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tv   Experts Testify on State of Nutrition in America  CSPAN  January 21, 2022 4:47pm-7:01pm EST

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institutions with the support that they need and deserve. thank you again to our witnesses. if there is no further business, without objection, this subcommittee stands adjourned. washington, unfiltered. c-span in your pocket. download c-span now today. >> c-span is c-span's online store. browse through our latest collection of c-span products, apparel, books, home decor, and accessories. there's something for every c-span fan. and every purchase helps support our nonprofit operations. shop now or anytime at
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>> now, a senate hearing on nutrition touching on a number of issues including federal subsidies and food production and availability. this is two hours ten minutes.
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good morning, everyone. i am so pleased to call this subcommittee on food and nutrition, specialty crops, organics, and research to order. i am privileged to be sitting next to the ranking member braun and on behalf of him and members of the subcommittee, i would like to really welcome our witnesses and say thank you all for coming here. it's a lot of time and energy and effort to come to washington, d.c. but this is so important, and you all understand the urgency of this moment in american history. i would say human history. i want to start off by stating the fact that all of our witnesses agree on this reality. this urgency, that today in
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america, we are facing a massive broad-based nutrition crisis. a crisis where diet related diseases pose a serious threat to the health and wellbeing of our of our country. nearly one out of every three dollars in the federal budget -- i want to say that again. nearly one out of every $3 in the federal budget now goes to health care spending. with 80% of this money paying for the treatment of preventable diseases. and these costs are rising at a staggering rate. currently in the united states half -- half of the u.s. population is prediabetic or has type 2 diabetes. in 1960 approximately 3% of the u.s. population was obese. today more than 40% of americans are obese, and more than 70% of americans -- 70% of americans
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are either obese or overweight. even more shocking one quarter of our teenagers today are prediabetic or have type 2 diabetes. and obesity is the leading medical reason that 71% of young americans are disqualified from military service. these data points are staggering. and they need to be fully digested. now, the numbers are worse in minority communities dramatically so. the risk of diabetes, for example, is 77% higher for black people in america and we are twice as likely to die from diabetes. and as we will hear in today's testimony, the statistics are week wale if not more so grim in our indigenous community. the deadly nature of our nutrition crisis, which is in
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some of these diseases at epidemic levels has been tragically magnified by the pandemic, by covid-19 where we have seen much higher hospitalization rates and death rates for people with those diet related diseases. so now let's be clear about something. the majority of our food system is being now controlled by just a handful of big multi-national corporations. these food companies carefully formulate and market nutrient-poor, addictive, ultra-processed foods. ultra-processed foods which now comprise two-thirds of the calories of children and teens in their diets in the united states. and these companies want us to believe that the resulted diet related diseases such as obesity and diabetes are somehow a moral failing, that they represent a lack of will power or a failure to get enough exercise.
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that is just a lie. it's a lie. the problem we have right now is not a individual moral failing. it is our collective policy failure. it is a policy failure because the federal government is currently subsidizing easy access to the foods that are high in calories but have minimal nutritional value while at the same time too many communities rural and urban alike lack access to the healthy foods they need to thrive. it is a policy failure because while the federal government tells us that our plates should consistent largely of fruits and vegetables, currently less than 2%f our federal agriculture subsidies in the united states go to these healthy foods. a policy failure because while other countries have begun to take on this crisis focusing on
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the problems with big food companies and banning the marketing of junk food to children in the united states, however we continue to allow big corporations to spend billions of dollars every year to advertise the least nutritious products to our children. in august the government accountability office released a report that analyzed efforts by the federal government to address diet related chronic health conditions that as i said are at epidemic levels. the gao concluded that the federal government lacks a coordinated over-arching strategy aimed at reducing americans risk of diet related chronic diseases. so how do we now align our federal policy with this goal of addressing this nutrition crisis causing so much death and disease? we can start by looking at history as a guide.
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in 1969 the year that i was born, actually, president nixon convened the white house conference on food, nutrition and health to address the urgent national concern of widespread hunger in the united states. what resulted was on unprecedented expansion and creation of vital programs dealing with that hunger crisis. programs like wick that went onto tackle access to food. but fast forward 52 years while we have made progress addressing hunger in america, we are still grappling with food insecurity, but now we face that second food crisis, one of nutrition insecurity where too many americans are overfed but undernourished and are seeing these staggering rates of disease and early death.
