If we Americans learned one thing from the previous occupants of the White House, Presidents matter. President Barack Obama has been left a huge mess to clean up. He will need wisdom, courage, phenomenal leadership skills, and a great deal of good will and luck to undo the damage of the last eight years and move the country to a healthier and more sustainable future. For public health nutrition – from agriculture to food, nutrition and health – his agenda is long and challenging.
Address root causes of public health problems
President Obama has no choice but to begin by dealing with fundamental issues that affect public health(Reference Marmot, Friel and Bell1). He can and must extricate the country from the ill-conceived, expensive and destructive wars in Iraq and Afghanistan, close the prison camp at Guantánamo and end state-sanctioned torture. He can and must get the economy back on track by reining in the excesses of Wall Street, creating jobs and investing in long-neglected public works, most notably schools and transportation.
Perhaps most obviously, he can address the crisis in health care. Even before the economic downturn, 40 million Americans lacked health insurance. Because the current system is tied to employment, rapidly rising rates of unemployment are adding millions to the ranks of the uninsured. Obama can consider a universal health insurance plan, one preferably based on a single payer model and independent of for-profit insurance companies(Reference Himmelstein and Woolhandler2).
Overall, he can and must restore the predominance of public rather than corporate interests in government action and public life. With respect to public health nutrition, this means dealing right away with acute problems in four areas: food security, food safety, obesity and related chronic disease risks, and agricultural productivity and sustainability.
Make food assistance programmes entitlements; make school food programmes universal
National surveys identify 11 % of American families as food-insecure, meaning that they lack reliable access to an adequate and healthful diet. These families include more than 20 % of America’s children(Reference Nord, Andrews and Carlson3). The current crises in food prices, housing and employment (and associated health insurance) are already increasing demands for federal food and welfare assistance beyond their capacity.
Obama needs to follow the pattern established during the Great Depression of the 1930s and create a job corps to put Americans back to work(Reference Rauchway4). He can convert current food assistance programmes to entitlements, so that all eligible families can participate. Some food assistance programmes already are entitlements (e.g. the Supplemental Nutrition Assistance Program, formerly known as Food Stamps); others, most notably WIC (Special Supplemental Program for Women, Infants, and Children), are not(5). He also can immediately remove the barriers that make the programmes so difficult to access.
American schoolchildren are not entitled to free or reduced-price school breakfasts or lunches unless their families document eligibility through substantial paperwork. The present system stigmatises qualified children, generates large administrative costs, and undermines the ability of school lunch programmes to produce healthful meals. Children behave better and learn better when fed adequately, and many of the present problems with the programmes could be eliminated by providing meals to all schoolchildren(Reference Levine6).
Consolidate federal food safety oversight into a single agency
Food safety scandals of the past few years – Escherichia coli 0157:H7 in spinach(7), Salmonella in tomatoes or jalapeño peppers(8) and melamine in pet food ingredients imported from China(Reference Nestle9) – revealed gaping holes in the ability of federal agencies to ensure a safe food supply(10).
For decades, congressional watchdog agencies have argued that the country’s food safety system, split as it is between the Food and Drug Administration (FDA) and US Department of Agriculture (USDA; as well as multiple minor agencies), is inadequate to address the safety problems posed by an increasingly globalised food supply. They propose that federal food safety functions be consolidated within a single agency devoted to protecting the safety of the food supply from farm to table(Reference Becker and Porter11). Obama can make this action an immediate priority.
He must also require all food producers and distributors, regardless of position in the food chain, to follow standard food safety procedures – HACCP (Hazard Analysis and Critical Control Point) with Pathogen Reduction. The present system requires food producers to follow HACCP procedures for only a handful of foods – meat and poultry on the USDA side and sprouts, juices, shell eggs and fish on the FDA side(12). Obama can require such plans of all food producers, and require monitoring to make sure the plans are designed and implemented appropriately.
Ban food marketing to children; eliminate junk foods from schools
Diet-related chronic diseases – heart disease, stroke, diabetes, cancers – remain the leading causes of death and disability among Americans. Risk factors for these diseases, particularly obesity, are now common even among very young children. Obama can take several steps to make it easier for adults and children to eat diets that are better balanced in calories. He must prohibit the marketing of ‘junk’ foods – those of minimal nutritional value relative to their calories – to children. Such marketing has been shown to increase children’s preferences for, demands for and consumption of such foods(13). Habitual consumption of junk foods, especially sugary drinks, is strongly associated with less nutritious diets and higher rates of obesity. Food companies argue that promoting such products is protected by constitutional rights to free speech. Surely, the founding fathers did not intend the First Amendment to protect the right of corporations to market junk foods to children. We can protect First Amendment rights while also protecting children from undue marketing influences. Obama’s legal staff should be smart enough to figure out how to do this.
To help deal with adult obesity, Obama can ask Congress to institute national calorie labelling of fast foods. Hardly anyone understands the energy value of food and calorie labelling has the potential to be a powerful educational tool. The imposition of calorie labelling on menu boards of fast-food chains in New York City has induced public shock at the high levels of calories in fast food(Reference Bassett, Dumanovsky and Huang14). The effects of this initiative have been to discourage consumption of high-calorie items by the public and to encourage chains to reduce the calories in some of their offerings. Obama can take this system national.
Reconstitute the Department of Agriculture as a Department of Food
Agriculture is the basis of public health nutrition: without food, we do not eat. Current agricultural policies support an industrial system of production in which subsidies go to the largest producers of animal and plant commodities. Vegetables, in contrast, are considered specialty crops. Industrial agriculture causes widespread pollution of air, soil and water, adversely affects the health of farm workers and residents of local communities, and is unsustainable(15). The entire system warrants reconsideration.
Prominent journalists, most notably Michael Pollan, argue for elimination of farm subsidies, especially for corn and soyabeans, and for new policies that promote a more diverse and localised agricultural system. They point out that key issues in the Obama presidential campaign – health care, climate change and energy independence – depend on the way we conduct agriculture. Without agricultural reform, we cannot make progress on these and other issues critical to public health. What is really needed is a Department of Food to deal with the full range of agricultural issues that face Americans(Reference Pollan16, Reference Kristof17).
Although organisations devoted to food democracy collected thousands of signatures on petitions urging appointment of a USDA Secretary sensitive to the public health implications of agricultural production, Obama instead has selected a former Governor of an industrial farm state. Whether this new administration will initiate more sustainable farm, food, nutrition and health policies remains to be seen. In the meantime, advocates have plenty of work to do.
