Food is a life and health-sustaining necessity. But, the diets of many Americans are making them sick. Six in ten in the U.S. have one or more diet-related chronic conditions such as cardiovascular disease, type 2 diabetes, liver disease and certain cancers, costing the nation $1.1 trillion annually. A poor-quality diet is now the leading risk factor for disability and mortality in the U.S., causing 500,000 deaths each year.
Poor nutritional diets associated with chronic disease include low amounts of fresh vegetables, fruits, whole grains and fatty fish, along with high levels of processed foods high in saturated fat, sodium and added sugars, as well as sugar-sweetened beverages.
While rates of diet-related disease are high among all U.S. adults, these conditions disproportionately impact historically underserved populations, frequently as a result of health inequities. The prevalence of many of these diseases is greatest among low-income individuals, people of color and those affected by food insecurity.
To help stem the tide of the ever-increasing incidence of diet-related illness, the food is medicine (FIM) movement has drawn rapid interest and investment from a wide spectrum of stakeholders, including government agencies, healthcare organizations and philanthropies. Broadly speaking, FIM interventions aim to support and promote healthy dietary habits to treat and prevent diet-related disease through access to affordable, nutritious foods, education and policy change. In reality, these efforts’ major focus has been treatment, rather than prevention. Effective public health focuses on both elements.
Implementation of FIM interventions typically occurs in a medical setting as part of the treatment approach to a diagnosed diet-related disease. The most commonly prescribed FIM interventions are medically tailored meals, medically tailored groceries and produce prescriptions, programs that are often eligible for insurance reimbursement and can be supported by the healthcare system infrastructure. These interventions are undeniably an important advance in integrating nutrition into the treatment of disease, but they are not the only approach needed to effectively change dietary behaviors in the long term. Attention and adoption of nutrition as a means of disease prevention should also be an important part of the conversation when it comes to reducing the human and financial costs of diet-related conditions.
Investing in prevention with the food as health approach
The food as health approach, which embraces good nutrition as a way of life from childhood to old age, has come to define efforts that address the barriers to obtaining and consuming nutritionally-rich foods as part of the larger food and health ecosystem. While there is exciting progress being made in the food is medicine movement, more work is needed to implement and promote food as health initiatives.
Overcoming the systemic, structural and cultural issues that lead to poor nutrition is complex, making it even more essential for both private and public investment in food as health programs and policies that have been shown to be effective.
Early education and exposure to nutrition-rich foods
Establishing healthy dietary habits in children can lead to life-long behaviors that reduce diet-related disease in adulthood. In the U.S., low levels of fruit and vegetable consumption may, in part, be linked to unhealthy food preferences ingrained during childhood. While the promotion of nutrition-rich foods in the home setting is important, schools can play a pivotal role in shaping children’s preferences through nutrition education and regular exposure to healthy foods. Unfortunately, according to the Centers for Disease Control and Prevention (CDC), students receive less than eight hours of required nutrition education each school year, when many more hours are needed to change behavior.
However, progress is being made with efforts to support school-based nutrition education through nonprofit and community partnerships, particularly in low-resourced areas. These initiatives can include bringing specially trained educators into the classroom, providing teacher and school nutrition leader training, and integrating hands-on educational opportunities into the curriculum, such as school-based gardens that provide experiential learning and involvement in the growing of food.
Bringing culturally relevant, nutritious foods close to home
It’s challenging to have a healthy diet when living in a food desert. These communities lack access to fresh, nutritious and affordable foods and are heavily concentrated in low-income areas. Government incentives and health organization investments could encourage the entrance of locally-owned grocery stores that provide high-quality, culturally-relevant foods at affordable prices.
For older Americans, there are often additional obstacles to obtaining affordable nutrient-rich foods, such as lack of transportation and mobility issues. Food banks and other nonprofits are working to fill this need with mobile markets that deliver fresh fruits and vegetables to older adults’ homes and communities.
Community gardens, farmers markets and mobile fresh food carts that reflect the community’s food preferences are additional ways to provide access to and increase consumption of healthy food.
Everyone deserves to have choices that include nutritious foods. We need more spaces that offer that option as an alternative to the many fast food restaurants in certain neighborhoods.
Food assistance program access and expansion
Poor dietary behaviors and diet-related disease can often be the result of food insecurity, a health disparity affecting higher numbers of Black-headed households (19.8%), Hispanic-headed households (16.2%), and low-income households (26.5%). Not having access or being able to afford healthy foods leaves people with little choice but to consume high-fat and sugary processed foods, which are often cheaper and more easily available.
Schools are also central in combating food insecurity by providing free healthy breakfasts and lunches to students. Unfortunately, administrative hurdles and language barriers, as well as restrictive income requirements and associated stigma can prevent food insecure children from participating in these state-run programs. One solution, universal school meals – which makes meals available to all students – was implemented nationally in response to the Covid-19 pandemic. A study comparing states that continued that approach after the national program ended and states that no longer offered meals for all students found a 9.8% increase in food insufficiency among school-aged children in states that had discontinued the universal meal program.
The Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps, can also help prevent diet-related diseases by enabling the purchase of healthier foods. This federally funded benefit reduces the prevalence of food insecurity by as much as 30% by providing nutritional support for low-income families and seniors, as well as people with disabilities living on fixed incomes.
Although SNAP is the nation’s largest federal program aimed at reducing hunger, one in six eligible Americans do not participate in the program due to many of the same hurdles experienced by non-participants of school meal programs. More education and support are needed to ensure eligible individuals and families can access this critical benefit. A recently launched effort by the online grocery delivery service, Instacart, is an example of efforts that could help increase SNAP enrollment. The online platform now includes a nationwide eligibility screening tool that allows users to anonymously check if they are eligible for the benefit and directs them to relevant state resources that help streamline enrollment.
Food as health requires new approaches and investments in the broader food ecosystem. While more expansive and challenging than many of the current FIM efforts, they will have a far more significant impact on the health and well-being of Americans in the long run by preventing – rather than treating – diet-related disease.
Photo: fcafotodigital, Getty Images
Tiffany Benjamin serves as the Humana Foundation’s Chief Executive Officer. In her role as CEO, Tiffany guides the Foundation in establishing new ways to co-create healthy communities and eliminate unjust differences in U.S. health and health care. She is committed to closing systemic equity gaps in mental/behavioral health, nutrition, and food security. She leads the Foundation’s philanthropic disaster response and recovery strategy, as well as its scholarships and associate giving programs. She brings a strong understanding of healthcare systems and policy, the social determinants of health, and equity issues.
Tiffany serves on the boards of the Center for Disaster Philanthropy (Chair), Indiana University Lilly School of Philanthropy (Chair Emeritus), the 2024 NBA All Star Game Committee, Indiana University College of Arts and Sciences Dean’s Advisory Board, and Early Learning Indiana.
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