced women from food production, degraded the soil and undermined peasant knowledge of seed and water management. She critiques hybrid seeds in particular stating, “These technologies … were aimed neither at protecting the soil and maintaining its fertility, nor at making food available to all as a basic human right” (Shiva, 1989,p. 104). Her critique of hybrid seeds is not solely about added production costs but the injustice of the patents that accompany the seeds and rules that protect their sale in market. In ‘Protect and Plunder’ Shiva explains how companies “can collect rent for every seed sown” thus displacing subsistence farmers and consequently changing local food availability, local livelihoods and economic stability. (Shiva, 42). Shiva is not alone in her criticism of the Green Revolution, in their book Food Rebellions!, authors Holt-Gimenez and Patel note, “An unspoken objective of the Green Revolution was to avoid implementing agrarian reform. In this sense, the Green Revolution was less a campaign to feed the urban poor than a strategy to prevent the rural poor from seizing land to feed themselves” (2009, p. 669).
While seemingly contradictory, food aid is also related to the impaired food distribution system. Post World War II, food aid helped to feed the poor while simultaneously undermining the resurgence of local food markets. This practice continued throughout the world. Over abundance of food grown in the North was “used as a battering ram to open up markets in the global South for the benefit of…agro-industries-to the detriment of farmers in the South who could not compete” (Holt-Gimenez and Patel, 530). This practice is seen today through programs like USAID that rely on US agriculture to feed the global South.
Using Pragmatic Solidarity
We believe that the timing is right for workplaces and schools, employing the “pragmatic solidarity” described in this Journal’s full commentary, to be a leading force in alleviating the burdens of food waste and food insecurity. What’s more, including this broader objective in food policy making not only makes healthy eating choices the easy choice, but also the socially responsible choice.
Barndt, Deborah, ed. (1999) Women Working the NAFTA Food Chain: Women, Food and Globalization. Toronto: Sumach Press.
Brown, Sandy & Getz, Christy. “Farmworker Food Insecurity and the Production of Hunger in California,” in Alkon and Agyeman, Cultivating Food Justice: Race, Class, and Sustainability.
Dangl, “Brazil: Lula and the Landless” in Dancing with Dynamite: Social Movements and States in Latin America, pp. 119-137
Farmer, Paul. (2010) “Making human rights substantial” in Saussy, ed, Partner to the Poor: A Paul Farmer Reader.
Guthman, Julie. (2011) Weighing In: Obesity, Food Justice, and the Limits of Capitalism. Berkeley: University of California Press.
Holmes, Seth, and Philippe Bourgois. (2013) Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States. Berkeley: University of California Press.
Holt-Gimenez, Eric, and Raj Patel. (2009) Food Rebellions!: Forging Food Sovereignty to Solve the Global Food Crisis. Cape Town; Oakland, CA; Boston, MA: Pambazuka Press.
(2) Holt-Gimenez, Eric and Patel, Raj. (2009) Food Rebellions!: Crisis and the Hunger for Justice (Kindle Locations 511-513). Food First Books. Kindle Edition. Oxford: Pambazuka Press.
Holt-Gimenez, “Food Security, Food Justice, or Food Sovereignty?” in Alkon and Agyeman, Cultivating Food Justice: Race, Class, and Sustainability.
Knaup, Hornad. Schiessl, Michaela and Seith, Anne. (2011) “Speculating with lives: how global investors make money out of hunger,” Parts 1-4, Der Spiegel.
Lee, Katie. (2014). The Farm Bill and International Food Aid: What You Need to Know. The Huffington Post. Posted 2/6/2014. Retrieved from: http://www.huffingtonpost.com/katie-lee/the-farm-bill-internation_b_4733249.html
National Public Radio. (2015) ‘Just Eat It,’ Filmmakers Feast For 6 Months On Discarded Food. Retrieved from: http://www.npr.org/sections/thesalt/2015/11/18/456489490/in-just-eat-it-filmmakers-feast-for-6-months-on-discarded-food
Rutten, Lila and Yaroch, Amy and Patrick, Heather and Story, Mary. (2012) Obesity Prevention and National Food Security: A Food Systems Approach. Review Article. ISRN Public Health. Volume 2012. Article ID 539764. Retrieved from: http://www.hindawi.com/journals/isrn/2012/539764/
Shiva, Vandana. (1989) Staying Alive: Women, Ecology and Development. London: Zed Books.
USAID.GOV (2011). “Our Neighbors, Ourselves: Guatemala’s Chronic Malnutrition Crosses Borders. Nov/Dec 2011. Retrieved from: https://www.usaid.gov/news-information/frontlines/50-years-and-food-security/our-neighbors-ourselves-guatemala%E2%80%99s-chronic
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