Food Fix

CHAPTER 1

THE TRUE COST OF FOOD—THE HEALTH, ECONOMIC, ENVIRONMENTAL, AND CLIMATE IMPACT OF OUR FOOD SYSTEM

Ninety-five trillion dollars—$95,000,000,000,000—is an almost unimaginable number. Yet this is an estimate of the burden that will be put on our economy by chronic disease over the next 35 years in both direct health care costs and lost productivity and disability. To put it in perspective, that is almost five times our nation’s gross domestic product of $20 trillion a year. According to the World Bank, in 2017, the entire world’s GDP was just $80 trillion.

For that amount of money, we could…

That $95 trillion is the total cost of chronic illness to the United States over the next 35 years (or 91 percent of the total tax collected by the US government), in both direct health care costs and the loss of productivity due to heart disease, diabetes, cancer, mental illness, and other chronic conditions.¹ Imagine if we had a significant portion of those resources to spend on things that matter to all of us rather than preventable chronic disease. Most of those diseases are caused by our industrial diet, which means they are avoidable if we transform the food we grow, the food we produce, and the food we eat. The $95 trillion is just the start of the value to our economy if we fix all the broken parts of our food system. Clearly not all chronic disease will disappear, nor will all those who are chronically ill be able to go back to work. But if even a conservative fraction of that money, an estimated $15 trillion, is available, it would provide crucial resources to solve our most critical problems. And $15 trillion is still about four years of our total federal tax collections.

Eleven million people die every year from a bad diet. And more than a billion people in the world are overweight and sick from eating our processed, industrialized diet and not eating a healthy whole foods diet.² In fact, the number one factor causing these deaths is the lack of fruits and vegetables in our diet. The sad thing is that in America only 2 percent of our farmland is used to grow fruits and vegetables, despite our government’s recommendations that 50 percent of our diet should be fruits and vegetables. Fifty-nine percent of our farmland is used to grow commodity crops (corn, wheat, soy) that get turned into ultraprocessed foods that we know are deadly. These processed foods make up about 60 percent of our diet!

Why does this matter? For every 10 percent of your diet that comes from processed food, your risk of death goes up 14 percent.³ That means a lot of extra deaths because we support agriculture that creates food that makes us sick and fat and harms the environment, and not the production of fruits and vegetables and whole foods that make us healthy.

The complexity of the problem prevents people from connecting the dots and taking action. And most of the true costs are not even recognized, limiting the motivation to change the system. Let’s take a journey through every aspect of the food system and connect those dots.

THE COSTS OF CHRONIC DISEASE

In 2018, the Milken Institute issued two major reports. The first, The Cost of Chronic Diseases in the US,⁴ and the second, America’s Obesity Crisis: The Health and Economic Costs of Excess Weight,⁵ map out the staggering impact of food obesity and disease caused mostly by our current food system. It’s overwhelming, but here are just a few of the key facts:

Now let’s think about this globally. If 2.2 billion people around the world are overweight, the costs are beyond comprehension. If the burden of chronic disease will cost the American economy $95 trillion over the next 35 years, what might the global costs be?

Global per capita health care costs are one-tenth that of the United States and the global obesity rates are lower as well, but the global costs are also staggering. For argument’s sake, if you assume that there are 1,000 times (over 2.2 billion worldwide) as many people overweight in the world as there are in the United States,⁶ could the global costs be in the quadrillions of dollars? That’s a lot of zeros.

How does this impact us? While Democrats argue to create Medicare for All and Republicans argue to reduce entitlements to bring down our $22 trillion national debt, both are missing the obvious fact. Fix the reason why we have those costs in the first place. Stop the flow of sick people into the system and the harm to our environment and climate by fixing the cause: our food system.

Yet most of our government’s policies promote the growing, production, marketing, sale, and consumption of the worst diet on the planet—billions in subsidies (known as crop insurance or other supports) for commodity crops turned into processed food and food for factory-farmed animals; $75 billion a year in food stamp payments that effectively reduce hunger but are mostly for processed food and soda; unregulated food marketing of soda and junk food; confusing food labels; industry-influenced dietary guidelines; and more. Its very policies also support agricultural practices that pollute the environment and worsen climate change.

