A new study shows subsidized fruits and vegetables could also prevent millions of cases of cardiovascular disease.
According to a new model, subsidizing fruits, vegetables, and other healthy foods under Medicare and Medicaid could prevent millions of cases and deaths from cardiovascular disease.
Every day, doctors write prescriptions for medications to treat various ailments in their patients. Those prescriptions, though, come once the patient is already sick. In an effort to stop the disease before it starts, some researchers are pushing for policies and programs that would let doctors prescribe healthy foods and insurers cover them—actively helping patients shift to a health-promoting diet.
These types of programs work: According to a new model, subsidizing fruits, vegetables, and other healthy foods under Medicare and Medicaid could prevent millions of cases and deaths from cardiovascular disease. It would also prevent hundreds of thousands of diabetes cases and save billions of dollars in healthcare costs.
“The power of food as medicine is increasingly clear,” says study author Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University. And the idea of treating food as a key element of healthcare is catching on across the healthcare industry, says Rita Nguyen, Medical Director of Healthy Food Initiatives at Zuckerberg San Francisco General Hospital. “People are recognizing the common sense of it all,” she says. “We spend so much on healthcare, and our outcomes are abysmal. We don’t invest in prevention.”
Food as medicine doesn’t mean that individual foods can be used to treat particular conditions or diseases, but that a healthy diet can help manage the disease, Nguyen notes—the leading risk factor for cardiovascular disease, for example, is a poor diet. “With food insecurity, treating someone with food can improve health. For those who are food secure, anyone given a good diet will have improved health management,” she says.
The new model analyzed the effects of two policy scenarios: In the first, 30 percent of the costs of fruits and vegetables would be covered under Medicare and Medicaid; in the second, 30 percent of fruits, vegetables, and other healthy foods like whole grains and seafood would be covered. The model incorporated socioeconomic demographics and health risk factors of people enrolled in Medicare and Medicaid, data on how price decreases change healthy food purchasing behaviors, and subsidy costs.
The study team found that subsidizing fruits and vegetables would prevent 1.93 million cardiovascular events, like heart attacks, and 350,000 deaths from the conditions. Subsidizing fruits, vegetables, and other healthy foods would prevent 3.28 million cardiovascular events, 620,000 deaths, and 120,000 cases of diabetes. The fruits and vegetables program would save nearly $40 billion in healthcare costs, and the addition of other healthy foods would save over $100 billion.
“It costs money, but most of that is offset by lower healthcare costs,” Mozaffarian says. “When you look at the cost per year of life saved, all interventions were extremely cost-effective.” It’s just as cost-effective, he says, as paying for drugs to prevent high blood pressure.
“So many of us want health insurance companies to recognize the value of food,” Nguyen says. “It’s not because we’re ‘bleeding heart liberals.’ It’s based on science. When you give people food and healthy food, it saves money.”
While the new model provides a big-picture look at the national effect of such a program, on-the-ground efforts to implement similar interventions are also key to understanding the impact of food subsidies and prescriptions. Such studies are underway or in planning stages: A $6 million study in California provides medically tailored meals to patients, and the 2018 Farm Bill included $25 million in funding to produce prescription pilot studies.
“This food as medicine approaches are gaining real traction,” Mozaffarian says. “If pilot studies are implemented and work, there’s a real chance you could shortly go to the doctor, a doctor could prescribe food, and an insurance company will pay for the part.”
The conversations around health-focused food subsidies also highlight that the barriers to healthy food are largely financial. “Food security is a money issue,” Nguyen says. “If you have the money, you can get healthy food.” While food deserts are important issues, they’re not the primary hurdle—and research shows that simply adding grocery stores doesn’t increase people’s consumption of healthy food or their health. “It’s not to say access isn’t an issue, but often in low-income communities, it’s not the main thing,” she says.
However, food prescription and subsidy programs that lower costs can help and are designed to stop healthcare problems and costs from ever appearing. “If our social structures aren’t aligned to support people meeting their basic needs to support health, we’ve chosen to pay for it in other ways. And then we have worse health outcomes,” Nguyen says.
In other words, if we’re worried about high blood sugar, food interventions might be better than doctor visits and high-tech medicine. She says that if we’re focused on ensuring people get their blood sugar levels checked regularly, it’s already too late. “Access to healthcare isn’t going to stop the source.”
