1.4 Health Factors and Their Impact

In addition to nutrition, health is affected by genetics, the environment, life cycle, and lifestyle. These factors are referred to as “determinants” of health and they all interact with each other. For example, family income influences the food choices available and the quantity and quality of food that can be purchased, which of course affects nutrition. Except for nutrition and lifestyle, these factors can be difficult or impossible to change.

Genetics

Everyone starts out in life with the genes handed down to them from the families of their mother and father. Genes are responsible for your many traits as an individual and are defined as the sequences of DNA that code for all the proteins in your body. The expression of different genes can determine the color of your hair, skin, and eyes, and even if you are more likely to be fat or thin and if you have an increased risk for a certain disease. The sequence of DNA that makes up your genes determines your genetic makeup, also called your genome, which is inherited from your mother and father. In 2003, the Human Genome Project was completed and now the entire sequence of DNA in humans is known. It consists of about three billion individual units and contains between twenty-five and thirty thousand genes. The human genome that was sequenced was taken from a small population of donors and is used as a reference DNA sequence for the entire population. Each of us has a similar but unique DNA sequence. Only identical twins and cloned animals have the exact same DNA sequence.

Now that we understand the map of the human genome, let us enter the fields of nutrigenomics and epigenetics. Recall that nutrigenomics is an emerging scientific discipline aimed at defining healthy genes and not-so healthy genes and how nutrients affect them.

Currently, scientists cannot change a person’s DNA sequence. However, they have discovered that chemical reactions in the body can turn genes “on” and “off,” causing changes in the amounts and types of proteins expressed. Epigenetics is another rapidly advancing scientific field in which researchers study how chemical reactions turn genes “on” and “off” and the factors that influence the chemical reactions. Some of these factors are now known to be nutrients. Researchers at the Genetic Science Learning Center at the University of Utah conducted an experiment in which some pregnant mice were fed a diet containing folate, choline, vitamin B12, and betaine, and other pregnant mice were fed a diet that did not contain these nutrients and chemicals. Both groups of pregnant mice were also fed bisphenol A, a chemical in plastic, which alters DNA by inhibiting a specific chemical reaction. The mice born from the mother fed the supplemented diet were brown, thin, and healthy. The mice born from the mother fed the unsupplemented diet were yellow, fat, and unhealthy. This is a dramatic example of how nutrients change not the sequence of DNA, but which genes are expressed.

These two mice look different, but have identical DNA sequences. Thus, not only do the things you eat determine your health but so do the things your mother ate during pregnancy.

Moreover, other studies have demonstrated what your dad ate—and what your grandmother ate while she was pregnant with your mother!—also can affect your gene expression and, consequently, your health. Does this make it OK for you to blame your mother and father for all of your shortcomings? No. Genetics are important in determining your health, but they are certainly not the only determinant.

The Life Cycle

The life cycle of human beings originates from a fertilized egg, which develops into a fetus that is eventually born as a baby. A baby develops into a child, transitions through the wonderful phase of adolescence, becomes an adult, and then advances into old age and eventually death (Figure 1.6 “The Life Cycle: The Forward March to Old Age and Ultimately Death”). The current average life expectancy in America is approaching eighty. To see how this compares with other countries, see Note 1.39 “Interactive 1.3”.

© Shutterstock

Figure 1.6 The Life Cycle: The Forward March to Old Age and Ultimately Death.

A person’s stage of life influences their health and nutritional requirements. For example, when you are an adolescent, your bones grow quickly. More calcium, a bone-building nutrient, is required in the diet during this life stage than at other ages. As you get older, the aging process affects how your body functions. One effect of aging, apparently earlier in women than in men, is the deterioration of bone tissue. As a result, women over age fifty-one need more calcium in their diet than younger adult women. Another life-cycle stage, pregnancy, requires several adjustments to nutrition compared to non-pregnant women. It is recommended that a pregnant woman consume more protein than a non-pregnant woman to support growth and

development, and to consume more of some vitamins, such as folate, to prevent certain birth defects. The USDA provides information on healthy diets for many different stages of the life cycle on their website. Healthy aging requires eating a diet that matches one’s life stages to support the body’s specific physiological requirements. What else is known to help a person age slowly and gracefully? Diets high in vegetables and fruits are associated with increased longevity and a decreased risk of many diseases.

