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Back to Table of Contents | December 2012


Our Unhealthy Food System

Why physicians’ voices are critically needed.
By David Wallinga, M.D., M.P.A.

The current U.S. food system works at odds with the health of children.1 — Mary Story, Ph.D.

Mary Story is right. Our food system is unhealthy. But not just for children—for all of us. The signs are everywhere: high rates of obesity and chronic diseases such as diabetes and cardiovascular disease, near-constant outbreaks of foodborne illnesses and the problem of antibiotic resistance, exacerbated by the huge quantities of human antibiotics put into livestock and poultry feed.

What has gone wrong? There is no single, simple answer. But I and other public health researchers point to the decades-long industrialization of the food system as a critical factor.2 When talking about our food system, we are referring to everything from the farm to the plate—food production, harvesting, processing, marketing and distribution. Industrialization describes the increasing tendency of economists, policymakers and agribusiness companies to treat farms as rural factories, with off-farm inputs (energy, antibiotics, synthetic fertilizers, genetically modified seed) marshaled in the service of producing caloric energy (feed corn and starches, soybeans and refined flour). Industrialization also describes a system in which economic return is paramount—more important than concern for the public’s health, the potential health effects of pesticide exposure, the long-term resilience of the land where crops are grown, and the methods by which food is processed and delivered.

The hallmark of any system is that—for better or for worse—it functions as a complex whole, making it impossible to easily divorce one part from another. The plethora of problems in and related to our food system do not exist in isolation. They are intimately connected. Put another way, the healthfulness of our food, the health of the natural world (the soil, water, bacteria and genetic resources that gives rise to it), and the health of our patients cannot be considered apart from one another.3

Industrial models of farm production have been efficient at extracting profit from the system; but they have shifted the future costs of agricultural pollution, or soil and water degradation, onto consumers, local governments and other entities including the health care system. And our public agricultural policies have tended to support the industrial model. More specifically, they have supported goals such as increasing corn yield or acreage planted, and not promoted nutritional quality or better stewardship of antibiotics.

Effect on Health
Our industrialized food system has been a major contributor to the obesity crisis in this country, which now costs $190 billion annually in treatment costs alone. According to United States Department of Agriculture data, the average American now consumes 600 more calories per day than in 1970.4 Most come from the added fats, sugars and refined grains commonly found in highly processed foods and junk foods—soda, frozen pizza, donuts and scones, burgers and fries, and the like. These additional calories have overwhelmingly come from corn (corn starches, corn syrup, high fructose corn syrup, feed corn fed to livestock), soybeans (soy proteins, vegetable oils, salad oils, partially hydrogenated oils, and fryer oils in fast-food restaurants) and wheat (refined flour). These three crops account for the vast majority of crop acreage planted in the United States.

A food system focused so narrowly on production is also a reason for ongoing problems with foodborne illnesses. In recent years, we have seen outbreaks of foodborne illnesses from contaminated ground beef, ground turkey, eggs, peanut butter and other foods. In 2009, the New York Times ran a story that illustrated the problem. A young Minnesota dancer was felled by E. coli O157:H7 from a contaminated hamburger. That hamburger contained meat from cows that came from slaughterhouses in Nebraska, Texas and Uruguay. Another 10 percent came from trimmed beef fat from who-knows-how-many cows collected by Beef Products, Inc., a South Dakota company. Meat companies often rely on suppliers to test for E. coli and other contaminants after the meat is ground. However, according to the story, unwritten agreements between suppliers and distributors can stand in the way of this testing, with some slaughterhouses agreeing to sell their product only to grinders who agree not to test for fear that discovery of E. coli could lead to a recall of product sold to others.5

Industrialization also contributes to antibiotic resistance through the use of penicillins, tetracyclines, erythromycins, sulfa drugs and others in the production of animals for food. According to the Food and Drug Administration, 80% of all antimicrobials sold in this country—nearly 30 million pounds per year—are used in food animals.6 Ninety percent of those are added to animal feed or their drinking water at nontherapeutic dosages for what are nontherapeutic purposes, such as promoting growth.7 The overuse of antibiotics is a primary driver in the formation and spread of antibiotic resistance. The extensive use of antibiotics in animal feed, therefore, promotes resistance, resulting in the spread of more drug-resistant bacteria on meat, in waterways and among farmers and veterinarians.