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we have created a food system that relentlessly encourages the overeating and literally makes us spend trillions of dollars a year on health care costs to treat diet related diseases such as type 2 diabetes, heart disease, stroke, certain types of cancer and chronic kidney disease that are among the leading causes of preventable premature death in our country. and so i believe we need to rethink the way we approach food and nutrition policy. our lives literally depend upon it. and that is why last week senator braun and i along with congressman mcgovern and others introduced legislation to create a second white house conference on food, nutrition, hunger and health that convenes public and private stakeholders to reimagine our federal food and nutrition policy.
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the second white house conference needs to hear perspectives from a diverse set of stakeholders and communities such as we have here represented on our panel today. so let me close with this. this nutrition crisis we face is a threat. in fact, i would say it is the greatest threat to the health and well-being of our country right now. millions and millions of americans see this and understand this threat in their communities and homes, in their families and own lives. it's also a threat to our economic security and our national security. we must act now. i will now turn to my friend and deeply grateful partner ranking member braun for his opening
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statement. >> thank you, mr. chairman. thank you for the witnesses joining us here today, the state of nutrition in america. a very important topic. that was a lofty goal back in '69 and one as we can see we're still chasing to some degree five decades later. as such i hope that our hearing today will address both the successes and shortcomings, and it'll truly look at nutrition as being maybe the thing that we can use here to avoid entering the health care system because you're healthy enough to be in shape day after day. since the white house conference of '69 america's farmers have answered the goal of growing population and malnutrition in growing communities. agriculture is now able to make
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more from less and help protect the soils along the way. the u.s. has made great progress to reduce food insecurity, nutritional deficits, food borne illness over the course of the last five decades. however, our work is still far from over. until no american goes to sleep hungry or is unsure for where his or her next meal will come from, we have not successfully completed the task. our robust food security safety net is supported by usda's nutrition programs totaling more than 100 billion per year in federal spending. following the white house conference, these programs were bolstered and fine tuned to ensure that caloric deficiencies were on the path to eradication in the u.s. while the usda's nutrition programs have helped more americans during times of need, any discussion about state of nutrition in america today must
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include a discussion about the quality -- the quality of the foods that can be purchased through these programs. we all know that an excess of low quality foods can have negative health outcomes for americans, empty calories, not one that are making you stronger and healthier. since '69 obesity rates in the u.s. have increased from 12% to over 42%, clearly not heading in the right direction. like wise preventable chronic illnesses like type 2 diabetes and coronary heart disease continue to plague more and more americans. federal nutrition policies are still geared strictly to address caloric deficiencies. failing to prioritize the nutritional content of our food. as a result reports consistently show that programs are even making poorer choices when it
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comes to americans' nutrition. worst outcomes. let me repeat that our federal nutrition programs may be making poor nutritional outcomes worse for low income american families. this is an irresponsible use of taxpayer dollars as congress' responsibility lies in ensuring that nutrition programs like snap are serving the best interests of both the recipients and our nation as a whole. failing to address issues of nutrition have broader spillover effects like increasing federal outlays for health care. it's already where we spend way too much money visa vi the rest of the world. our health care expenses run between 18% to 20% of our gdp. most other countries with similar results do it for 11% to 13%. finally, we cannot have a conversation about the state of nutrition without discussing the
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harmful effects of unrestrained inflation has on the purchasing power of every american family. "the new york times" recently highlighted the damaging impact of inflation showing that in the last year prices for key staples have risen by more than 10%, unsustainable and that's the cruellest of all taxes when we're trying to head in the other direction. these rising costs are driven by a multitude of factors not least of which is irresponsible federal spending, where we've got to get a better bang for our buck. as this subcommittee considers policies to help address nutrition insecurity, we must remember that simply dumping more money into our economy will only exacerbate the issue of nutrition insecurity for our most vulnerable not to mention what inflation will do as well. nutrition insecurity is a
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challenging problem and impacts our rural and urban communities alike. that is why i was proud to work with chairman booker to introduce legislation to convene a second white house conference on food, nutrition, hunger and health. only through a serious bipartisan analysis and effort will we make true headway. in my own life's experience i've chosen to live holistically through good nutrition. and when you stick with it, it works. it should be the foundation for every american citizen. in my own company when i was wrestling with high health care costs, 13 years ago i made that as a priority. changed our system into being enabling my employees to become health care consumers, giving them tools like free biometric screenings, telling them about good nutrition, putting a little skin in the game to incentivize that you do it.
