From the days of Hippocrates to today, nutrition has always been deeply integrated in the collective understanding of healthcare as a preventative measure for disease. Once “let food be thy medicine, and let medicine be thy food”, the saying now goes “an apple a day keeps the doctor away” [1]. Despite its timelessness, it seems as though this message has been lost in examining the state of modern US healthcare; instead, the nation’s current healthcare philosophy manifests itself in a system that prioritizes confronting illness after its onset. With rates of chronic illnesses increasing among the American people, perhaps the adage ‘food as medicine’ can be used to reconstruct medicine's relationship with nutrition and reduce medical spending on chronic diseases.
This call to reimagine US healthcare is not simply a futuristic ideology, rather it is a warranted solution to the nation’s growing medical expenditures and cost of care. Since 1970, healthcare spending in the United States has grown “2.5 percentage points faster than the economy”, making costs more difficult to contain and health insurance less affordable. Among the leading causes for this high medical spending are cutting edge technological innovations. However, many of these technological innovations are used to combat a relatively small group of chronic diseases, such as “heart disease, cancer, stroke, respiratory disease” or “diabetes” [2]. For example, technology to treat cardiovascular disease has gone from blood-thinning agents in the 1980s, to angioplasty in the 1990s, to Angiotensin-converting enzyme (ACE) inhibitors seen in the 2000s, with the US overall heart attack mortality rate falling by almost half over these 20 years [2]. Nevertheless, incidences of cardiovascular diseases in the United States can be linked significantly to the pro-inflammatory nature of the Western diet, high in foods like red meat while lacking anti-inflammatory foods like nuts and legumes [3]. Among other effects, a pro-inflammatory diet can result in arterial plaque buildup, which can occlude arteries and cause cardiovascular diseases. One study by investigators from Brigham and Women’s Hospital found “that suboptimal diet costs approximately $300” of medical spending “per person, or $50 billion nationally, accounting for 18 percent of all heart disease, stroke and type 2 diabetes costs in the country” [4]. Integrating nutritional guidance into common medical practice could likely curb these costs, leading to a reduction in prescription drug and expensive medical technology use for chronic diseases.
It is clear that nutrition — the driver behind $50 billion of medical spending annually — plays a significant role not only in disease prevention, but also in the prevention of growing medical technology expenditures. It is as if the medical establishment is suturing a wound that is cut repeatedly, only using more expensive suture each time. At the core, however, it is the physician that decides how to treat the wound, driving the standard of medical care. If nutrition is to be integrated into medical practice, physicians must be equipped with the necessary information to provide nutritional insight for their patients. Currently, nutrition is a remarkably small part of medical education, accounting for “less than one percent of total lecture hours” in the average American medical school according to the Harvard Food Law & Policy Clinic [5]. The inclusion of a nutrition curriculum in medical education could be incentivized at many levels. For example, medical schools could require undergraduate students to take courses in introductory nutrition along with other requisite coursework. Governments could also tie funding for medical schools or residency programs with the inclusion of nutrition curriculum [5].
On the other side of medical care, the patient’s access to healthy foods must also be accounted for when implementing preventative medicine through nutrition. This need is especially dire in low income communities where food insecurity, the lack of access to nutritional food, would make current nutritional recommendations useless. Some communities have taken food as medicine in its most literal sense, creating food prescription programs that work with food suppliers to provide fresh foods from farmers’ markets to underserved communities. One such program was implemented in the South Side of Chicago to combat diabetes, a chronic disease that affects communities of color disproportionately [6]. The University of Chicago partnered with “six health centers, Walgreens, and a local farmers market” to create FoodRx, leveraging “the symbolic nature of the prescription” by providing prescriptions with financial aid, such as vouchers, to purchase foods at the partnered vendors [6]. This framework provides one manifestation of an idea that can be expanded nationally: identifying food accessibility as a key component of healthcare. Nevertheless, price reduction for high quality healthy foods in the United States is an arduous process, a sentiment echoed by the architects of FoodRx [6]. The integration of food accessibility into healthcare could perhaps lead to subsidies for access to healthy food, similar to how Medicaid subsidies healthcare.
Reimagining food as medicine will require a comprehensive restructuring of not only American medical systems, but also its educational systems and food supply chains. On an even greater scale, understanding food as medicine pushes the United States to broaden its perspective of healthcare, urging it to value preventative measures above retrospective approaches to health. Even so, this investment will likely reap long term benefits in the reduction of chronic illness occurrence and mortality in the US, an epidemic that has gripped the United States with no visible end in sight.
References:
Smith R. (2004). “Let food be thy medicine...”. British Medical Journal, 328(7433), 0.
(2013). Snapshots: How Changes in Medical Technology Affect Health Care Costs. KFF. https://www.kff.org/health-costs/issue-brief/snapshots-how-changes-in-medical-technology-affect/.
Casas, R., Castro-Barquero, S., Estruch, R., & Sacanella, E. (2018). Nutrition and Cardiovascular Health. International Journal of Molecular Sciences, 19(12), 3988. https://doi.org/10.3390/ijms19123988
(2019, December 17). Healthy Diet Could Save $50B in Health Care Costs. Brigham and Women’s Hospital. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3517
Broad Leib, E.M., Shapiro M, Chan A. et al. (2019, September). Doctoring our Diet: Policy Tools to Include Nutrition in U.S. Medical Training. Harvard Law School Food Law and Policy Clinic. https://www.chlpi.org/wp-content/uploads/2013/12/Doctoring-Our-Diet_-September-2019-V2.pdf
Goddu, A. P., Roberson, T. S., Raffel, K. E., Chin, M. H., & Peek, M. E. (2015). Food Rx: a community-university partnership to prescribe healthy eating on the South Side of Chicago. Journal of prevention & intervention in the community, 43(2), 148–162. https://doi.org/10.1080/10852352.2014.973251
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