A couple of weeks ago, the New Yorker had a fascinating article on McAllen, Texas, a county that ranks among the highest in the nation in health-care costs. Funny thing is, the outcomes of the patients in the system weren't any better than places that spent far less. The moral of the story, by physician and writer Atul Gawande, was that you must control the culture of spending (and earning) to contain out-of-control health care costs.
What he spent less time on was the make-up of the county, which ranks high in alcohol consumption, diabetes and heart disease. The per capita income, he noted, was $12,000 a year and the Tex-Mex diet contributed to a 38% obesity rate (the national average is 34%). While acknowledging these social causes of illness, Gawande didn't take the next step and consider diet as a cost-efficient way to rein in health costs. Obviously, costs have to be contained in the system, especially one that rewards doctors for every test, procedure and visit. But why not include or integrate factors outside the health-care system that breed disease in the first place? Why not change the playing field so there are, in effect, fewer patients for doctors to over treat?
If Gawande didn't consider this argument, I was surprised that the American Medical Association did this week. In a fairly remarkable development, the AMA voted at its convention to support "practices and policies within health care systems that promote and model a healthy and ecologically sustainable food system."
This statement wasn't just your usual "eat your fruits and vegetables, cut down on fatty food and exercise" type of recommendation. It was a blanket endorsement of organic and local foods, recognizing that the way food is produced effects health, the environment, even the conditions of workers. The resolution, in turn, was based on a report by its Council on Science and Public Health, which presents an informed view of the current nutritionally deficient food system. The report (pdf) states:
The report then describes the way industrialized food production has actually threatened health. "These methods have contributed to the development of antibiotic resistance; air and water pollution; contamination of food and water with animal waste, pesticides, hormones and other toxins; increased dependence on nonrenewable fossil fuels (including fertilizers)," the doctors' report says.
It also adds the clincher that I wish Gawande had considered: "Clinical approaches to addressing diet-related health concerns are costly and not sustainable."
The resolution passed this week states:
- That our AMA support practices and policies in medical schools, hospitals, and other health care facilities that support and model a healthy and ecologically sustainable food system, which provides food and beverages of naturally high nutritional quality.
- That our AMA encourage the development of a healthier food system through the US Farm Bill and other federal legislation.
- That our AMA consider working with other health care and public health organizations to educate the health care community and the public about the importance of healthy and ecologically sustainable food systems.
Industrial food producers are already in a tizzy over the documentary Food Inc., but I bet they didn't expect to be facing the nation's doctors.
I would note a last bit of irony to this resolution. For years -- back in the 1950s and 1960s -- the AMA did battle with one of the earliest proponents of organic farming, J.I. Rodale. They investigated him, and brought complaints to the Federal Trade Commission (over Rodale's over-zealous promotion of vitamins). It took a few more years -- OK decades -- for the AMA to change its position and at least endorse one point that Rodale got right: That the way food is produced effects health. He realized this in the 1940s. The AMA acknowledges it today.
- Samuel Fromartz