‘We Are So Sick as a Nation’: Food Is Medicine Summit Puts Focus on Nutrition

How can policymakers, healthcare systems, and patients themselves work to make food and nutrition the center of healthcare? That was the question nonprofit, government, and private sector leaders sought to answer at the Food is Medicine National Summit: Transforming Healthcare, held at the Friedman School of Nutrition Science and Policy recently.

“We are at a tipping point to characterize and catalyze the most promising solutions to reduce the crushing and inequitable health and economic burdens of diet-related diseases — an opportunity we must not let go to waste,” said Dariush Mozaffarian, Jean Mayer Professor of Nutrition and dean for policy at the Friedman School.

Following the summit, four community organizations and four individual leaders were honored for their work advancing nutrition security with the 2022 Jean Mayer Prize for Excellence in Nutrition Science and Policy. Supported through a gift to the Friedman School from John Hancock, the shared $100,000 prize is named after Tufts University’s tenth president, pioneering nutrition scientist Jean Mayer,

The winners were Robert Bertram (USAID), Sara Bleich (Harvard University), Ismahane Elouafi (Food and Agriculture Organization of the U.N.), and Oran Hesterman (Food Fair Network). The nonprofit groups About Fresh, Community Servings, Concern Worldwide, and Valid Nutrition also received honors for their groundbreaking efforts to ensure equitable access to healthy food, around Boston and beyond.

In announcing the winners, Lindsay Hanson, head of behavioral insurance, global strategy, and delivery at John Hancock, said she was “proud of the work that we've done together to advocate for the sensible solutions to the systemic challenges that face society today, including the need for greater federal nutrition research, coordination, and investments.”

Summit on Solutions

Throughout the Food is Medicine summit, stakeholders from across the country favored approaches ranging from medically tailored meals and produce prescriptions, to professional education for doctors and added medical coverage for dietitian counseling.

“We are so sick as a nation,” said Mozaffarian. “One in two adults in the U.S. have diabetes or prediabetes. Three in four are overweight or obese. And if you put that together with blood pressure and cholesterol levels, only one in 15 adults in the U.S. are metabolically healthy.”

During a panel on current healthcare challenges, Shantanu Agrawal, chief health officer at Elevance Health, pointed to the connection between diet-related disease and anxiety and depression. “There’s an incredible correlation between social needs and healthcare behavior,” Agrawal said. “It paints a really critical picture that this is an area that we must address if we are going to address disease burden, generally both mental as well as physical health.”

Daphne Miller, director of integrative and community medicine at the Lifelong Family Medicine Residency Program, highlighted the main driver of food insecurity: poverty and lack of capital. “So healthcare needs to go deep and address that. We need to harness the power of food, but in a way that is not just in a regular sick, screen-and-provide model,” Miller said.

Solutions aimed at informing consumers of the contents of packaged foods arose often. In a keynote speech, U.S. Commissioner of Food and Drugs Robert Califf reminded the audience that the FDA can nix food ingredients that don’t meet their safety standards—as it did with trans fats, which have largely disappeared from ingredient lists. “Food labeling can be a powerful tool for change,” Califf said. “We hope and expect that manufacturers may reformulate and produce new foods in order to bear the ‘healthy’ claim.”

Admiral and Assistant Secretary for Health Rachel Levine placed the discussion in context of the national five-pillar strategy to bolster universal health and nutrition. “One of the most critical elements of our national strategy is the growing momentum around food as medicine,” Levine said during a keynote address. “As public health professionals, the more we hear from patients and public health advocates, the more we agree that the healthcare setting alone cannot be the only place where food as medicine is practiced.”

At a concluding panel featuring voices from the field, Concetta Paul, a member of the Massachusetts Food is Medicine Advisory Board and a former recipient of medically tailored meals, highlighted income as a key determinant of health. 

“Buying cheaper, more highly processed alternatives that have multiple ingredients, that is a function of income,” Paul said. “You might buy a product and it might tell you the level of this chemical ingredient is okay to use. But over your lifetime – 20, 30, 40 years of using this one product and multitudes of other products – what about the cumulative effect?”

Martin Richards, executive director of the Community Farm Alliance in Kentucky, said it’s a popular misconception to think that our food system is broken. “It is not broken. It’s working exactly the way it was designed,” he said.

During the Great Depression and the beginning of World War II, the nation became focused on producing as many calories as cheapy as possible, Richards said—and although the situation has changed, this approach to farming and food has not.

“‘Food is medicine,’ especially the national strategy on hunger, nutrition, and health, is the opportunity to reorient our farm system in this country, from quantity to quality,” Richards said.

Celebrating Success

After discussing how to solve problems with the nation’s food system, stakeholders shifted to what’s going right, with a ceremony honoring the winners of the Jean Mayer Prize.

“A lot of the conversation has been about problem solving. How do we deal with the problems we have?” Mozaffarian said. “I think we also need to step back and celebrate success.”

The Jean Mayer Prize is awarded biennially for achievements made during the previous year. In addition to furnishing cash gifts to the nonprofits, Tufts will support an internship for one graduate student per organization to “work with them and advance their agenda.”

Oran Hesterman, CEO of the Fair Food Network, a nonprofit dedicated to supporting farmers through financial investments, capacity-building, and policy advocacy, accepted the award via video message. “For more than 50 years of my career in sustainable agriculture and food systems, I’ve always believed that when we start with food, anything is possible,” Hesterman said. “Food is medicine for our own bodies, but it’s the same medicine needed to heal the Earth’s body, to heal our communities, and our economic body.”

“Many of you have heard me say this before, but I’ll say it again,” Hesterman added. “We can pay the farmer today or the doctor tomorrow.”

David Waters, CEO of the Jamaica Plain-based nonprofit Community Servings, said his team aims to be the best in their mission to improve community health through delivering custom-made meals for people with chronic, diet-related diseases.

“To receive this recognition is so validating for those working in the trenches, whether they’re registered dietitians, counseling clients, or people peeling carrots and driving trucks,” Waters said. “Knowing that our work is respected at the level of this award is incredibly important for our team.”

Prize winners present at the ceremony took part in a brief Q&A about the future of nutrition security. After highlighting past advances made to prevent hunger, such as the creation of agricultural subsidies resulting in an array of affordable, fortified cereals, Mozaffarian asked: “Given how we got here, what do you think we need to do now?”

Ismahane Elouafi, chief scientist of the FAO of the United Nations, highlighted the lack of diversity in our agricultural system. Of 400,000 plant species, only 125 are in the market right now, three of which provide 40 percent of our needs, he said. “In 2013, we had the international year of quinoa. In 2016, we had the international year of pulses, and this year is the International Year of Millet,” he said. “Those are examples of crops or species that some governments are pushing for.”

Most of our proteins come from only eight animal species, Elouafi added. “So when we think about diversity in the field or on the planet, we are really using very little,” he said.

Sara Bleich, professor of public health policy and vice provost of special projects at Harvard, emphasized obstacles to domestic and international health equity, citing the lack of coordination across different efforts.

“There are limited dollars in this space. And if we can't work together, if we can't figure out how to get out of our own way and reach across the table and talk to people…we're not going to be able to maximize scarce resources,” Bleich said. “It's really important that we talk to those who are not necessarily in our field.”

For a positive example, Bleich referred to her time as director of nutrition security and health equity at the USDA, when she worked on initiatives including last year’s historic White House Conference on Hunger, Nutrition, and Health.

“I've never seen anything like it,” she said. “Many people think the federal government is slow and bureaucratic and that it doesn't move. It can move. It can be nimble, when you've got the right people at the top who are committed and want to see it happen.”