A reason the poor suffer more from coronavirus

Americans living in economically challenged communities, and especially people of colour, are bearing the heaviest burden of Covid-19 infections

Of the many heartbreaking stories I’ve read or heard during this ghastly pandemic, one stands out as especially distressing, almost criminal. The headline, on Page 1 of The New York Times on April 12, read “Empty Shelves, but Farms Put Food to Waste — Milk, Eggs and Produce Buried and Dumped”.

That day I was researching food insecurity and soaring rates of metabolic disease as an often overlooked reason for the high risk of Covid-related illness and death among African-Americans, Hispanics and people in poor communities.

The article told of staggering food waste — tens of millions of pounds of fresh food, including 3.7 million gallons of milk a day, that farmers cannot sell because restaurants, hotels and schools were closed in a belated effort to squelch the pandemic. Some of the surplus food was donated to food banks and feeding programmes that have been overwhelmed by demands to nourish the needy but have limited ability to store and distribute perishable food.

Despite America’s ability to produce so much healthful food, fewer than 20% of American adults is metabolically healthy, Dr Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University, had told me the week before. He cited a recent national report describing poor diet as “now the leading cause of poor health in the US” and the cause of more than half-amillion deaths per year.

Mozaffarian explained that poor metabolic health was the immunity-impairing factor underlying cardiovascular disease, Type 2 diabetes and obesity-related cancers that left so many nutritionally compromised Americans especially vulnerable to the lethal coronavirus now all but paralysing the country.

“Only 12% of Americans are without high blood pressure, high cholesterol, diabetes or pre-diabetes,” he said in an interview recently. “The statistics are horrifying, but unlike Covid they happened gradually enough that people just shrugged their shoulders. However, beyond age, these are the biggest risk factors for illness and death from Covid-19.”

The characteristics of what doctors call the metabolic syndrome — excess fat around the middle, hypertension, high blood sugar, high triglycerides and a poor cholesterol profile — suppress the immune system and increase the risk of infections, pneumonia and cancers. They’re all associated with low-grade, body-wide inflammation, Dr Mozaffarian explained, “and Covid kills by causing an overwhelming inflammatory response that disables the body’s ability to fight off pathogens”.

Alas, the metabolic well-being of many Americans is now further endangered by currently advised limits on shopping trips, an increased reliance on canned and packaged foods high in fat, sugar and salt, and emotional distress that prompts some people to turn to nutritionally questionable “comfort foods”.

The Covid pandemic has cast a glaring light on long-standing costly and life-threatening inequities in American society. Those living in economically challenged communities, and especially people of colour, are bearing the heaviest burden of Covid-19 infections. But while diet-related disorders increase vulnerability to the virus, limited national attention has been paid to lack of access to nutritionally wholesome foods that can sustain metabolic health and support a vigorous immune system.

Clearly, when this pandemic subsides, a lot more attention to the American diet will be needed to ward off future medical, economic and social calamities from whatever pathogen next comes down the pike.

The report Mozaffarian cited, issued in March in honour of the 50th anniversary of the White House Conference on Food, Nutrition and Health, was unexpectedly timely. It pointed out that “severe malnutrition has largely been replaced with food insecurity

— the limited or uncertain availability of nutritionally adequate and safe foods and beverages”, a circumstance that in 2018 affected 14.3 million American households.

The US government spends about US$70 billion a year to support food insecure individuals and families through the Supplemental Nutrition Assistance Program (SNAP, formerly called food stamps). But other than disallowing purchases of alcohol, tobacco, pet foods, hot prepared foods and foods eaten in the store, SNAP does not restrict the kinds of foods people can buy with their state-issued allowance.

Rather than limiting people’s food choices with SNAP dollars, experts are devising programmes that can prompt them to choose foods and beverages that can enhance, rather than impair, their health. For example, under an expanded version of SNAP, in some states recipients who use the supplement to buy foods like fruits, vegetables and whole grains get $1.30 (42 baht) on the dollar. But under a proposed disincentive, if the benefit were spent on sodas and snacks, they would get only 70 cents on the dollar.

For those relying on their own funds to buy food, tax strategies could be used to increase the cost of foods and beverages that are less healthful, with the resulting tax revenues used to lower prices for healthy foods.

There have also been several successful pilot programmes demonstrating the cost savings and health benefits of actually providing healthy foods to people with diet-related disease.

The Pennsylvania-based Geisinger Health System began a programme in 2016 called Fresh Food Farmacy to give free nutritious food to food-insecure people with Type 2 diabetes and their families.

The organisation created a food pantry in its Shamokin, Pennsylvania, clinical centre that provides enough fresh fruits and vegetables, whole grains, and lean proteins to feed each family two healthy meals a day five days a week, along with weekly menus and recipes.

Among the first 95 members enrolled, there was a 40% decrease in the risk of death or serious complications and an 80% drop in medical costs per year, Dr Andrea Feinberg and colleagues reported.

In 2018, John Hancock replaced its usual life insurance policies with John Hancock Vitality providing financial incentives to foster healthier lifestyles, including up to $600 per year to purchase healthier foods.

In October, Kaiser Permanente started Food for Life to enhance access to affordable, healthy food, which the organisation estimates could reduce medical care costs by about 45%. As a first step, residents eligible for California’s SNAP benefits will be offered medically tailored meal delivery options for patients and their families.

Last spring, Mozaffarian and colleagues published a brief report headlined “Food Is Medicine — The Promise and Challenges of Integrating Food and Nutrition Into Health Care” in JAMA Internal Medicine.

Promoting the benefits of providing free medically tailored meals to food-insecure patients and their families, they noted that diet-related diseases lead to “suboptimal school and work performance, increased health costs and lower productivity and wages”.

In other words, consuming a more wholesome diet is a win-win investment. And there’s no better time to make it than now, as the country begins the struggle to get back on a healthful footing.

Only 12% of Americans are without high blood pressure, high cholesterol, diabetes or pre-diabetes