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this is a topic for another day and another conversation. we've not had a premium increase from my employee's companies in 13 years. and they enter in their deductibles less now than they did 13 years ago because we're emphasizing prevention not remediation and making my employees, and i think we can do it even in government where they invest in their own well-being and we give them the tools to do it. thank you, mr. chairman. >> thank you, senator braun. senator braun, you should put your plaque up there. senator leahy. we are excited you'd like to come and make an opening statement. >> i appreciate the opening statement of both of you. and when i became chairman of the agriculture committee quite
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a few years ago it was called the senate agriculture and forestry committee. i changed the name to agriculture, nutrition and forestry, which is what it had been originally. i wanted to bring back the word nutrition for exactly the reasons both of you have said. when we're the welgiest nation on earth and we can't handle our nutrition needs, that -- that's a national security problem as well as anything else. and i see in this pandemic the food insecurity issue has risen. children are left behind, part of the effort is to meet the needs of those struggling in our communities, the historic
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investment in child nutrition programs currently including the build back better act that will increase access to school summer meals for millions of children. but we need to do more than just get the food on the table, as you both said, it needs to be healthy and nutritious food. coming from a state like mine i think it particularly helps if it's grown locally. we need a coordinated effort from the federal government down to the local level to make sure all americans have access to nutritious foods. they're also bolstering regional supply chains that can best deliver food to the these communities particularly in our school. and i wrote that some of the statements that are going to be made i'm our sure outstanding witnesses today will tell us how porn it is for the health outcomes and dietary habits. school meals include locally
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grown foods, and my staff will be here following this and i'll actually read all you've said when i get back from my appropriations meeting. my state of vermont provides healthy local choices in our supermarkets. in fact, nearly 60% of the usda foods in schools program have 15 multi-national corporations and we know they've been plagued by supply chain that's caused food shortages in schools across the country. so we need more resilient supply chains. we need lower procurement
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barriers to make it easier for local small scale producers to feed their children. so, mr. chairman, i thank your leadership on this issue to work with usda to ensure more schools have the opportunity to work with their local farmers. all three of us can give a quick list of farmers. and i've also long championed the farm to school program, which strengthens and supports between local school and students. i'm interested in what might be said about how farm to school can help that. so i look forward to hearing from all of you. i'm just so happy you're doing this. and i would state to the
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witnesses and the press who might be here. and the ranking member we've talked about this usually in our prayer meetings in our inner sanctum sometimes late in the evening and the need that we have to do this, whether we're parents or grandparents or citizens. if we don't get hold of this, if we don't do something about this issue, what are we leaving our children and the next generation? so, thank you, mr. chairman, i'm so proud of this hearing. >> thank you very much. again, we understand you're going to an appropriation meeting and we hope you'll remember new jersey. i'd like to now introduce the witnesses. i want to acknowledge the presence of senator jodi ernst,
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another person concerned about these issues. i'd like to start off by introducing the doctor, a cardiologist. he has a heart, too. and he's a dean and the dean mayor professor at tufts freeman school of nutrition at science and policy. his work aims to create a food system that is nutritious, equitable and sustainable. the doctor has authored more than 450 scientific publications on dietary priorities for obesity, diabetes, cardiovascular disease and on evidence-based approaches with innovations to reduce these burdens in the u.s. and globally. he has served in numerous advisory roles, and his work has been featured in a wide array of media outlets. thompson reuters has named him
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one of the world's most influential scientific minds. i'm grateful you're here today. dr. otis young is a director of the food and nutrition new york education programs. in 2001 she joined the cornell faculty after spending 13 years at chicago in the department of nutrition. her work also centers on developing culturally responsive programs and policies that promote health, equity, food and community resilience. i want to thank dr. odoms young
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for being a part of this hearing as well. dr. donald warne serves as associate dean of diversity, equity and inclusion. he is chair of department of indigenous health, director of the indians into medicine and public health programs and professor of family and community medicine at the school of medicine and health sciences at the university of north dakota. the doctor is the principal investigators for the indigenous trauma and resilience research senator at und. and he also serves as the senior policy advisor to the great plains tribal leaders health board in south dakota. he also spent several years as a primary care physician. he's a member of the -- tribe from pine ridge, south dakota,
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and comes from a long line of traditional healers and medicine men. i want to now recognize ranking member braun who will now introduce our next two witnesses. >> thank you, mr. chairman. our next witness is the vice-chancellor and dean for agriculture and life sciences at texas a&m agrilife and has advised policy makers from the centers of disease control and prevention, world health organization and the united states food and drug administration. a testament to his leadership in vial chemistry, nutrition and food systems dr. stover is an elected member of the national academy of sciences and the former president of the american society of nutrition. our final witness this morning,
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dr. angela is joining us remotely from wisconsin. dr. rashidi is a senior fellow at the institute where she studies poverty and the effects of the federal safety net programs on low income people in america. she specializes in support programs for low income families including the temporary assistance for needy families, the child care and development bloc grant and the supplemental nutrition assistance program. before joining aei she was a deputy commissioner for policy research in new york city department of social services. thank you, doctor, and to each of our other witnesses for joining us this evening. >> all right, everyone, fasten your seat belts. i've read all the testimonies. these are extraordinary declarations of the state of our nutrition and i'm excited about them. so doctor, would you please
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proceed with your testimony? >> dear chairman booker, ranking member braun, and other distinguishes members of the committee thank you for convening this critical hearing today. as a doctor i see first-hand people of all ages and backgrounds suffering from diet related illness. as a public health expert i see the incredible challenges americans face every day to obtain and eat nourishing food. and as a scientist i see exciting advances on which foods help or hurt our bodies and which policy changes can support nutrition, security and health. we face a national nutrition crisis, one cutting lives short and holding us back from achieving our goals and as a nation. the situation is dire. because of nutrition insecurity and diet related disease more americans today are sick than are healthy.