Environment

Your environment has a large influence on your health, genetics, life cycle, and lifestyle. Scientists say that the majority of your expressed traits are a product of your genes and environment, of which nutrition is a component. An example of this interaction can be observed in people who have the rare genetic disorder, phenylketonuria (PKU) (Figure 1.7).

Figure 1.7 The interplay of genetics and environment.

Sources: http://topnews.co.uk/214471-rare-disorder-known-phenylketonuria and http://www.georgiapku.org/AboutUs.html. © Shutterstock

The clinical signs of PKU are mental retardation, brain damage, and seizures and are caused by the build-up of the amino acid phenylalanine and its metabolites (breakdown products produced during metabolism) in the body. The high level of phenylalanine in a person who has PKU is the result of a change in the gene that encodes for an enzyme that converts phenylalanine into the amino acid tyrosine. This genetic change, called a mutation, causes the enzyme to not function properly. In this country and many others, all newborn babies are screened for PKU in order to diagnose and treat the disease before the development of mental retardation and brain damage. Once diagnosed, PKU is treated by strict adherence to a diet low

in phenylalanine, consisting mostly of fruits, vegetables, and grains. Adhering to this diet for life allows an individual with PKU to lead a normal life without suffering the consequences of brain damage, mental retardation, or seizures. In the example of PKU, the consequences of a genetic mutation are modified by diet. Thus, a person’s genes can make them more susceptible to a particular disease, or cause a disease, and their environment can decrease or increase the progression and severity of the condition.

Socioeconomic Status

Multiple aspects of a person’s environment can affect nutrition, which in turn affects health. One of the best environmental predictors of a population’s health is socioeconomic status. Socioeconomic status is a measurement made up of three variables: income, occupation, and education. Socioeconomic status affects nutrition by influencing what foods you can afford and consequently, food choice and food quality. Nutrition and health are generally better in populations that have higher incomes, better jobs, and more education. On the other hand, the burden of disease is highest in the most disadvantaged populations. A commentary in the Journal of the American Medical Association reports that the lower life expectancy of populations of lower socioeconomic status is largely attributable to increased death from heart disease. The American Heart Association states that having a healthy diet is one of the best weapons to fight heart disease and it is therefore essential that all socioeconomic status groups have access to high-quality, nutrient-dense foods. The disparities in nutrition and health in America are directly related to the disparity in socioeconomic status.¹

Other dimensions that affect health disparity are race, ethnic group, sex, sexual identity, age, disability, and geographic location. The federal government recognizes the issue of inequitable health among Americans and one of the overarching goals of Healthy People 2020, a large program managed by the HHS, is to “Achieve health equity, eliminate disparities, and improve the health of all groups.” To work toward this monumental goal, the HHS is actively tracking disease patterns, chronic conditions, and death rates among the many different types of people that live in the United States.

Lifestyle

One facet of lifestyle is your dietary habits. Recall that we discussed briefly how nutrition affects health. A greater discussion of this will follow in subsequent chapters of this book as there is an enormous amount of information regarding this aspect of lifestyle. Dietary habits include what a person eats, how much a person eats during a meal, how frequently meals are consumed, and how often a person eats out at restaurants. Other aspects of lifestyle include physical activity level, recreational drug use, and sleeping patterns, all of which play a role in health and impact nutrition. Following a healthy lifestyle improves your overall health.

Physical Activity Level

In 2008, the HHS released the Physical Activity Guidelines for Americans (Interactive web link 1.3). The HHS states, “Being physically active is one of the most important steps that Americans of all ages can take to improve their health. The 2008 Physical Activity Guidelines for Americans provides science-based guidance to help Americans aged six and older improve their health through appropriate physical activity.” The guidelines recommend exercise programs for people in many different stages of their lifecycle including for pregnant women and for adults and children who have disabilities. The HHS reports that there is strong evidence that increased physical activity decreases the risk of early death, heart disease, stroke, Type 2 diabetes, high blood pressure, and certain cancers; prevents weight gain and falls; and improves cognitive function in the elderly. New guidelines are expected to be released in 2018.

