Agriculture, Public Health, and Viable Society: Another Eternal Golden Braid by Russell Jaffe Fellow, Health Studies Collegium

Today, many seem to operate in a compartmentalized, disintermediated world. The narrowness of their view is largely the product of a reductionist, mechanistic educational system. In the age of systems biology, quantum physics and interdependence, narrow vision can lead to profound unforeseen consequences. From lead in the water to formaldehyde in the water and air to asbestos to PCBs/PBBs to Agent Orange/Dioxins to bis-phenol A to phthalates we have become too late smart about environmental pollutants that harm indiscriminately, widely and for a long time. The widespread use of antibiotics for reasons other an infection is another example of costly unforeseen consequences through ecosystem disruption that propagates up the food chain. Too often in this context, profits are privatized and health risks transferred to the public and the public purse.

An example of the consequences of intellectual isolation can be seen in the practice by both the Executive department Office of Management and Budget (OMB) and the Congressional Budget Office (CBO) to not score behavior change and thus not score prevention. From a legislative perspective, until OMB and CBO ‘score’ the economic consequences of the legislation, the issue is of no substance in the making of law. The basis for this ‘non-scoring’ is the uncertainty of behavior change and, thus, of prevention being chosen as a life style. Today, it is quite possible to predict for a group given a set of incentives what the uptake in that group will be.

Given the million annual avoidable deaths and given $8,000,000 as the average value of a life saved, scoring prevention holds promise of adding $8 trillion annually to the balance sheet of America for at least a decade. The million avoidable deaths are all from conditions where science knows how to avoid the problem yet the evidence-based solutions are not implemented due to the fragmented nature of healthcare in America. We can save a million lives, reduce suffering for ten million and build the nation’s balance sheet by $8 trillion annually once CBO and OMB are instructed to score prevention.

A million lives can be saved through:

* Preventing and reversing diabetes and its many systemic consequences. 500-600,000 lives a year and thus be saved.

* Avoiding catastrophic damage to liver, kidneys, brain or gut by monitoring medication use and avoiding collateral damage from multiple, not always necessary, medications. There are 150,000-300,000 lives claimed each year due to medication complications.

* Avoiding the depression, trauma, family violence, and suicide that result from feeling helpless and hopeless to the consequences of avoidable complications. There are 350,000-600,000 lives lost annually to avoidable collateral damage from medical therapies.

Agriculture is either an extractive business seeking maximum short-term investment returns or agriculture is a trust held on behalf of generations to come. Agricultural priorities that view the land as a trust to be improved and passed on ‘better than received’ appreciate by direct experience how these interconnections link to public and private health and to the costs of healthcare in that society. In contrast, agricultural priorities that view volume rather than value as a higher priority discount the costs to soil quality as essential nutrients reduce and persisting pollutants enrich in the environs.

Agricultural practices impacts on farmland, farmers and larger community health are easily obscured by the lack of sufficient data or confirmatory studies or even enough properly conducted studies. The data available suggest the current course is neither sustainable nor inevitable. We can debate until it is too late or we can act from prudence and caution using wisdom and experience to choose sustainable life over probably extinction. Centers of interdisciplinary sciences are needed that extend from farm to fork and down to the epigenetic molecular consequences of essential nutrient depletion and excess that lead to imbalances as for example increases in the omega-6/omega-3 fatty acid ratio or when oxidative free radical challenges are 100-10,000 times more than they were before the industrial revolution.

For the risks and rewards of such interconnectedness to be properly explored and to break through the current isolation, regional centers of collaborative research, practice and policy development are needed. For these centers to be successful, they must function as a meritocracy. This includes the need for sufficient funds that all creative and well-developed approaches can be funded; that these centers not compete with each other for scarce resources. These centers of excellence can be more effective if interdisciplinary training, practice validation and policy specialist development are concurrent. These centers can be modeled after the more proactive national academies of sciences and such integrative sciences private sector institutes such as Salk, Whitehead, and Broad.

The result can be ecologically sustainable and permanently profitable. The alternatives involve much more suffering, healthcare costs and social disruptions. Collateral benefits include avoidance of boom and bust cycles.

Dr. Dennis Burkitt received the Nobel Prize in Medicine for his discovery of a link between a chronic viral infection and an unusual tumor. Later in his career, he summed up the challenge at hand for society as a choice. This choice is between a health promoting diet that produces ample bulky stool and needs small hospitals with modest health care budgets or the choice of a health costing diet that produces small stools and needs large hospitals with ever expanding health care budgets.

