As US cases of COVID-19 near 1.7 million, we continue to learn more about the nature of the disease, including the factors that influence susceptibility to COVID-19 and the severity of symptoms.
Some of these risk factors, like age and certain health conditions, are beyond our ability to control.
Others, we have a shot at improving.
For example, reports of new cases continue to show that the people bearing a disproportionate burden of COVID-19 infections are people of color, including Black and Hispanic populations. The Navajo Nation now has the highest per-capita infection rate in the US. Importantly, the risk factor here is not “race,” but rather racism, a tenacious feature of most social and political systems in the US. Aggressively addressing systemic racism would have innumerable benefits for communities throughout the country—not the least of which would be improved health outcomes in the face of a pandemic.
Another population with increased susceptibility to COVID-19 is composed of individuals with poor nutrition and higher rates of diet-related conditions like type 2 diabetes. This is no small population—nine in ten adults fall short of daily recommendations for fruits and vegetables, and about six in ten US adults are living with one or more chronic diseases. Again, people of color are disproportionately represented, reflecting deeply rooted racism within the food system. And again, the potential benefits of reducing this risk factor go far beyond COVID-19: an abundance of research supports the notion that better nutrition translates to better overall health and longevity and lower healthcare costs.
Tackling big issues like racism, poor nutrition, and resulting diet-related health disparities may seem daunting in the midst of meeting the immediate needs of a country in crisis. But it’s critical that we act now—and there’s a policy opportunity ready and waiting that could help.
While the government scrambles to find solutions to the sudden financial instability and food insecurity facing millions of families, another process is quietly proceeding in the background that could have enormous implications for diet and health for years to come. By the year’s end, scientific experts and federal agencies will have developed the 2020-2025 Dietary Guidelines for Americans—an opportunity to take decisive action to address diet-related health disparities for good.
Right now, families need more help putting food on the table. Then what?
Nutrition programs have become front-page news in recent months as more of us face financial strain and struggle to put food on the table. Anti-hunger and public health groups have petitioned the federal government to meet the burgeoning need by providing more funding and flexibility for the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps), school meals, and other nutrition programs. And it appears that The Heroes Act, the new stimulus package passed by the House last week (now awaiting a response from the Senate), would deliver. The bill would boost maximum SNAP benefits by 15 percent, provide additional pandemic benefits to families with school-aged kids, and help schools cover the costs of adapting their food preparation and service to provide “grab-and-go” meals for kids and community members, among many other things.
The importance of the federal safety net in mitigating the effects of this public health crisis can’t be overstated. But we would be foolish to assume that even the strongest safety net is anything more than that—a safeguard that prevents people from hitting the ground when they fall.
But what if we could also plan ahead by making substantial investments in addressing diet-related health disparities—particularly for conditions like obesity, heart disease, and type 2 diabetes—that would not only improve the health and quality of life for millions of people today, but could also better protect our most vulnerable populations from future pandemics?
In other words, what if we could develop nutrition policies that prevented more people from falling in the first place?
Investing in Dietary Guidelines: Nutrition as a national defense strategy
The federal government has been publishing new editions of the Dietary Guidelines every five years since 1980. The primary purpose of these recommendations is to inform the national nutrition programs, like SNAP and school meal programs, that serve millions of children, families, seniors, and veterans every year and are now helping many more weather the COVID-19 crisis.
The Dietary Guidelines is based on the work of a committee of leading health and nutrition experts, the Dietary Guidelines Advisory Committee, and typically reflects the best available science. In fact, the core advice of the guidelines has changed little over the last 40 years: recommendations typically call on Americans to consume more fruit, vegetables, and whole grains; limit foods that contain high amounts of sugar or sodium; and develop healthy eating habits based on moderation and variety.
But anyone who eats can tell you that knowing what’s healthy and eating what’s healthy are two different things entirely. There are dozens of barriers that can keep your plate from looking like MyPlate, not least of which are the accessibility, affordability, and appeal of healthy foods. It doesn’t help that a multi-billion dollar food industry can (and does) spend an inordinate amount of money on research, development, and marketing to best exploit human psychology and physiology to make sure we keep eating what’s in the best interest of food companies, rather than our health.
At the risk of redundancy: all of these challenges are magnified by systemic racism that often keeps communities of color in poverty, living in neighborhoods inundated with fast food options and lacking in quality food choices, disproportionately exposed to junk food marketing, and subject to experiences of discrimination throughout systems ostensibly designed to support them.
And the guidelines haven’t ignored these factors entirely. Recent editions have begun to acknowledge the role that the systems and environments around us play in guiding decisions about our diets. The 2015-2020 Dietary Guidelines dedicated an entire chapter to this issue, outlining the roles and responsibilities of the public and private sector (like ensuring that places like schools, workplaces, and other food service establishments make it easy for people to eat healthfully) and identifying sector-specific solutions to help address household challenges to healthy food access. If fully implemented, these interventions could go a long way toward improving public health and resilience to outbreaks of contagious disease.
But here’s the thing: five years after making these recommendations, the federal government still hasn’t invested a dime in them. All the while, poor diets continue to plague the US population and diet-related disparities persist. The Dietary Guidelines is a rigorous, science-based document. But when it comes to addressing diet-related health disparities, that’s all it is.
Public pressure will be paramount in bringing nutrition recommendations to life
I’m not the first person to speculate that the current COVID-19 pandemic will leave lasting impacts on our daily lives long after its most immediate threats have passed. Nor am I the first to suggest that, if we’re thoughtful, we might be able to shape this new world order to reimagine, rather than restore, the social and economic conditions that have left so many communities uniquely vulnerable to its consequences. But unfortunately, foresight is not the Trump administration’s forte. Absent significant political pressure, our federal government is not likely to make the investments needed in nutrition research and practice to ensure that the future looks different when the next pandemic arrives.
That’s why it’s critical that the public speaks up and demands that investments in national nutrition become a public health priority. If we want the 2020-2025 Dietary Guidelines for Americans to leave us better prepared for the next pandemic and to help see us through this one, we need to ask our elected officials to start investing in actionable recommendations to address diet-related health disparities now. For the guidelines to achieve their full potential impact, there needs to be a robust and consistent implementation effort across all federal agencies, including federal nutrition programs; better coordinated and funded federal nutrition research; and comprehensive proposals to effect policy, systems and environment changes that support the social determinants of diet and health.
We’ll know more about the recommendations included in the next edition of the Dietary Guidelines on June 17, when the Committee previews the findings of its scientific report via webcast. By mid-July, the public will have the opportunity to view the scientific report in full and provide comments to the federal agencies that will develop the final guidelines—including input on the importance of thorough implementation. Check back on our website, or visit dietaryguidelines.gov, to stay up-to-date and learn how to make your voice heard in this critical process.