Interactive web links 1.3:2008 Physical Activity Guidelines for Americanshttps://health.gov/PAGuidelines/default.aspx

Recreational Drug Use

Recreational drug use, which includes tobacco smoking and alcohol consumption along with narcotic and other illegal drug use, has a large impact on health. Smoking cigarettes causes lung cancer, eleven other types of cancer, heart disease, and several other disorders or diseases that markedly decrease quality of life and increase mortality. In the United States, smoking causes more than four hundred thousand deaths every single year, which is far more than deaths associated with any other lifestyle component.² Also according to the CDC, excessive alcohol intake causes an estimated seventy-five thousand deaths per year.³

Staying away from excessive alcohol intake lowers blood pressure, the risk from injury, heart disease, stroke, liver problems, and some types of cancer. Abstaining from alcohol also aids in weight loss and increases the money in your wallet. While heavy drinking of alcoholic beverages is associated with several bad health effects, consuming alcohol in moderation has been found to promote health such as reducing the risk for heart disease and Type 2 diabetes in some people. The HHS defines drinking in moderation as no more than one drink a day for women and two drinks a day for men. Illicit and prescription drug abuse are associated with decreased health and is a prominent problem in the United States. The health effects of drug abuse can be far-reaching including increased risk for stroke, heart disease, cancer, lung disease, and liver disease.

Sleeping Patterns

Inadequate amounts of sleep, or not sleeping well, can also have remarkable effects on a person’s health. In fact, sleeping can affect your health just as much as diet or exercise. At least 10 percent of Americans have chronic insomnia. Scientific studies have shown that insufficient sleep increases the risk for heart disease, Type 2 diabetes, obesity, and depression. Abnormal breathing during sleep, a condition called sleep apnea, is also linked to an increased risk for chronic disease.⁴ (Watch Video 1.5)

Required Video 1.5Brief promotional video with easy to follow tips to improve your sleep and hence overall well- being. https://youtu.be/DMX1P8fDrlc

Nutrition, Genetics, Environment, and Lifestyle Interact to Affect Health

The Pima Indians who inhabit parts of southern Arizona and the Pima Indians that live across the border in Mexico are genetically and culturally similar, but there are vast differences in the health of these two populations. In America, the Pima Indians have the highest rate of obesity and Type 2 diabetes compared to any other ethnic group. However, the Pima Indians who live in Mexico do not share these same health problems because of a complex interplay between nutrition, genetics, environment, and lifestyle. Over one hundred years ago, the Pima Indians were farmers, hunters, and gatherers and their diets consisted of about 70 percent carbohydrate, 15 percent protein, and 10 to 15 percent fat. Typical of the lives of farmers, hunters, and gatherers a century ago, they lived through times of feast and times of famine.

The geneticist James Neel proposed in 1962 that the Pima Indians carried a “thrifty gene” that makes them very efficient at storing fat during times of plenty so they do not starve when food is scarce. After World War II, the Pima Indians in America either went back to reservations in southern Arizona or moved to the cities for work. They rapidly adopted the American diet and lifestyle and consumed high-fat, processed foods, and refined grains and were more sedentary than their counterparts in Mexico, who retained their more traditional diet and lifestyle. Today, the typical American Pima Indian diet obtains more than 40 percent of calories from fat. The “thrifty gene” in the American Pima Indian population increased their susceptibility to the consequences of the high-fat American diet and sedentary lifestyle because they were genetically better at storing fat than others. The story of the Pima Indians and the difference between the health of their populations in America and Mexico demonstrates the interactions between nutrition, genetics, environment, and lifestyle. Indeed, preliminary studies suggest that when American Pima Indians switch back to the diets of their ancestors and consume

beans, corn, grains, and greens and other low-fat, high-fiber plant foods, the benefits are weight loss and reduced risk of chronic disease. The health status of American Pima Indians is considered “a canary in the coal mine,” meaning they provide a warning to the American people (Figure 1.8).

Although the health consequences of the American diet and lifestyle in Pima Indians appeared rapidly in their population, all Americans that partake in the current trends of American diet and lifestyle are at risk. On the lighter side (literally!), the new studies that show changing back to more traditional diets markedly improved the health of the American Pima Indians suggest that all Americans can reduce their risk for diet-related diseases even when their genetic susceptibility for these diseases is high.

Pima Indians living in America are genetically similar to those who live in Mexico, but differences in their nutrition, environment, and lifestyle changes their health.