His observations point to the health promoting, chronic disease avoiding, cost conserving, civil society enhancing values of integrating healthier agricultural, public health and industrial policies. Healthier employees are also more productive, have fewer accidents and make for more profitable companies.

Dr. Burkitt, along with William Osler, Rene Dubos, Albert Szent Gyørgy, Alex Leaf and Don Friedrickson, called attention to the 92% of health that is due to choices about what people eat, drink, think, and do. While eight per cent of health is under genetic control, ninety two per cent is epigenetic; the product is life style habits according to the National Institutes of Health (NIH). This figure has remained constant over the last 30+ years even as information has doubled every four years or so.

Habits are learned and can be relearned; proactive prevention is possible. Given incentives for healthier habits, most people trend that way.

Given the current incentives for less healthy habits, most people are trending away from good health and into the territory of expensive chronic, degenerative and/or autoimmune illnesses. Paradoxically, convenient, less healthy choices are often subsidized indirectly through food and agricultural policies formed in isolation from their health or social costs.

Uwe Rheinhard, the Princeton University Health Economist, explains as follows the future of society if current trends are maintained: By 2050, everyone will be in a hospital bed taking care of the person next to them. Clearly, the current course is unsustainable if the growth in chronic diseases from diabetes to Autism to attention deficit to Alzheimer’s senility provides indicators of the future.

It is increasingly clear that addressing the causes of problems is more cost and outcome effective than addressing the symptoms. We can avoid the dystopic future by scoring, embracing and making priority to primary proactive prevention in policy, practice, and research.

Certain classic aphorisms can help frame an understanding of the prevention related issues:

* A stitch in time does save nine.

* An ounce of prevention is worth a pound of cure.

* A person becomes the sum of what they eat, drink, think and do.

* If we are not for ourselves, who will be for us? If we are only for ourselves, what are we? If not now, when?

The essential nutrients the body cannot make must be derived from the diet for good health to be maintained. Due to current policies and practices, people are increasingly over fed yet under nourished while being under informed about the long-term connections between powerful chemicals and their parent’s mental clarity, their own vitality and their children’s fertility.

As Hippocrates, Chang Zu, Maimonides, and Thomas Edison all emphasized: Let your food be your medicine and your medicine be your food. As an abstraction, it is easy to dismiss the elegant, profound simplicity of this message. With experience, the clarity is near self-evident. Having started as a skeptic who is now a practitioner, the opportunities, dangers and costs have never been higher.

Commercial agriculture has opportunity to lead a healthful, prosperous renaissance for a well-fed, well-nourished productive society.

The opportunity becomes clearer at a high strategic level where interdependences become apparent. The interdependence of air, water, and soil quality with the nutritional density value of farming’s production and the health impact on consumers is clear by direct experience to organic, biodynamic and permaculture practitioners. The same interdependence is clear to many systems thinkers across all scientific disciplines. Interdependence is hard to impossible for reductionist-trained thinkers to appreciate.

The opportunities are being realized today through locally optimized biodiversity in contrast to nationally standardized farm monocultures where the opportunities remain largely receding possibilities. The apparent war between agribusiness and nature is based on the illusion that control is possible and adaptation impossible. Instead of recognizing that healthier plants are innately pest resistant, progressively more intense applications of chemicals are needed to produce increasingly weaker and more vulnerable cultivars.

The vulnerability of monocropping with monocultures is becoming increasingly clear as topsoil disappears; persisting pollutant increase throughout the environment and food production becomes more costly. Healthier crops and inoculants await consumer demand and expert leadership. Persisting organic pollutants (POPs) are often hormone disrupters or create metabolic short circuits.

Food foresting, edible landscaping, permaculture, and biodynamics provide options to renew and restore cropland, forestland, and habited land. Crops with enhanced nutrients through novel hybridization such as vitamin A rich rice and essential fat enhanced oil seeds are examples of technology applied in the service of better health, better care, and lower costs through coalitions of the willing. Personal edible landscaping tiny gardens produce so plurifically that a few square yards or meters is enough to replace what commercial farmers would have extracted from the entire yard, including home, garage and kitchen garden.

As important are other options, the centers of excellence envisioned here are among the highest priorities if society is to be affordable, sustainable, and viable. Saving a million lives and adding eight trillion dollars to the US balance sheet each year are the collateral benefits. Virtuous cycles are possible even in troubled times.