Science and Public Health Take a Good Look at the Food System

February has been ripe with discourse about the transforming the food system to one that can feed the world equitably and healthfully while mitigating the effects of climate change and environmental degradation.

On Feb 12, a special edition of the journal Science devoted to the question of feeding a growing population with finite resources was made available online for free.  I’ve just begun getting through pieces like Food Security: The Challenge of Feeding 9 Billion People, What It Takes to Make That Meal, Measuring Food Insecurity, and Sustainability and Global Seafood, but I can wholeheartedly recommend it as an important resource for those interested in taking a serious look at our global public health and environmental crises and considering the solutions. The introductory article Feeding the Future starts off dramatically:

Feeding the 9 billion people expected to inhabit our planet by 2050 will be an unprecedented challenge. This special issue examines the obstacles to achieving global food security and some promising solutions…. We have little time to waste. Godfray et al. (p. 812) note that we have perhaps 40 years to radically transform agriculture, work out how to grow more food without exacerbating environmental problems, and simultaneously cope with climate change. Although estimates of food insecurity vary (Barrett et al., p. 825), the number of undernourished people already exceeds 1 billion; feeding this many people requires more than incremental changes (Federoff et al., p. 833).

Then last week, the Institute for Healthcare Improvement sponsored a web program in their WIHI series, titled  “ Tipping the Scales: Fresh Ideas to Combat Obesity.”   The program focused on our food environment and it’s impact on our food intake.   In it, I was impressed to hear Dr David Kessler former FDA Commissioner and author of The End of Overeating say, “Unless we dramatically change our relationship with food, including the environment..” ...the epidemic of obesity will go unresolved.  Then Charles J. Homer, MD, MPH, said, “overweight is not a matter of personal choice…we live in a toxic environment and we need to change it.”   And Rachelle Mirkin of the National Initiative for Children’s Healthcare Quality talked about how a big, systemic change will be needed to make a difference in the epidemic of obesity.   She said, that for “real change” to happen, “we’re going to need to change the environment.” 

And today  an exciting webinar on Bridging Food Systems and Public Health was aired. The hosts promised it would be available online tomorrow.  For now you can access the special issues of the Journal of Hunger and Environmental Nutrition  that the webinar explored: Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier Communities.  David Wallinga, MD, MPA, of the Institute for Agriculture and Trade Policy, Michael Hamm, PhD, of Michigan State University, and Angie Tagtow, MS, RD, LD, HEN/ADA Managing Editor were the featured speakers.  I can’t say enough about this webinar.  Not only did the speakers address opportunities for positive changes in local and federal policy and ways for health professionals to “dig in”, they shared visions of what a healthy and sustainable food system might actually look like.

Sustainable Nutrition Bottom-line:  Our environmental and public health crises intersect in the food system.  And there is a lot of work to be done to tackle these crises.  I loved when Michael Hamm of the JHEN webinar defined our food system challenges as a “wicked problem”--a problem that is "difficult or impossible to fix…. because of complex interdependencies.”  But in acknowledging the scope of the problem we should not give up.   Each and every one of us has opportunities to make positive changes on the individual, local, nationwide and global level.  If we find ways to act quickly and act together to support good policies that can help us to change our collective and individual foodways, we just might be able to create an equitable, healthy, and sustainable food system.

America's Move to Raise a Healthier Generation

This week Michelle Obama helped launch a national campaign to fight childhood obesity—Let’s  Move: America’s Move to Raise a Healthier Generation of Kids. 

What's refreshing about this high profile initiative is that it not only includes a focus on Healthier Choices and Physical Activity but also Healthier Food in Schools and Healthy Food Access.  This moves the issue of healthy food access (or food insecurity) from what some might call the fringe to the spotlight.  Though healthy food insecurity has long been recognized as a problem in public health and community activist circles, this increased attention, funding, and acknowledgment that obesity is tied to lack of healthy food access may have positive results.  With Will Allen of Milwaukee’s very own Growing Power and many other high profile Americans including the president of the American Acadamy of Pediatrics at her side, the first lady outlined the program priorities.

