While Americans were freaking out over Ebola, another outbreak has been brewing in the United States for the past few weeks. A series of cases were reported – based on reports, each case has been quietly spreading for several years and now affects millions of Americans. The cases probably share a common origin. Yet none of them inspired much public outcry.
What is it? Health disparities – specifically, nutrition health disparities – are clearly getting worse.
Maybe they didn’t inspire outcry because, frankly, health inequity has become synonymous with Red, White, & Blue. But a string of 3 studies in 3 weeks made it clear that the U.S. is outdoing its own low standards when it comes to widening gaps in health. Each study reported an increase in nutrition-related disparities in the U.S., even if the overall health of Americans was improving:
- On September 17, a study published in JAMA reported that average waist circumference, a marker of abdominal obesity, increased steadily in U.S. adults from 1999-2000 to 2011-12. The increase was seen in all groups, but it was greatest among non-Hispanic blacks and Mexican-Americans.
- On September 24, another JAMA study reported that diabetes incidence stabilized in the U.S. overall from 2008 to 2012, but it continued to increase among non-Hispanic blacks and Hispanics.
- On October 1, a JAMA Internal Medicine study reported that American adults’ overall diet became healthier from 1999 to 2010, but socioeconomic disparities in diet quality grew during this period.
If that wasn’t enough, a 4th study that was published on October 8 could be a smoking gun tied to the other 3. It reported that food prices increased the most for healthier food groups (e.g., fruits and vegetables) from 2002 to 2012. This study was based in the U.K., but the cost of healthy eating has been widely documented worldwide.
4 independent studies that all pointed to the same general conclusion. You know what they say:
Once is an event …
Twice is a coincidence …
Three times is a pattern …
Four times means you’re an idiot if you still think this is a coincidence …
“Signs of progress”?
Results like these make you wonder if policies and programs that have targeted nutrition for the past 10-15 years are directly making disparities worse. Even when we’re celebrating “signs of progress,” such as obesity prevalence stabilizing, who is actually progressing? We look at obesity rates and want to party because it’s 1999 again. But it’s entirely possible that the stabilization is due to low-risk groups getting better while high-risk groups get worse. The September 24 diabetes study seems to suggest that is exactly what is happening.
Furthermore, the growth in disparities has immediate relevance for 2 policy initiatives that are being hotly debated. One policy is designed to benefit high-risk groups (if it isn’t axed in Congress); the other might fail because of bogus claims that it does not benefit high-risk groups:
School lunch nutrition standards
Low-income students benefit more than anyone from healthy school lunches. The National School Lunch Program (NSLP) was designed primarily for low-income students, but instead it was probably an accomplice to obesity disparities in the past because NSLP nutrition standards were inadequate and outdated.
As part of the Healthy, Hunger Free-Kids Act, NSLP standards were updated and school meals have become healthier. Studies have reported that healthier USDA standards were particularly well-received by low-income schools and state school meal standards were associated with healthier weight status in low-income students. The program is finally showing the potential to achieve its objective.
Yet the School Nutrition Association (SNA) continues to dismiss all that health nonsense. Nick Confessore wrote in The New York Times last week how the SNA has become “Washington’s loudest and most public critic of the Healthy, Hunger-Free Kids Act” as SNA leaders oppose continued improvements to school lunch standards. Thanks to their lobbying, healthier school meals may be on the chopping block in the near future. And if the ax falls, it will be at the expense of low-income students.
San Francisco and Berkeley sweetened beverage taxes
Both San Francisco and Berkeley are proposing large sweetened beverage taxs that will be up for vote on November 4. Tax opponents cry that these taxes are unfair to low-income people, or might even cost jobs; this “regressive tax” argument makes no sense for several reasons:
- Opponents’ logic is based on the assumption that consumers won’t change their behavior. The whole point of a sweetened tax is to change behavior – as such taxes have done in Mexico.
- There is nothing about opponents’ logic that is unique to sweetened beverage taxes. You could use the same logic for any tax that is applied uniformly – like, say, gasoline taxes. I don’t hear opponents crying to get rid of oil.
- Research has shown that a sweetened beverage tax could actually increase jobs
Most importantly, Type 2 diabetes is far more regressive than any tax. The JAMA study published on September 24 showed it.
Will either school lunch reforms or sweetened beverages taxes reduce disparities? I don’t know. Based on the evidence we’ve got, though, both policies stand a better chance of doing so than any program or initiative we’ve tried in the past. And any unbiased person would have to agree that nothing we’ve tried in the past has reduced nutrition inequity in the U.S.
(Speaking of what we’ve tried … it’s ironic that these 4 studies were published right when food and beverage companies were awarding themselves a Nobel Prize for cutting 6.4 trillion calories. I could talk all day about how industry’s self-regulatory pledges may be fueling health inequity. But I’m getting perilously close to 1000 words and need to cut myself off.)
Four studies in four weeks suggested that nutrition-related health inequities are growing. Any signs of progress are coming at the expense of people who are at the highest risk. The strategies we’ve used to stabilize obesity in the U.S. might be widening gaps in health rather than reduce them. And depending on how votes swing on November 4, things could get worse before they get better.
I need to start blogging about happier topics.
(Image Sources: Flickr/Eneas, Under a Creative Commons Attribution 2.0; Flickr/Old Shoe Woman, Under a Creative Commons Attribution-NonCommerical-NoDerivs 2.0; and Flickr/Salim Virji, Under a Creative Commons Attribution-ShareAlike 2.0)
I am an Assistant Professor at the University of Texas School of Public Health, where I specialize in childhood obesity policy research and systems science. My research has been featured in the New York Times, Los Angeles Times, NPR, CNN, Wall Street Journal, and several other media outlets. This is my personal blog; any views or opinions expressed do not represent the University of Texas or anyone else with power.
You can follow me on Twitter at @DanTaber47, where I often tweet about obesity news, school nutrition, public transit, systems science, and occasionally random topics like Seattle sports, marathon training, or my latest off-the-beaten-path vacation destination (July 2014 – Kyrgyzstan!!)