Source: http://paleobioticslab.com/general-interest-articles/so-go-the-pimas-so-go-the-rest-of-us/.

Figure 1.8 The Interplay of Nutrition, Genetics, Environment, and Lifestyle Affects Health.

Personal Choice: The Challenge of Choosing Foods

From visiting websites about traditional foods of different cultures and ethnic groups, you may have noticed that a few more things besides environment and lifestyle that influence the foods you choose to eat. Different foods affect energy level, mood, how much is eaten, how long before you eat again, and if cravings are satisfied. We have talked about some of the physical effects of food on your body, but there are other effects too. Food regulates your appetite and

how you feel. Multiple studies have demonstrated that some high-fiber foods and high-protein foods decrease appetite by slowing the digestive process and prolonging the feeling of being full. The effects of individual foods and nutrients on mood are not backed by consistent scientific evidence but in general, most studies support that healthier diets are associated with a decrease in depression and improved well-being. To date, science has not been able to track the exact path in the brain that occurs in response to eating a particular food, but it is quite clear that foods, in general, stimulate emotional responses in people.

Food also has psychological, cultural, and religious significance, so your personal choices of food affect your body, mind, and soul. The social implications of food have a great deal to do with what people eat, as well as how and when. Special events in individual lives—from birthdays to funerals—are commemorated with equally special foods. Being aware of these forces can help people make healthier food choices—and still honor the traditions and ties they hold dear. Typically, eating kosher food means a person is Jewish; eating fish on Fridays during Lent means a person is Catholic; fasting during the ninth month of the Islamic calendar means a person is Muslim. On New Year’s Day, people from New England like to combine pork and sauerkraut as a way to eat their way to luck. Several hundred miles away in the southern United States, people eat Hoppin’ John, a favorite local dish made with black-eyed peas and pork, while fish is the “lucky” food of choice for Japanese Americans. National food traditions are carried to other countries when people immigrate. American cuisine would not be what it is today without the contributions of Italian, Chinese, Mexican, and other immigrants.

Factors that Drive Food Choices

Along with these influences, a number of other factors affect the dietary choices individuals make, including:

• Taste, texture, and appearance. Individuals have a wide range of tastes, which influence their food choices, leading some to dislike milk and others to hate raw vegetables. Some foods that are very healthy, such as tofu, may be unappealing at first to many people. However, creative cooks can adapt healthy foods to meet most peoples’ taste.
• Economics. Access to fresh fruits and vegetables may be scant, particularly for those who live in economically disadvantaged or remote areas, where cheaper food options are limited to convenience stores and fast food.
• Early food experiences. People who were not exposed to different foods as children, or who were forced to swallow every last bite of overcooked vegetables, may make limited food choices as adults.
• Habits. It is common to establish eating routines, which can work both for and against optimal health. Habitually grabbing a fast food sandwich for breakfast can seem

convenient, but might not offer substantial nutrition. Yet getting in the habit of drinking an ample amount of water each day can yield multiple benefits.

• Culture. The culture in which one grows up affects how one sees food in daily life and on special occasions.
• Geography. Where a person lives influences food choices. For instance, people who live in Midwestern US states have less access to seafood than those living along the coasts.
• Advertising. The media greatly influences food choice by persuading consumers to eat certain foods.
• Social factors. Any school lunchroom observer can testify to the impact of peer pressure on eating habits, and this influence lasts through adulthood. People make food choices based on how they see others and want others to see them. For example, individuals can purchase cheap and fast pizzas or opt for high-end versions at fancy restaurants.
• Health concerns. Some people have significant food allergies, to lactose or peanuts for example, and need to avoid those foods. Others may have developed health issues, which require them to follow a low-salt diet. In addition, people who have never worried about their weight have a very different approach to eating than those who have long struggled with excess pounds.
• Emotions. There is a wide range in how emotional issues affect eating habits. When faced with a great deal of stress, some people tend to overeat, while others find it hard to eat at all.
• Green food/Sustainability choices. Based on a growing understanding of diet as a public and personal issue, more and more people are starting to make food choices based on their environmental impact. Realizing that their food choices help shape the world, many individuals are opting for a vegetarian diet, or, if they do eat animal products, striving to find the most “cruelty-free” options possible. Purchasing local and organic food products and items grown through sustainable products also helps shrink the size of one’s dietary footprint.

