Eating, Smoking and Health

Two weeks ago, March 15-16, the Culinary Institute of America hosted its tenth annual “Healthy Kitchens, Healthy Lives” conference in California, a meeting of some 450 medical and dietician professionals and chefs.  Some of the chefs are pretty prominent ones, including, for example, David Bouley of the New York restaurants bearing his name.  The conference seeks to help chefs and doctors learn from each other about cooking great dishes that are healthy too.

Our attention was called to this event by an article in the March 15 Wall Street Journal “A Delicious Prescription”.  We passed the link to Debbie Loeb at the Geranium Farm’s Hodgepodge page, and she ran a feature from it on fruits and vegetables that are not only full of nutrition but good to eat and colorful.  See that here: http://geraniumfarmhodgepodge.blogspot.com/2014/03/health-food-for-foodies.html.  There is fine information in all this for Ways of the World readers as well, aside from their desire to eat as well as anyone else.

In our commentary that follows, we omit footnotes, since nearly every sentence would carry one.  See our list of sources at the end of the article.

Our emphasis is on healthcare costs and the economics of medical care.  We want people to be healthy and we want achieving better health to cost less and be less burdensome than has seemed to be case in recent years.  Two important trends in our own behavior can help achieve this without resort to medical treatment: maintaining reasonable weight and not smoking.

Fewer Smokers, Stronger Cigarettes

Coincidentally, last Monday, Debbie over at Hodgepodge ran a wonderful picture from the Australian government of the ways not smoking can improve several aspects of our bodies and health, including general breathing and the extent to which we taste and smell our food.  Go see this Hodgepodge feature:  http://geraniumfarmhodgepodge.blogspot.com/2014/03/still-smoking.html.

In the U.S., fortunately, we’re doing pretty well reducing smoking.  In 2012, only 18.2% of adults were current cigarette smokers, according to the Centers for Disease Control (CDC), compared to 22.3% ten years before and fully one-third of adults in 1979.  A recent Surgeon General’s report indicates that carcinogens in cigarettes have actually become more potent, making them more dangerous, but at least the numbers of smokers are decreasing consistently.

Overweight, Though, Affects 2/3 of the U.S. Population . . .

Overweight is on a different path, however.  Maybe we all know this, but we found these numbers to be quite striking.  In the mid-1960s about 46% of the U.S. population over age 20 was “overweight”, according to the CDC.  By 1990, the share overweight had grown to about 56%, and in 2007-2010, it was 68.5%, that is, more than two-thirds!  Fully 35% of the population was “obese” in 2007-2010, compared to just 14% in the mid-1960s.  These measures use the “body mass index” or BMI, a commonly used ratio of weight to height developed in Europe in the mid-19^th Century.  U.S. standards deem overweight to occur above a BMI of 25, which corresponds to about 145 pounds for someone 5’4” or 184 pounds for someone 6’0”.  Obesity is defined as a BMI of more than 30, equivalent to 174 pounds for someone 5’4” or 221 pounds for someone 6’0”.

. . . Contributing to Higher Patient Numbers and Higher Healthcare Spending

Tobacco surely generates health problems, beginning with lung cancer and COPD.  But we look more instead right here at the laundry list of issues associated with obesity:

Heart disease

Type 2 diabetes

High blood pressure

High cholesterol levels

Stroke

Liver and gallbladder disease

Sleep apnea and respiratory problems

Arthritis

Abnormal menstrual periods and infertility in women

Certain cancers

Not surprisingly, survey data from the Department of Health and Human Services show that five of these conditions have the highest growth rates in the numbers of people treated since 2000 and six of these are among the top ten conditions for total treatment expenditures in 2011 out of 55 conditions covered.  Clearly, there are many causes for heart disease, diabetes, high blood pressure, cholesterol problems and arthritis.  But obesity is one cause we have some role in.  We can help our own health by eating more thoughtfully, and that will take a further edge off healthcare spending pressures as well.

