Diet-related diseases are the leading cause of death in the United States. Poor diet is associated with ailments such as heart disease, cancer, and Type 2 diabetes, which together kill nearly 678,000 Americans annually — a number that far exceeds current projected deaths from COVID-19 in the U.S.[i] Having worked in both the farming and healthcare industries, I often think about how farmers can help save lives by producing healthier food.
This article will summarize why agricultural subsidies are frequently blamed for America’s dietary health problems, and it will explore farmers’ ideas for improving Americans’ dietary health. I will argue that current proposed changes to agricultural subsidies in the next Farm Bill are insufficient to increase Americans’ access to healthy food or change their dietary health. The U.S. Department of Agriculture (USDA) must consider other innovative policy interventions to promote dietary diversity and health, such as behavioral nudges and produce prescriptions.
Changing agricultural subsidies will likely not solve America’s dietary health problems
The obesity rate in the U.S. is high and growing fast — 40% of adults and 19% of children are currently obese.[ii] Obesity increases the risk of heart disease, which causes one in four American deaths each year.[iii] It may also contribute to a higher COVID-19 mortality rate, according to preliminary studies.[iv]A report from the National Institute of Health (NIH) estimates that nearly half of all Americans will be obese by 2030, and that medical costs associated with treating the disease will grow by $50-60 billion annually.[v]
Many critics blame farmers for Americans’ poor dietary health. They argue that Farm Bill subsidies, which pay $145 billion for crop insurance and commodity programs over a ten-year time period,[vi] allow farmers to overgrow commodity crops such as corn and wheat. In turn, food manufacturers use those commodity crops to produce large quantities of unhealthy processed foods at low cost. Stores ultimately sell these unhealthy processed foods to Americans, while offering few healthy produce choices like fruits and vegetables. The result of this process — higher obesity. [vii], [viii], [ix] Public health advocates propose reducing commodity subsidies or increasing subsidies for specialty crops (i.e., fruits and vegetables) in the next Farm Bill to increase production of healthier foods.
Changing agricultural subsidies, however, will likely not cure America’s obesity epidemic.
Firstly, studies have found no clear relationship between commodity crop prices and final price of packaged and processed foods to consumers.[x] Secondly, many farmers are not capable of switching the type of crops they grow, even if the federal government offered more incentives to grow fruits and vegetables. Incentives like the $10 billion earmarked for specialty crops in the coronavirus stimulus bill will support farmers already growing fruits and vegetables but may not help commodity farmers diversify into specialty crops.[xi] Thirdly, the total U.S. supply of healthy foods may not increase even if more healthy foods are domestically produced, since the food industry could simply source less fruits and vegetables foods from abroad. And lastly, people tend to maintain their dietary preferences even when healthier food options become available.[xii]
Role that farmers play in affecting consumers’ dietary health
I recently met with seven food commodity interest groups and five farmers to gather ideas on how to improve consumers’ dietary health in the U.S. Based on my conversations, I learned the following:
- Farmers do not feel responsible for consumers’ dietary health issues.
- Farmers support measures that aim to improve consumers’ dietary health.
- Farmers face numerous obstacles to growing healthier specialty crops.
Farmers do not feel responsible for consumers’ dietary health issues
Farmers recognize that diet-related diseases are a serious problem in the U.S., but they do not feel responsible for consumers’ dietary health beyond food safety. Farmers have primarily been focused on complying with USDA’s food safety standards. Some farmer associations, such as those representing meat and sugar producers, said that their foods can be consumed in moderation while still maintaining good dietary health. They also question if policies that aim to improve dietary health will work in practice and argue that well-intentioned food policies may have unintended negative consequences. In one example, a report from the NIH shows that calorie labeling does not substantially reduce caloric consumption.[xiii] In another example, nutrition standards for public school lunches have generated food waste because students do not want to eat healthy foods that their school serves them.[xiv]
Farmers believe consumers and food manufacturers are responsible for poor dietary health in the U.S. Many people blame food manufacturers for processing foods to be unhealthy, as they formulate food to be delicious to drive customer loyalty and high-volume consumption. Several farmers lamented the strategies food manufacturers deploy to engineer their products to be more addictive and delicious. For example, Frito-Lay manufactures its potato chips with a tantalizing combination of fat, salt, and sugar, and has advertised them as a vegetable side dish for all meals of the day. A study found that potato chips are the top weight-inducing food for American adults, contributing to an average weight gain of nearly one pound per year. [xv]
Farmers may not feel responsible for the dietary health of consumers because they are so far removed from the people that consume their crops. Only 8% of dollars spent on food in the U.S. goes to growers.[xvi] The food system is so complicated that about half of Americans report that they do not know where their food comes from or how it was produced.[xvii] With such disconnect, farmers are unable to assess if people are consuming their products responsibly. This in turn inhibits them from taking action to improve consumers’ dietary health.