References & Links

1Fiscella, K. and D. Tancredi. “Socioeconomic Status and Coronary Heart Disease Risk Prediction.” JAMA 300, no. 22 (2008): 2666–68.

2Centers for Disease Control and Prevention. “Smoking and Tobacco Use.” Last updated March 21, 2011. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm 3Centers for Disease Control and Prevention. “Alcohol and Drug Use.” Last updated June 7, 2012. http://www.cdc.gov/healthyyouth/alcoholdrug/

4National Sleep Foundation. “Can’t Sleep? What to Know about Insomnia.” Accessed February 12, 2012. http://www.sleepfoundation.org/article/sleep-related-problems/insomniaand-sleep

• Assessing Personal Health

You may remember that when you were younger your mother or grandmother made you swallow that teaspoonful of cod liver oil because she said it was good for you. You don’t have to have a PhD to know some of the basic ways you can adapt your life to be healthier. However, the mainstream media inundates the American population with health cures and tips, making it confusing to develop the best plan for your health. This section will equip you with tools to assess and improve your health.

Personal Health Assessment

One of the easiest places to begin a personal health assessment is by examining the results from your last physical. Often a person will leave the doctor’s office without these results. Remember that the results belong to you and having this information on hand provides you with much of what you need to keep track of your health. During a physical, after obtaining weight and height measurements, a nurse will typically examine blood pressure. Blood pressure is a measurement of the forces in the arteries that occur during each heartbeat. It is a principle vital sign and an indicator of cardiovascular health.

In most circumstances, a physical includes blood tests, which measure many health indicators, and you have to request the results. Once you have the results-in-hand, it is good practice to file them in a binder so you can compare them from year to year. This way you can track your blood-cholesterol levels and other blood-lipid levels and blood-glucose levels. These are some of the more general measurements taken but in many instances, blood tests also examine liver and kidney function, vitamin and mineral levels, hormone levels, and disease markers. Your doctor uses all of these numbers to assess your health and you can use them to play a more active role in keeping track of your health.

Hearing and vision are additionally part of a general health assessment. If you wear glasses, contacts, or a hearing aid you already are aware of how important it is to know the results of these exams. If you have not experienced vision or hearing problems yet your likelihood of experiencing them markedly increases over the age of forty. Another component of overall health is oral health. The health of your teeth, gums, and everything else in your mouth are an integral component of your overall health. This becomes apparent when a person experiences a tooth infection, which if left untreated significantly impairs physical, mental, and social well- being.

Other indicators of health that you can measure yourself are body mass index (BMI) and fitness. BMI is a standardized measurement that indicates if a person is underweight, of normal weight,

overweight, or obese and is based on data from the average population. You can calculate this yourself or use one of the many BMI calculators on the web (Interactive web links 1.4). It has some limitations. One limitation is that it does not take into account how much of your weight is made up of muscle mass, which weighs more than fat tissue. BMI and other measurements of body composition and fitness are more fully discussed in later chapters. This discussion of a personal health assessment has focused primarily on physical health, but remember that mental and social well-being also affect health. During a physical, a doctor will ask how you are feeling, if you are depressed, and if you are experiencing behavioral problems. Be prepared to answer these questions truthfully, so that your doctor can develop a proper treatment plan to manage these aspects of health.

Interactive web links 1.4:BMI Calculator for Adults: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calcula tor.htmlBMI Calculator for Teens and Children: https://nccd.cdc.gov/dnpabmi/calculator.aspx

Taking charge of your health will pay off and equip you with the knowledge to better take advantage of your doctor’s advice during your next physical. Health calculators, such as those that calculate BMI, ideal weight, target heart rate among many others, and personal health assessments will help you to take charge of your health, but they should not take the place of visiting your doctor.

Dietary Assessment

The first step in assessing your diet is to find out if the foods you eat are good for your health and provide you with all the nutrients you need. Begin by recording in a journal what you eat every day, including snacks and beverages. You can track calories over time, diet quality, and find many other tools to evaluate your daily food consumption at www.choosemyplate.org. The questions these tools can help answer include: How much food do you have to eat to match your level of activity? How many calories should you eat? What are the best types of food to get the most nutrients? What nutrients are contained in different foods? How do you plan a menu that contains all the nutrients you need? Make the first step and assess your diet. This book will provide you with interactive resources, videos, and audio files to empower you to create a diet that improves your health.

