The Democratic debate on health care has to date centred around who should be covered and who should pay the bill. That debate, which has been going on for decades, has no clear answers and cannot be easily resolved because of two fundamental realities: Health care is expensive, and Americans are sick.
Instead of debating who should pay for all these, no one is asking the far more simple and imperative question: What is making us so sick, and how can we reverse this so we need less health care? The answer is staring us in the face, on average three times a day: our food.
Poor diet is the leading cause of mortality in the United States, causing more than half a million deaths per year. Just 10 dietary factors are estimated to cause nearly 1,000 deaths every day from heart disease(心血管疾病), stroke and diabetes alone. These conditions are dizzyingly expensive. Cardiovascular disease costs $351 billion annually in health care spending and lost productivity, while diabetes costs $327 billion annually. The total economic cost of obesity is estimated at $1.72 trillion per year, or 9.3 per cent of gross domestic product.
Fortunately, advances in nutrition science and policy now provide a road map for addressing this national nutrition crisis. The "Food Is Medicine" solutions are win－win, promoting better well－being, lower health care costs, greater sustainability, reduced disparities among population groups, improved economic competitiveness and greater national security.
Some simple, measurable improvements can be made in several health and related areas. For example, Medicare, Medicaid, private insurers and hospitals should include nutrition in any electronic health record; update medical training, licensing and continuing education guidelines to put an emphasis on nutrition; offer patient prescription programmes for healthy produce; and, for the sickest patients, cover home－delivered, medically－tailored meals. Just the last action, for example, can save a net $9，000 in health care costs per patient per year.
Taxes on sugary beverages and junk food can be paired with subsidies on protective foods like fruits, nuts, vegetables, beans, plant oils, whole grains, yogurt and fish. Emphasizing protective foods represents an important positive message for the public and food industry that celebrates and rewards good nutrition. Levels of harmful additives like sodium, added sugar and trans fat can be lowered through voluntary industry targets or regulatory safety standards.
The private sector can also play a key role. Changes in shareholder criteria and new investor coalitions should financially reward companies for tackling obesity, diabetes and other diet－related illness. Public－private partnerships should emphasize research and development on best agricultural and food－processing practices. All work sites should demand healthy food when negotiating with cafeteria vendors and include incentives for healthy eating in their wellness benefits.
Government plays a crucial role. The significant impacts of the food system on well－being, health care spending, the economy and the environment—together with mounting public and industry awareness of these issues—have created an opportunity for government leaders to champion real solutions.
Yet with rare exceptions, the current presidential candidates are not being asked about these critical national issues. Every candidate should have a food platform, and every debate should explore these positions. A new emphasis on the problems and promise of nutrition to improve health and lower health care costs is long overdue for the presidential primary debates and should be prominent in the 2020 general election and the next administration.
