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The Brown Political Review is a non-partisan political publication that seeks to promote ideological diversity. All of the views reflected in BPR’s content are views held by authors and not reflective of the views held by the wider organization or the Executive Board.

The Price of Eating Right

In 2019, the United States spent $3.8 trillion on health care, averaging $11,582 per person. This figure accounts for approximately 17 percent of gross domestic product spending in the US, a value which has grown from approximately 13 percent since 2000. Despite the exorbitant amount of money spent each year on health care, the US lags behind other advanced nations when it comes to delivering high-quality, accessible care. Much of the debate about health care in the US centers around lowering drug costs, expanding public options, and restructuring who pays for it — all valid and necessary conversations to have. But not enough emphasis is placed on addressing social determinants of health, such as access to food, education, and economic stability, that play a larger role in determining an individual’s health than the health care system itself. Aside from genetic factors, medical care is only responsible for 10 to 20 percent of a person’s health status. The other 80 to 90 percent is attributed to the aforementioned social determinants of health. While there are many social determinants of health that should be addressed, perhaps most realistically, the US government should address food-mediated health issues by working to decrease the cost of healthy food and to increase access to healthier foods in economically disadvantaged communities. 

In a recent Harvard Medical School study, it was found that poor diets alone accounted for $50 billion in preventable cardiometabolic disease costs, comprising 18.2% of total cardiometabolic disease costs in the US each year. BlueCross BlueShield of North Carolina reported an even more alarming figure of $1.5 trillion in preventable disease costs incurred annually. It’s clear that one way to significantly reduce health care expenditures would be to simply encourage Americans to live healthier lifestyles and eat more nutritious diets. Many lives would also be saved in the process. 

But the cost of eating a whole foods diet, relative to that composed of highly-processed fast food, often makes doing so an unrealistic proposition for many American households. Another Harvard University study found that, on average, it costs $1.50 extra per day per person to eat what’s considered a healthy diet of fruits, vegetables, nuts, and fish, as opposed to a less healthy diet of processed foods, meats, and refined grains. This comes out to $550 per year in extra costs, which, for a family of four, totals just over $2,200 per year. So for a family of four living at or below the poverty line making $26,801 per year, this means that it would cost them, at the very least, north of 8% of their income in order to simply eat healthier. Currently there are 34 million people at or below the poverty line in America, which is around 11% of the population. So for a large swath of America, it’s nearly impossible to get proper nutrition. This issue of inaccessibility ends up having a multiplier effect when you consider that populations at or below the federal poverty line are the most at risk for developing chronic health conditions and have substantially shorter life expectancies than those above the poverty line. 

So why is it that eating healthier in the US costs so much more than having an unhealthy diet? Government subsidies, such as the 1973 US Farm Bill that favors the farming of non-perishable crops such as corn, rice, and wheat, are one explanation. The ‘73 Farm Bill was passed during the Nixon administration to ensure that the country had a surplus of non-perishable crops after an unexpected shortage resulted in a spike in prices. Farmers were paid direct subsidies to overproduce corn, wheat, rice, and soy, which resulted in an oversaturated market that reduced crop prices. The 1996 Freedom to Farm bill was later passed in order to counteract the effect of these subsidies, but farmers continued to produce at their current rates and prices fell even further, setting the stage for the low prices we see today. The indirect effect of these low prices due to high supply is that products consisting of high fructose corn syrup, hydrogenated fats, and corn-fed meats are largely inexpensive to produce and thus more easily accessible. This drop in food prices is largely responsible for the 50% increase in obesity rates over the past few decades and, taking this a step further, for the billions of dollars in health care costs that are spent each year on diet-mediated preventable diseases. 

These subsidies have created an artificially large price gap that further widens the already gaping price differential between farming fruits/vegetables and commodities like corn. When compared on a serving by serving basis, one serving of broccoli costs around 14 cents to grow, a cup of strawberries costs 32 cents, and a cup of blackberries costs 74 cents. When you compare these markups to non-perishable crops, enough wheat for a slice of bread with the same calorie content costs a mere half-cent to produce. 

The issue is that subsidies for farmers who grow commodities like corn, wheat, and soy have become so entrenched in the farming industry that it’s nearly impossible to withdraw funding without thousands of farms going bust. If funding was withdrawn, Montana would receive zero net income from farming, and Colorado would see 75% of its farms operating in a deficit. It’s unclear how to dismantle the decades of poor fiscal policy that’s brought the farming industry to the point that they’re at today. But what is clear is that the federal government needs to start subsidizing fruit and vegetable farmers if the US is to combat the obesity epidemic that’s sweeping the nation and driving health care costs through the roof.  

While there are large-scale studies that claim consumption habits would remain unchanged even if the price of healthier foods were to decline, there are also a number of small-scale studies that show the opposite is true. In a work-place cafeteria study, an experiment was conducted where 3 weeks of baseline conditions were observed, followed by 3 weeks of reduced food prices for healthier options like fruits and salads, then 3 more weeks of baseline conditions. The results collected show that reducing the price of fruits and salads by 50% resulted in a 3-fold increase in consumption relative to the baseline periods. A similar study was conducted in two schools with differing demographics — a suburban school where 0.5% of students received free or reduced-price lunches, and an urban school where 29% of students received free or reduced-price lunches. When the price of carrots and fruits offered were reduced by 50%, it was found that fruit consumption increased by almost 300% while carrot consumption increased by more than 100%. The takeaway from both of these studies is that price can have an influence on food consumption habits, from children to adults, regardless of income. Particular attention should be paid to these studies in schools, where consumption habits can be influenced and more easily regulated.          

Other solutions that have been suggested — and in certain states and cities, implemented — include levying taxes on sugary drinks. This is actually somewhat of a controversial plan to adopt, due to the fact that two-thirds of revenue raised from soda taxes typically come from households making between $20,000 to $100,000 per year, making this tax regressive at its core. Additionally, studies have found that taxes on sugary drinks don’t actually decrease consumption all that much. In Philadelphia, a 1.5-cent per ounce tax was placed on sodas, which seemingly decreased consumption by 46% in the city. However, consumers would simply drive outside of the city limits to purchase their sodas, which resulted in a consumption decline of less than 50% of what was originally recorded. While the efficacy of plans to reduce consumption habits via a “sin-tax” like with cigarettes and alcohol is questionable, what isn’t up for debate is the idea that these taxes are significant revenue generators. In its first two years of existence, the Philadelphia sugar tax raised $191.7 million in revenue. This money was allocated towards the city’s Parks and Recreation department, as well as community schools, which are all worthy causes, no doubt. But perhaps a better use of these funds would be to subsidize healthier foods that are served in school cafeterias. As enumerated earlier, reducing the prices of healthier food options such as fruits and vegetables in schools is shown to increase consumption by students. A sugar tax itself may not decrease consumption of sugary drinks enough to justify the cost, but using those funds to make healthier food options for students more attainable may be an equally appealing option. 

The bottom line is that Americans need to start eating healthier if we want to substantively reduce health care costs. For the lowest earners in the US, doing so is an issue of means more so than will. Financial barriers often make it impossible for individuals at or below the poverty line to spend extra on healthier options, which puts them at greater risk of developing chronic health conditions later on in life that are costly to the health care system. The cost of eating healthy lies at the root of rising health care costs. Unless we start putting our money where our mouth is (so to speak), we won’t see health care costs decline any time soon.  

Image: Original illustration by Kelly (Tsae Yung) Wu