Family Medical History

Because genetics play a large role in defining your health, it is a good idea to take the time to learn some of the diseases and conditions that may affect you. To do this, you need to record your family’s medical history. Start by simply drawing a chart that details your immediate family and relatives. Many families have this and you may have a good start already. The next time you attend a family event start filling in the blanks. What did people die from? What country did Grandpa come from? While this may be a more interesting project historically, it can also provide you with a practical tool to determine what diseases you might be more susceptible.

This will allow you to make better dietary and lifestyle changes early on to help prevent a disease from being handed down from your family to you. It is good to compile your information from multiple relatives.

Lifestyle Assessment

A lifestyle assessment includes evaluating your personal habits, level of fitness, emotional health, sleep patterns, and work-life balance. Many diseases are preventable by simply staying away from certain lifestyles. Don’t smoke, don’t drink excessively, and don’t do recreational drugs. Instead, make sure you exercise. Find out how much to exercise by reading the 2008 Physical Activity Guidelines for Americans. There is a wealth of scientific evidence that increased physical activity promotes health, prevents disease, and is a mood enhancer. Emotional health is often hard to talk about; however, a person’s quality of life is highly affected by emotional stability. Harvard’s Women’s Health Watch notes six reasons to get enough sleep: Sleep promotes healthy brain function, while lack of sleep can cause weight gain and increase appetite, decrease safety (falling asleep while driving), make a person moody and irritable, decrease health of the cardiovascular system and prevent the immune system from functioning well.¹

Finding balance between work and life is a difficult and continuous process involving keeping track of your time, taking advantage of job flexibility options, saying no, and finding support when you need it. Work-life balance can influence what you eat too.

References & Links

1Harvard Health Publications. “Importance of Sleep: Six Reasons Not to Scrimp on Sleep.” Harvard’s Women’s Health Watch (January 2006). c 2000–2012 Harvard University.

http://www.health.harvard.edu/press_releases/importance_of_sleep_and _health

• A Fresh Perspective: Sustainable Food Systems

The science of nutrition includes the study of how organisms obtain food from their environment. An ecosystem is defined as the biological and physical environments and their interactions with the community of organisms that inhabit those environments as well as the interactions among the organisms. Human nutrition and the health of the world’s ecosystem are interdependent, meaning that what we eat and where we get it from affects the world. In turn, the health of the earth influences our health. The term sustainability is used to indicate the variety of approaches aimed at improving our way of life. Sustainability promotes the development of conditions under which people and nature can interact harmoniously. It is based upon the principle that everything needed for human survival depends upon the natural environment.

A major theme of sustainability is to ensure that the resources needed for human and environmental health will continue to exist. A healthy ecosystem, one that is maintained over time, is harmonious and allows for social and economic fulfillment for present and future generations. Nutritious foods come from our ecosystem and to ensure its availability for generations to come, it must be produced and distributed in a sustainable way. The American Public Health Association (APHA) defines a sustainable food system as “one that provides healthy food to meet current food needs while maintaining healthy ecosystems that can also provide food for generations to come with minimal negative impact to the environment.”¹

It also states the attributes of a sustainable food system are:

Available Accessible Affordable to all Humane

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A sustainable food system does not just include the food and those who consume the food, but also those that produce the food, like farmers and fishermen, and those who process, package, distribute, and regulate food. Unfortunately, we have a long way to go to build a sustainable food system.

The Challenges

The most prominent challenge to building a sustainable food system is to make food available and accessible to all. The Food and Agricultural Organization of the United Nations (FAO) states the right to food is a fundamental human right and its mission is to assist in building a food- secure world. Food security in America (Figure 1.9) is defined as the “access by all people at all times to enough food for an active, healthy life.”²

Image Source: Calculated by ERS using data from the December 2009 Current Population Survey Food Security Supplement.

Figure 1.9 Food Security Status in the United States.

