Changing the cost to consumers of just seven types of food — making the healthful ones (like fruits and vegetables) cheaper and the unhealthful ones (like sugary drinks) more expensive — could significantly reduce the number of Americans who die each year from coronary heart disease, stroke and type 2 diabetes, according to a study published recently in the journal BMC Medicine.
Such changes would especially benefit lower-income Americans and would therefore help address the growing health disparities between the rich and the poor in the United States, the study also found.
An unhealthful diet is considered a major cause of coronary heart disease, stroke and type 2 diabetes, and people with lower incomes are known to be at higher risk of developing these and other cardiometabolic diseases.
As the authors of the study point out in their paper, past public health interventions to get people to improve their food choices, such as education campaigns or more detailed food labeling, have had some positive effects on Americans’ dietary habits — but mostly among people with higher incomes and more education.
For the current study, a team of researchers from Tufts University did a comparative risk assessment analysis using national data on the food choices of Americans (broken down by age, gender and socioeconomic status), the known associations between those foods and the risk of developing cardiometabolic diseases, and the effects of price changes on people’s buying habits.
The researchers focused on five foods that have been associated with a lower risk of disease (fruits, vegetables, whole grains, nuts and seeds) and on two that have been associated with a higher risk (processed and unprocessed red meats and sugary drinks).
The analysis revealed that if the prices of all of these foods were altered by 10 percent each (lowered for the healthful foods and increased for the unhealthful ones), an estimated 23,000 deaths per year could be prevented in the United States — or about 3.4 percent of all deaths from coronary heart disease, stroke and type 2 diabetes.
If prices were altered by 30 percent, the number of lives saved would triple, to an estimated 63,000 per year, or 9.2 percent of all deaths from the three cardiometabolic diseases.
The largest impact of the altered food prices was observed for stroke, followed by diabetes and then coronary heart disease. Stroke deaths were most influenced by subsidies for fruits and vegetables, while diabetes and coronary heart disease deaths were most influenced by taxes on sugary beverages.
The analysis also showed that the people who would benefit the most from strategically designed food subsidies and taxes were those whose education did not extend beyond high school — an outcome that would greatly reduce socioeconomic disparities in all three diseases: heart disease, stroke and diabetes.
“Given the large and growing inequities in dietary quality and [cardiometabolic disease] risk in the U.S., our findings for disparities are particularly relevant,” the study’s authors write.
Limitations and implications
The study has several limitations. For example, the dietary data used in the analysis were based on people’s self reports of their eating habits, which can be unreliable. In addition, knowledge about the effects of various dietary factors on disease comes mostly from observational studies, which can show only a correlation, not a causal relationship, between those factors and health. (The harmful effect of the saturated fat in meat on heart health is a particularly controversial topic.)
Furthermore, there’s no way of knowing for sure what foods consumers will turn to if harmful foods are taxed.
Still, the study’s findings are interesting, particularly given the fact that previous public health efforts to get consumers to make more healthful food choices has done little to change behavior.
The “traditional focus in the United States has been on education and willpower and personal responsibility as though food is just entirely an individual choice and there’s nothing else anybody should do about,” Dariush Mozaffarian, the study’s senior author and dean of the nutrition science and policy school at Tufts University, told Newsweek reporter Sydney Pereira.
But, other public health crises in the U.S. — such as tobacco use and motor vehicle safety — were dealt with systematically rather than shifting blame on the individual, Mozaffarian added.
Food is the “single biggest missed opportunity to good health in this country,” he said. “Prices and fiscal incentives are a great way to do that for the food system while preserving choice.”
FMI: You can read the study in full on the BMC Medicine website.