There is both a human and financial toll to antibiotic overuse. In the United States alone, an estimated 900,000 cases of antibiotic-resistant infection occur annually; methicillin-resistant Staphylococcus aureus alone is responsible for 18,650 deaths and 94,000 cases of infection.8,9 Antibiotic-resistant infection also results in longer hospitalizations, which cost the U.S. health care system $20 billion a year.9 Lost productivity and other societal costs add another $35 billion to the annual cost.9

Advocating for Healthier Food Systems

In Schools

In Hospitals

In Communities

What You Can Do
Clearly, we have a food system in this country that contributes to our burden of disease. I mention only a few of the systemic issues and not others such as the widespread use of synthetic, petroleum-derived food dyes, the presence of multiple pesticide residues on fruits and vegetables or the inclusion of estrogen-like bisphenol A in food packaging. All of these problems are representative of a food system in which decisions are made and policies are set in concert with pharmaceutical companies and makers of industrial and agricultural chemicals—stakeholders that have a vested interest in leaving industrialized food production as it is. There is little regard for the potential impact on public health and little or no input from health professionals.

Putting the responsibility on individuals to eat healthfully and achieve health amid such an unhealthy food system is wrong-headed and will not prove to be effective. To truly improve health, change has to happen at the system level. Physicians have an opportunity to play a crucial role in much the same way we did in the fight against tobacco use. We learned from antismoking campaigns that physicians’ voices are respected and their involvement is important to changing conditions in their communities. Had it not been for the health care community’s critical and necessary counterweight to the financial and political might of the tobacco industry, more people would continue to smoke today. Therefore, it makes sense for physicians to work to change the food system.

This is starting to happen on a larger scale. Medical societies such as the American Medical Association (AMA) and the Academy of Pediatrics are becoming increasingly involved in food policy issues. The AMA, the American Dietetic Association and the American Public Health Association have all developed positions on the importance of healthy, sustainable food systems. But more is needed, particularly at the local and state level. We need individual physicians to join with other health professionals to make Minnesota’s food system one that promotes health rather than profit. Our patients’ needs will not be met until we do so.

The medical community can no longer afford to stand on the sidelines. Now is the time for physicians to lead in building a healthier food system. MM

David Wallinga is senior advisor in science, food and health at the Institute for Agriculture and Trade Policy.

This commentary is adapted from one that appeared in San Francisco Medicine in November 2010.

1. Conference Summary: The Wingspread Conference on Childhood Obesity, Healthy Eating & Agricultural Policy, March 2007. Available at: Accessed November 19, 2012.
2. Wallinga D. Today’s food system: how healthy is it? J Hunger Environmental Nutrition. 2009;4(3):251-81
3. Naylor RL. Managing food production systems for resilience. In: Chapin FS, Kofinas GP, Folke C, eds. Principles of Natural Resource Stewardship: Resilience-Based Management in a Changing World. New York, NY: Springer; 2008:259-80.
4. Wallinga D. Agricultural policy and childhood obesity: a food systems and public health commentary. Health Affairs. 2010;29(3):404-9.
5. Moss M. The Burger That Shattered Her Life. New York Times. October 3, 2009.
6. Food and Drug Administration, Center for Veterinary Medicine. Antimicrobial Animal Drug Distribution Reports, 2009-2010. Available at: Accessed November 19, 2012.
7. Office of U.S. Rep. Louise Slaughter., Slaughter Says Lawsuit Against FDA Shows Growing Public Awareness, Concern Over Antibiotic Overuse. Press Release. May 25, 2011. Available at: Accessed: November 20, 2012.
8. Klevens RM, Morrison MA, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007;298(15):1763-71.
9. Roberts RR, Hota B, Ahmad I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis. 2009;49:1175-84.

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