The Congressional Research Service estimates that by 2025, 48 percent of our entire mandatory federal spending will be for health programs such as Medicare and Medicaid.⁷ Bill Haslam, the former governor of Tennessee, shared with me that one in three dollars of its state budget is spent on Medicaid. This does not account for all the federal programs covering health care, including the Department of Veterans Affairs, Department of Defense, Children’s Health Insurance Program, and Indian Health Service, among others. All in all, our government covers 50 to 60 percent of health care costs in America. The Government Accountability Office (GAO) projects that by 2048, Medicare and Medicaid will account for $3.2 trillion in federal spending. To put that in perspective, our entire federal tax collections are only $3.8 trillion.⁸ There will be almost nothing left for the government as a whole—for defense, education, transportation, or anything else. Neither cutting Medicare nor creating Medicare for All will solve this problem.

HOW TO FIX HEALTH CARE: BEYOND CUTTING ENTITLEMENTS OR MEDICARE FOR ALL

In 2013 I spoke at the World Economic Forum, and at a big gathering of the world’s health care leaders from government, the pharmaceutical industry, insurers, and health care systems, I asked a simple question. It was after a distinguished panel focused on fixing health care by better health information technology, improved care coordination, reduction of medical errors, improved efficiencies, and improved payment models, all necessary but not sufficient. Their plan was akin to moving the deck chairs around on the Titanic.

Here was the question: Wouldn’t it make more sense to address the root causes of chronic disease that are driving the costs, rather than trying to clean up after the fact? The room of 300 people went silent. It was as if I had just revealed the meaning of life. Afterward the panel moderator, the dean of Columbia University’s School of Public Health, told me how profound this insight was and how all the health leaders were talking about it after. Really? I was shocked. This is so obvious, yet no one had thought of it.

The World Economic Forum estimated that between 2010 and 2030 the global health care costs for chronic disease will exceed $47 trillion⁹ (probably an underestimate given the new, more robust analysis of $95 trillion over 35 years for the United States alone). They declared this the single biggest threat to global economic development. General Motors spends more on health care than on steel, and Starbucks spends more on health care than on coffee beans!

Other analyses from global management consulting firm McKinsey put the global cost of obesity at $2 trillion a year, which is roughly equivalent to the global impact from smoking, armed violence, war, and terrorism combined.¹⁰ In addition, according to the McKinsey Global Institute report, obesity accounts for $2 trillion in lost productivity.¹¹ Any way you slice it, the costs of obesity and chronic disease are weighing the world down.

We think of these problems as diseases of affluence, but the fact is that the greatest burden, or about 80 percent of obesity and chronic disease, is in the developing world, in low- and middle-income countries. They face what the World Health Organization (WHO) classifies as the “double burden of obesity and malnutrition” and are completely unprepared for this epidemic. There is little health care infrastructure, few doctors and nurses to treat these problems, and even less money.

The “cheap” food that causes disease is not so cheap after all. The hope and promise of the Green Revolution—to use agricultural technology to create abundant cheap food to feed the world—turned out to have horrible unintended consequences. In fact, cheap food turns out to be very, very expensive.

Yes, chronic disease is costly. And kills millions. But that is only a small part of the total cost driven by our food system. Add to these costs the real cost of our food system on the environment, economy, climate, social justice issues, poverty, education, national security, and so on, and this number grows dramatically. Let’s explore some of the costs.

THE COSTS WE PAY FOR FARMWORKERS AND FOOD WORKERS

Farmworkers and food industry workers are underpaid and exploited. They face high risks of injury and harm from agricultural chemicals. Most aren’t protected by minimum wage or overtime pay requirements. (However, New York State recently passed the Farm Laborers Fair Labor Practices Act.¹²) Many farmworkers live below the poverty line and have no health care, instead depending on emergency rooms and Medicaid. The truth is that the food system disproportionately affects the poor, immigrants, and people of color who actually work in the food system.

The average restaurant worker makes only about $10 an hour.¹³ That’s why we pay their salary through billions in tips and another $16.5 billion in food stamps. Their dependence on food stamps limits their food choices at the checkout counter, and healthy options are often not affordable enough or government approved.