Farmers support measures that aim to improve consumers’ dietary health
Some individual farmers are willing to be allies in the movement to improve consumers’ dietary health. Many farmers expressed support for evidence-based behavioral nudges (e.g. sweetened beverage taxes) and all were supportive of transparency measures to improve food consumption knowledge (e.g. nutrition labeling requirements). However, some larger interest groups that represent farmers and food manufacturers have been wary of adopting policy positions that may advantage some producers over others. For instance, Nestlé, Unilever, Mars Inc., and Danone North America left the Grocery Manufacturers Association (GMA) over policy disagreements that include GMA’s unwillingness to recommend guidance on reformulating foods to be healthier. Those four food manufactures formed a new group, the Sustainable Food Policy Alliance, which supports the FDA in issuing voluntary sodium targets.[xviii] The split demonstrates the challenge that food lobbies face when advocating for comprehensive reform that yields winners and losers, such as considerations for larger versus smaller operations and growers of specialty crops versus sugar producers.
Changing consumer preferences will encourage farmers to reassess what they grow. For example, after the federal government stated that high-fat diets were unhealthy, many consumers began to shift their diets toward leaner meats and more carbohydrates.[xix] Producers accordingly responded by keeping animals lean to yield higher market prices for their product.[xx] Unfortunately, the low-fat recommendations adversely contributed to worsening dietary health, as people increased their sugar consumption.[xxi]
Americans have also become increasingly concerned about the negative health effects of pesticides. In response to consumers’ health concerns, farmers have started to use organic farming methods to produce a larger amount of healthier produce. Over the past decade alone, organic food production has increased by 6 to 12% year-over-year.[xxii] As more Americans choose to eat fruits and vegetables, it is likely that a greater number of farmers who are capable of diversifying their crop production will in fact do so — even if agricultural subsidies do not change.
Farmers face numerous obstacles to growing healthier specialty crops.
While some farmers may be able to produce more specialty crops if American consumers demand healthier food, not all are capable of shifting production to specialty crops. Farmers admit that they would grow a larger amount of specialty crops if it became more profitable than commodity crops, but they face several barriers in changing their operations.
First, regional variation in climate, soil quality, and proximity to market put limitations on what crops farmers can productively cultivate. This makes the cost of gaining new expertise to grow specialty crops high. One young farmer said that he wanted to grow a new crop last season, but he abandoned the idea after he was unable to find a consultant to help. Second, although farms have been consolidating over time, most are still family owned and operated and rely on inherited farming knowledge.[xxiii] If a family farm wants to grow a new specialty crop, farmers typically have to hire someone to help them or teach them how. And third, switching to production of specialty crops would require cold storage and more labor-intensive processes that rely on migrant labor. A few farmers blamed tighter immigration policies for increasing their cost of labor, and they said that cultivating labor-intensive crops would not be financially viable.
Dietary health initiatives also compete with farmers’ other social responsibility priorities. Many family farmers are focused on expending their resources to adopt environmentally sustainable farming practices, to improve animal welfare, and to reduce use of antibiotics in farm animals. Examples of these include hiring consultants to help plant cover crops to promote soil health, adopting regenerative agriculture practices to support carbon sequestration, and improving animal health through better hygiene practices.
Policy interventions that incentivize farmers to grow more specialty crops have worked under narrow circumstances. In one case, farms located closer to food markets are more likely to grow specialty crops since a shorter supply chain makes it economically viable. Retailers like Walmart are working with local farmers to shorten their supply chain so that farmers have a market for growing healthy fruits and vegetables. In another case, farm-to-school purchasing programs facilitate procurement of healthy produce from small and disadvantaged farmers to increase children’s access to nutritious food.[xxiv] And in a third case, government supports for farmers markets created 91 new marketplaces and generated $1.7 million in sales by encouraging consumers to use food stamps for buying healthy produce.[xxv]
Farmers participating in all these projects reported that they diversified their food product offerings and expanded their market presence and customer base. [xxvi] However, these initiatives are still unlikely to incentivize large farms to grow more specialty crops since the market opportunities are generally too small and too distant from farms to be viable.
Ideas to increase production of specialty crops and encourage healthier eating
Given the numerous challenges that farmers and consumers face in producing and accessing healthier foods, what can be done to improve the U.S. food system and reduce diet-related diseases? Two approaches to addressing this issue are:
- Closing capacity gaps for growing specialty crops.
- Adopting innovative interventions that are working at a local level.
Close capacity gaps for growing specialty crops
In the next Farm Bill, any policy proposal to direct more agricultural subsidies toward the production of specialty crops must include measures that make farms more capable of growing these crops. The USDA should help farmers reduce the cost and risk of growing specialty crops by offering loans for the adoption of cold storage technologies that help preserve labor-intensive crops. The USDA should also provide training that helps farmers effectively grow specialty crops while increasing research and marketing funding to promote consumption of specialty crops. Without this type of assistance, new subsidies may not create enough incentives to grow more fruits and vegetables domestically.