As of 2009, 14.9 percent of households, or 17.4 million people in the United States, had very low or low food security and these numbers have risen in recent years.³

Food security is defined by the FAO as existing “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food which meets their dietary needs and food preferences for an active and healthy life.” (Figure 1.10) The FAO estimates that 925 million worldwide were undernourished in 2010. Although there was a recent decline in overall food insecurity (attributable mostly to a decline in undernourished people in Asia), the number of undernourished people world-wide is still higher than it was in 1970, despite many national and international goals to reduce it.⁴

Source: Calculated by ERS based on Current Population Survey Food Security Supplement data.

Figure 1.10 Food Insecurity: A Global Perspective.

Another challenge to building a sustainable food system is to supply high-quality nutritious food. The typical American diet does not adhere to dietary guidelines and recommendations, is unhealthy, and thus costs this country billions of dollars in healthcare. The average American diet contains too many processed foods with added sugars and saturated fats and not enough fruits, vegetables, and whole grains. Moreover, the average American takes in more kilocalories each day than ever before. This shift of the population toward unhealthy, high-calorie diets has fueled the obesity and diet-related disease crisis in this nation. Overall the cost of food for the average American household has declined since the 1970s; however, there has been a growth of “food deserts.” A food desert is a location that does not provide access to affordable, high- quality, nutritious food. One of the best examples of a “food desert” is in Detroit, Michigan. The lower socioeconomic status of the people who live in this city does not foster the building of grocery stores in the community. Therefore, the most accessible foods are the cheap, high- caloric ones sold in convenience stores. As a result, people who live in Detroit have some of the highest incidences of obesity, Type 2 diabetes, and cardiovascular disease in the country.

A fourth challenge to building a sustainable food system is to change how we produce, process, and distribute food. Large agribusiness, complex industrial processing, and massive retail conglomerations distort the connection we have between the food on our plate and where it came from. More food is being produced in this nation than ever before, which might sound

good at first. However, some factors that have contributed to higher food production include using genetically engineered plants, excessive use of herbicides and pesticides, and the selective promotion of only a few crops by the policy of crop-specific subsidies (money given to farmers by the federal government). The subsidies are given toward the support of only about eight crops, most notably corn and soybeans. This policy diminishes the variety of crops, decreases biodiversity among crops, and supports large agribusiness while disadvantaging small- and medium-sized farms. Additionally, the whole system of food production, processing, and distribution is lengthy, requiring a great deal of energy and fossil fuels, and promotes excessive use of chemicals to preserve foods during transportation and distribution. In fact, the current US food system uses approximately 22 percent of the energy in this country and is responsible for at least 20 percent of greenhouse gas emissions.⁵

Solutions to the Challenges

While these challenges are daunting there are many potential solutions that are gaining momentum in the United States. The APHA advocates expanding the infrastructure for locally grown food, improving access to healthy and local food for low-income Americans, providing education on food origin and production, building up the livelihoods of local farmers, and using sustainable farming methods. Detroit is currently a “food desert,” but there is a fantastic example of how to positively impact the growth of a sustainable food system within the city. It is called the Eastern Market and it is a six-block inner city market with over 250 vendors marketing local produce, meat, seafood, plants, fresh-cut flowers and much, much more. Unlike many urban farmers’ markets it sells foods that are of better quality and lower prices than grocery stores. Its forty-thousand visitors every Saturday demonstrate its success as a community-based way to foster good nutrition, good health, and social interaction.

References & Links

1American Public Health Association. “Towards a Healthy, Sustainable Food System.” Policy Statement Database. Policy no. 200712 (November 6, 2007). http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1361 2US Department of Agriculture, Economic Research Service. “Food Security in the United States: Key Statistics and Graphics.” Last updated June 4, 2012. http://www.ers.usda.gov/Briefing/FoodSecurity/stats_graphs.htm#food_secure

3Food and Agricultural Organization of the United Nations. “Food Security: Concepts and Measurement.” In

Corporate Document Repository, ID: 144369. 2003. http://www.fao.org/docrep/005/y4671e/y4671e06.htm

4Food and Agriculture Organization of the United Nations. “How Does International Price Volatility Affect Domestic Economies and Food Security? In The State of Food Insecurity in the World. 2011. http://www.fao.org/publications/sofi/en/

5Canning, P. et al. “Energy Use in the US Food System.” US Department of Agriculture, Economic Research Report, no. ERR-94 (March 2010). http://www.ers.usda.gov/Publications/ERR94/ERR94_ReportSummary.pdf