How the Food System Makes Food Choices For Us

Coming up on this week's episode of the Doctor's Pharmacy.

It's very hard for people to feel like they have the ability to control their life and their destiny. I think it's really tough to own that. And, you know, scientific research is really clear about this. When you look, for example, at your socioeconomic status and your risk of disease, it's more of a risk than obesity or smoking or a lot of exercising. And the defining aspect of that is powerlessness.

Hi, I'm Kaya Perowich, one of the producers of the Doctors Pharmacy Podcast. Research shows that your social environment, a lack of access to healthy food, your level of education, and even the safety of your neighborhood determine your health outcomes. Yet, when it comes to chronic disease, we often place the blame on the individuals. In this mini episode, Dr. Hyman speaks with former New York City Department of Health Deputy Commissioner, Dr. Sonia Angell, about the social determinants and the fallacy of personal choice in our food system.

You were part of the initiative in New York that said no more trans fats in the deep fryers.

Right, and I think, you know, because nobody goes into a fast food restaurant and says, I want my french fries with trans fats in them. Like that's a false choice. We didn't ever have that choice. It was put in there and we just received it that way. And when we talk about added sugar or sodium, right? The vast majority of sodium in our diet is already in the food when you purchase it. It's coming from processed and packaged foods. It's not what you're putting on at the table. table, it's not the salt that you're putting in your food when you're cooking.

That seems to be the most difficult thing for me to tackle with because how do we start to push the food industry to do the right thing?

Yeah, I mean, first thing that we need to acknowledge is that the healthiest diet is one that's based on whole foods, not a processed food diet and not an ultra-processed food diet. So while we can work with industry around packaged foods and beverages, and we have to because we rely heavily on them, we don't wanna lose sight of the the fact that the best foods that we really should have as a central part of our diet are not in that realm. So let's now look at the processed and manufactured foods because it's already in the food when you purchase it. You don't have the choice of having a lower sodium diet because the vast majority of foods already has it in there. If industry, however, lowers the amount of sodium in processed and packaged foods, then you do have the choice. The choice is back in the hands of the consumer. Now they can add it at the table. If they want, they can add it to taste or they can choose not to add it at all. at least it's a choice that the consumer has. I always say you can't make healthy choices if you don't have healthy choices. The thing that was causing most of the illness that I was seeing in my clinic was not just about an individual making a choice that may not have been a good choice for their health. It was actually where they were living and what was around them that was pushing them into having choices that weren't healthy for them, which is very different.

And only people realize the degree of health disparities in this country. I mean, it's really like two countries. It's a developing country and a developed country. And you've got African Americans having far greater rates of diabetes, heart disease, early death, cancers. You've got same thing in the Hispanic population. And it's not surprising because the environments that they live in are heavily targeted by processed food, fast food outlets, and even advertising and marketing.

It's pretty easy to see that where the disease is higher is also where the neighborhoods have less resources, not only with respect to food. We have higher rates of crime. When you have higher rates of crime, it's much more difficult to walk in the streets, to use the parks, kids are kept indoors, all of that.

It.

Snowballs, and in the end, you can see very much that this is about the structure. So the question is, how did that happen? And we in the United States have a long history of racism, of discrimination, of limitations, of opportunities and access. It's remarkable how A lot of things that have been in our community for a long time, we start to assume it's because there's some sort of cultural tendency towards that, when in fact some of it may be imposed from the outside for all of the reasons that we've just been discussing.

Many of our industrial processed foods have been found to be addictive. It is not a failing of personal responsibility, moral fiber, or even willpower that drives people to overconsume these unhealthy foods. Columbia University Teachers College professor Pam Coke discusses how government policy drives a food supply that acts as a main source of our chronic disease epidemic.

We have a big system that we have to change. I think we need to change our food supply. I think we need to make our food supply better. I think if we're going to look at it that way, we need to look at what's available in the communities where people are. There may be that there isn't any fresh fruits and vegetables, and so they're not buying it, not because that's what they want, but because that's the only thing that's available to them.

60% of the calories we consume in this country are from commodity crops, mostly wheat, corn, and soy, which has turned into refined foods.

Right, that's turned into all the high.

Ultra processed food products. We say to Americans, the government says eat five to nine servings of fruits and vegetables a day, but if everybody.

Did that, we'd only have enough for 2% of the population. That's right, only 5% of American adults eat enough fruits and vegetables because we're not producing enough. It is the Farm Bill that is supporting a food system that is a food system that has a lot of highly processed foods and it basically the big agriculture companies and the big food industry have been very influential over what goes into to the farm bill.

There's $500 million spent by 600 lobbyists just on the farm bill from the food industry. Exactly. It's frightening.

It's very frightening. And they have a lot of power and they are very, very inside. So just to give you an example.

Is- yeah, get us into the dirt on this.

What ends up, what they're really pushing for is supports for the big commodity crops. so that's corn and soy and a couple other crops.

And wheat.

And wheat. And so for the current farm bill, $40 billion went into supporting commodity crops. Then fruits and vegetables and the farm bill are called specialty crops. I think that we have to really figure out what we can do to.

Get.

More programs that provide incentives for healthy foods and make more high quality food available everywhere because it's not right now. So take some of that 40 billion and push it over to supporting the.

Production of healthier foods like specialty crops, right? Fruits and vegetables. That's right.

Collectively, we have the potential to reverse.

The chronic disease epidemic by moving away from a system which overwhelmingly supports the production of commodity crops, the distribution of unhealthful foods, and disproportionately targets our most vulnerable communities. This is a systemic generational problem and it will only change with our voices. When the things that create health are easy to access and the things that create disease are hard to get to, extraordinary change can occur. I hope you enjoyed this mini episode of the Doctor's Pharmacy. Thank you for being a part of the conversation.

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