Adopt innovative interventions that are working at a local level
While Farm Bill reforms alone are unlikely to improve Americans’ dietary health, certain innovative interventions show promise in changing people’s eating patterns. One type of intervention is a “behavioral nudge”, which subtly helps people make healthy choices. For example, a “behavioral nudge” that defaulted kids menus to have milk instead of soda was four times more effective in reducing calorie consumption when compared to nutrition education (e.g. calorie labeling on food packages).[xxvii] Another intervention is the Produce Prescription Program (PPP), which currently has about $50 million in annual pilot funding to increase access to nutritious foods through partnerships with healthcare providers.[xxviii]
Farmer and Representative Chellie Pingree (D-ME) helped secure funding for the PPP program in the 2018 Farm Bill. She said that the PPP program facilitated more physician-patient conversations about dietary health and increased access to healthy produce through health insurance programs.[xxix] In a similar approach, a wellness organization named Vitality has partnered with grocery stores to offer fresh produce at a lower cost to consumers.[xxx]
Each part of the food system — beginning with farmers and ending with consumers — has a role to play in improving the dietary health of all Americans. Farmers must build their capacity to grow crops that have a positive impact on the health of people and the planet. Food manufacturers and retailers must use behavioral nudges to help consumers make healthier food choices. And healthcare providers must work with their patients to develop eating plans that promote wellness and prevent the onset of diet-related diseases. Implementing policies to accomplish these objectives will save lives. Now is the time to act.
Edited by: Vinith Annam
Photo by: Dan Meyers
[i] “Unhealthy eating and physical inactivity are leading causes of death in the U.S.” Center for Science in the Public Interest.
[ii] “Prevalence of Childhood Obesity in the United States.” CDC. October 2017.
[iii] “Three Ways Obesity Contributes to Heart Disease.” Penn Medicine. March 2019.
[iv] “Obesity Link to Severe COVID-19, Especially in the Under 60s.” Medscape. April 2020.
[v] “Health and economic burden of the projected obesity trends in the USA and the UK.” NIH. November 2011.
[vi] “2018 Farm Bill by the Numbers.” Sustainable Agriculture. December 2018.
[vii] “USDA subsidies promote obesity.” HSPH.
[viii] “Hidden Cost of the Farm Bill.” Huffington Post. December 2017.
[ix] “USDA Subsidies Promote Obesity.” Harvard School of Public Health. 2017.
[x] “Even large commodity price increases result in modest food price inflation.” USDA.
[xi] “US Coronavirus Stimulus Bill Adds Billions in Support for Farmers.” Reuters. March 2020.
[xii] “Giving the Poor Easy Access to Healthy Food Doesn’t Mean They’ll Buy It” New York Times. May 2015.
[xiii] “A Systematic Review of Calorie Labeling and Modified Calorie Labeling Interventions: Impact on Consumer and Restaurant Behavior.” NIH. October 2017.
[xiv] “School Lunch Waste among Middle School Students: Implications for Nutrients Consumed and Food Waste Costs.” NIH. October 2013.
[xv] “The Extraordinary Science of Addictive Junk Food.” The New York Times. February 2013.
[xvi] “Where Do American Food Dollars Go?” USDA. May 2019.
[xvii] “Americans Are Confused About Food and Unsure Where to Turn for Answers, Survey Shows.” The Conversation. August 2017.
[xviii] “Trump Push to Finish Obama Crackdown on Salt Prompts Stealth Lobbying.” Politico. April 2019.
[xix] “Dietary Recommendations and How They Have Changed Over Time.” USDA.
[xx] Johnston, Gene. “Demand for Lean Beef Adds Premium to Prices for Lean, Healthy Market Cows.” Successful Farming. January 2017.
[xxi] “How the U.S. Low-Fat Diet Recommendations of 1977 Contributed to the Declining Health of Americans.” UCONN. 2016.
[xxii] “US Annual Organic Food Sales Near $48 billion.” Food Business News. May 2019.
[xxiii] “Farming is Still a Family Business.” Ag Week. March 2018.
[xxiv] A 2014 Farm Bill pilot enabled up to eight states procure unprocessed fruits and vegetables for school lunches.
[xxv] The Double Up Food Bucks” program, which doubles value of SNAP dollars when used to purchase fresh foods, has shown success since it launched in Michigan in 2009. In addition to increasing low-income families’ access to healthy foods, the program supports sales from small and medium sized farmers.
[xxvi] “Alliances for Obesity Prevention: Finding Common Ground Workshop Summary.” NCBI. May 2012.
[xxvii] Chandon, Pierre. “Which Healthy Eating Nudges Work Best?” Knowledge. July 2019.
[xxviii] “Local and Regional Foods.” USDA. Updated August 2019.
[xxix] “Press Releases.” Pingree. January 2019.
[xxx] “Vitality Rewards Consumers for Healthy Food Purchases through NutriSavings’ Growing National Network of Grocery Stores.” Business Wire. April 2016.