For those who work on a farm—there are 1 million farmworkers in our country—they have one of the most dangerous jobs in America. They die at seven times the rate of other workers.¹⁴ The Environmental Protection Agency (EPA) estimates that 10,000 to 20,000 farmworkers are harmed by acute pesticide poisoning every year, which doesn’t account for the long-term effects of being exposed to toxins day after day and year after year.¹⁵ The herbicides and pesticides that farmers use on their crops are neurotoxins, carcinogens, and hormone disruptors. Many of those used in the United States are banned in other countries. The government agencies (the Food and Drug Administration, or FDA, and EPA) that should be regulating these chemicals for human safety are not doing their job.

THE LOSS OF BIODIVERSITY IN NATURAL AND AGRICULTURAL SYSTEMS: WHY IT MATTERS

While these chemical inputs damage human health, they also disrupt natural ecosystems, deplete the diversity of life in the soil, threaten the loss of most of the plant and animal species we have consumed for millennia, and severely affect pollinators, like honeybees and butterflies, we depend on for agricultural crops.¹⁶ (Chapter 16 explains these consequences in depth.) But the loss of biodiversity, the result of industrial agriculture, is a much bigger problem that threatens global food security. Not only are we threatening insects essential for agricultural production but we are also losing varieties of plant foods and animals at an alarming rate.

According to the UN’s Food and Agriculture Organization (FAO), more than 90 percent of plant varieties and half of livestock varieties have been lost to farmers (and the world).¹⁷ Most of our food comes from just twelve plant varieties and five animal species, threatening our food security. Thirty percent of livestock breeds are facing extinction, and six breeds become extinct each month. Just three crops (wheat, corn, rice) account for 60 percent of our food. This occurred because of the centralization of seed production (farmers can’t even collect, store, or breed their own plants) by corporations such as Monsanto (now Bayer) as part of the “improvement” of agriculture promoted globally through the Green Revolution and the industrialization of agriculture. Most farmers no longer grow local, resilient, genetically diverse and nutrient-dense varieties. They use only genetically uniform (or GMO) high-yield varieties that require intensive use of fertilizers, pesticides, and herbicides—further destroying the organic matter and biodiversity of the soil that results in less nutrient-dense plants and increased need for irrigation and fertilizer. In all ecosystems, complexity is health; simplicity makes systems vulnerable. Think of monocrop corn (meaning it’s the only crop grown on a farm) compared to a rain forest. One plant dies in a rain forest, no problem. One plant dies on a monocrop corn or soy megafarm—no food.

How do we even measure the costs to human health and the threats to our pollinators and the loss of biodiversity? No more bees, no more pollination, no more plants, no more animals—no more humans.

BEYOND JUST THE HEALTH CARE AND SICKNESS COSTS

Before we get too deep into all the additional costs and harm of our food system, the good news is there are solutions that can solve all these problems. In other words, a food fix! It is a complex set of related strategies for citizens, businesses, philanthropists, and governments to fix our food system that can occur on a global level. It will not be easy, but it is necessary for our survival as a species, for the economic and political stability of national governments, and for the health of the planet.

The costs of the food system are not borne by the companies that cause these problems. Nor are they paid for at the grocery store or restaurant. They are paid for by all of us indirectly through the loss of our social capital (human happiness, health, productivity, etc.), our natural capital (health of our soil, air, water, climate, oceans, biodiversity, etc.), our economic capital (our ability to address economic disparities and social, environmental, educational, and health care problems), threats to national security, and more.

The silver lining in Food Fix is the potential for “the fix” to be an enormous driver of economic growth and innovation. Billions of dollars in investment are flooding into the food and agriculture sectors, creating new businesses, jobs, and national and global economic growth for innovations in farming, food manufacturing, retail, restaurants, health care, and wellness that improve the health of people and the planet. And the side effect will be significant economic growth and jobs from entire new industries and trillions in cost savings by addressing chronic disease; restoring ecosystems that include soil, water, and biodiversity; and reversing climate change. The countries that get this right will not only help humans and the earth, but leap ahead in the twenty-first-century economy for jobs and economic growth.

In Food Fix we will unpack how all these factors contribute to suffering and lack in the world. We will learn how we as citizens, businesses, philanthropists, and governments can begin to restore the health of our people, our communities, our economies, and the environment. There is a Jewish concept called tikkun olam