From the Let’s Move Website: 

Accessing Healthy, Affordable Food
More than 23 million Americans, including 6.5 million children, live in low-income urban and rural neighborhoods that are more than a mile from a supermarket. These communities, where access to affordable, quality, and nutritious foods is limited, are known as food deserts.  Lack of access is one reason why many children are not eating recommended levels of fruits, vegetables, and whole grains. And food insecurity and hunger among children is widespread.  A recent USDA report showed that in 2008, an estimated 49.1 million people, including 16.7 million children, lived in households that experienced hunger multiple times throughout the year. The Administration, through new federal investments and the creation of public private partnerships, will: 

• Eliminate Food Deserts:  As part of the President’s proposed FY 2011 budget, the Administration announced the new Healthy Food Financing Initiative – a partnership between the U.S. Departments of Treasury, Agriculture and Health and Human Services that will invest $400 million a year to help bring grocery stores to underserved areas and help places such as convenience stores and bodegas carry healthier food options.  Through these initiatives and private sector engagement, the Administration will work to eliminate food deserts across the country within seven years. 
• Increase Farmers Markets: The President’s 2011 Budget proposes an additional $5 million investment in the Farmers Market Promotion Program at the U.S. Department of Agriculture which provides grants to establish, and improve access to, farmers markets.

The initiative goals also include Healthier Food in Schools.  Again, from the Let’s Move website:

Serving Healthier Food in Schools 
Many children consume as many as half of their daily calories at school.  As families work to ensure that kids eat right and have active play at home, we also need to ensure our kids have access to healthy meals in their schools.  With more than 31 million children participating in the National School Lunch Program and more than 11 million participating in the National School Breakfast Program, good nutrition at school is more important than ever.  Together with the private sector and the non-profit community, we will take the following steps to get healthier food in our nation’s schools:   

• Reauthorize the Child Nutrition Act: The Administration is requesting an historic investment of an additional $10 billion over ten years starting in 2011 to improve the quality of the National School Lunch and Breakfast program, increase the number of kids participating, and ensure schools have the resources they need to make program changes, including training for school food service workers, upgraded kitchen equipment, and additional funding for meal reimbursements.  With this investment, additional fruits, vegetables, whole grains, and low-fat dairy products will be served in our school cafeterias and an additional one million students will be served in the next five years.   

Slow Food USA has been addressing the poor quality of US school lunches with it’s Time for Lunch Campaign since early last year—you may remember a blog post about labor day “Eat Ins” to call attention to the issue.   In a press release on Feb 9^th, Slow Food USA’s president pointed out that while this additional $10 billion is progress, it is not nearly enough in the grand scheme of things:

“President Obama’s proposal to add $1 billion per year to the Child Nutrition Act is an important step forward,” stated Josh Viertel, president, Slow Food USA. “But, it’s not enough to give America’s kids a healthy future, especially when nearly one third of our children are overweight or obese and when Congress spends at least $13 billion per year subsidizing the production of unhealthy processed foods. The public needs to speak up and tell Congress to make real improvements to school lunch.”

Sustainable Nutrition Bottom-line:   The burden of obesity does not lie solely, or even mostly, with personal choice.  A large body of research points to the powerful role the environment plays in our personal habits.  The socio-ecomonic model of health places the individual and their own modifiable layers of influence (things they have control over) within a sea of influences:  living and working conditions, agriculture and food supplies, education, access to good and services like healthcare and water and sanitation, and the overall economic, cultural and environmental influences. With this model, we can see that the burden of obesity lies within our society.  The changes in our way of life over the last few generations has re-shaped us, literally.

My practice affords me the opportunity to talk with parents and kids struggling with childhood obesity (and diabetes, hypercholesterolemia and hypertension.)   What I see in my conversations with these families are the same problems, over and over, stemming from a food system in disarray.  The barriers people have to overcome to resist or reduce obesity are overwhelming—which is why we have such a problem in the first place.  Yes, guardians should ensure their kids have daily active play, wholesome snacks, plenty of water, and the chance to sit down at the table together often for meals, but if we do not make drastic changes to the way we nourish ourselves en masse, the epidemic of obesity will only get worse until we run our of land, food, or resources.   The more resources, programs, initiatives, and so on we can use to provide sustainable real food to real kids, the better chances our kids will have at living long, healthy lives to face the challenges ahead.  So this initiative, Let’s Move, seems to provide a ray of hope in a worrisome time…