Many Low-Income Neighborhoods Need Supermarkets

In a separate application of the “right-eating” strategy to improve health and cut health spending, there’s been interest lately in the ability of people in low-income neighborhoods to buy fruits and vegetables and other healthy products at supermarkets.  This seems like a simple issue, but has turned out to carry some controversy.

In our own recent article about inequality and economic mobility, we learned that “segregation” of races and income classes in neighborhoods hurts people’s chances to move up in the world.  An obvious point, yes, but an important consideration in trying to design helpful policies.  Now, even more fundamentally, this segregation limits opportunities to acquire proper food because low-income neighborhoods tend not to have many supermarkets, health-food stores and similar outlets.  Recent studies document this shortage for a number of cities around the country.  Some of you may be ahead of us in knowledge of these “food deserts” and programs in several cities and states aimed at turning around this situation.  Ironically, it is widely reported that fast-food and liquor are far easier to come by in inner-city districts than reasonably priced fresh vegetables.  Some reports say that produce in the branches of chain stores in inner cities can sometimes be found in worse condition than it is in other branches of the same chain.

Fixing Food Deserts Also Creates Jobs

Our article on mobility highlighted the cultural and social barriers that exacerbate economic conditions.  The same is true here; local residents need education and information about the benefits of good eating and the cultural habits of at least a couple of generations need shifting.  Clearly, people need to eat right to have the energy to start their climb up an economic ladder.  We’re not sure what we can do ourselves toward this end, except to highlight these issues for you so you can encourage government officials and stores you like to invest in those needy locales.  As a recent discussion also emphasized, putting new supermarkets in new neighborhoods adds jobs in the very locations where they are needed most.  So it works on two problems at once.  Government policies might grant property tax exemptions and expedite zoning rulings to speed store construction.

Whatever people’s initial status in life, the punch-line here is that proper eating has all kinds of positive ramifications for health and economic welfare, for both individuals and society more broadly.

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Sources:

Data on portions of the population who smoke and who are overweight or obese: Health, United States 2012.  Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/data/hus/hus12.pdf.  Tables 54 (smoking) and 68 (weight conditions).

Surgeon General’s report on smoking: U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf.  Our comment on more dangerous cigarettes comes from the discussion of lung cancer on page 8.

BMI weight and height information taken from Department of Health and Human Services, National Heart, Lung and Blood Institute, BMI Tables: https://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm

Obesity health issues listing taken from the American Cancer Society:  http://www.cancer.org/cancer/cancercauses/dietandphysicalactivity/bodyweightandcancerrisk/body-weight-and-cancer-risk-health-issues )

Data on the number of people treated for various conditions and the expenditures for those treatments come from the Medical Expenditure Panel Survey (MEPS), the Department of Health and Human Services Agency for Healthcare Research and Quality.  Household Component Summary Tables:  Number of People with Care for Selected Conditions by Type of Service: United States, 2011 and  Total Expenses and Percent Distribution for Selected Conditions by Type of Service: United States, 2011 with comparable tables for the year 2000 and our own calculations.

Food deserts:  Yael Lehmann, “Neighborhood Grocery Stores Combat Obesity, Improve Food Perceptions”.  Health Affairs blog: http://healthaffairs.org/blog. March 12, 2014.

Judy Bell, et. al. “Access to Healthy Food and Why It Matters: A Review of the Research”.  PolicyLink.org and The Food Trust.  November 2013.  This paper is an extensive overview of numerous studies of food deserts and the multiple benefits of fixing them.  Some statistical evidence yields mixed conclusions about the severity of the food desert problem, but these writers argue that access to good food is an obvious prerequisite to better quality diets.

Note that food deserts are also a problem in rural areas, where some residents may have to travel 10 miles or more to reach a supermarket.  It is especially ironic that some agricultural regions where fruits and vegetables are grown are actually “food deserts” due to a lack of quality food retailers near the laborers who live and work in them.