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and 3 and 4 have overweight or obesity. the recent report senator booker mentioned puts an exclamation point on this concluding diet related cessions are deadly, costly and largely preventable. these diseases cause over half of u.s. deaths in 2018. and during 2019 americans with diet related conditions were 12 times more likely to die following infection. and in 2020 during the pandemic food insecurity grew for households with children. for every state in our nation nutrition insecurity and diet related diseases also disproportionately afflict americans who have the least advantage, those who are low income, rural, racial or ethnic minorities. poor nutrition is harming our children creating future suffering, disability. among 2 to 5-year-olds, 1 in 10
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are already oobese. among teens 1 in 5 has prediabetes. these diet related diseases are also the top drivers of health care spending. health care spending now accounts for 1 in $5 in our economy and nearly 1 in $3 in our federal budget. 80% of this goes to treat preventable chronic diseases. that simple but striking fact explains so much about where we are today, hundreds of millions of sick americans and spiraling preventable health care costs. top military leaders at mission readiness and elsewhere talked about this. 3 of 4 americans are ineligible to serve in the military. these are daunting challenges,
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but they're also opportunities. but today our country has no plan, no national strategy to address this. the sointist is now available to create a plan to address this national crisis with practical, evidence-based and cost-effective solutions. we have in our grasp the ability to create nourishing, sustainable food system, one that promotes health and well-being for all americans and economic well-being and national security for our nation. as i hope we'll discuss more during this hearing, there are specific actions across six priority domains that can catalyze a healthier food system. what do we actually need to do? six priority domains. number one, we need to advance nutrition, science and research. number two, we need to leverage the power of medicine in milwaukee. number three, we need to strengthen and leverage our federal nutrition program in particular school meals, snap
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and wick. number four, we have to catalyze business innovation, new businesses and jobs in this area. number five, we have to expand nutrition and public health, and number six, we have to actually coordinate all of this, coordinate policy including new leadership, instructture and authority to do so. it's time to fix food but we can only this if we actually have a plan, a real national strategy. senators booker and braun, the two of you have called for the second white house conference on food, nutrition, hunger and health. it's been 52 years since our nation came together to chart a national strategy around hunger. much has changed in these 52 years. it's time to bring everyone together again to imagine our food system. we can't make america the 21st century bread basket, supports our military, revitalizes rural
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america, stewards our natural resources and creates new jobs and businesses. thank you for your leadership. i'm pleased to answer any questions. >> thank you so much, doctor. i want to just thank senator marshall, someone who has an obvious concern for these issues and grateful for his leadership and presence here today. doctor, you are recognized for five minutes. >> thank you. chair booker, ranking member braun, and members of the agriculture subcommittee on food and nutrition specialty crops, organics and research, thank you for allowing me the opportunity to speak before you today about the state of nutrition in america with a specific focus on black communities. the efforts help social and economic consequences of suboptimal diets in the united states states are well documented as has been previously stated. extensive evidence indicates that poor nutrition is a major
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driver of america's high chronic disease burden leading to sizable rates of death and disability from cardiovascular disease, hypertension, type 2 diabetes and certain cancers. further exacerbating the national impact of poor nutrition is the reality that its associated burden is not equally shared across all racial, ethnic and socioeconomic groups. people over black populations specifically have diet care intakes that fall short of the national recommendations and face higher rates of diet related chronic diseases. for example, black americans are 60% more likely to be diagnosed with diabetes by a physician, and almost four times as likely to develop kidney failure when compared to rates for white americans. unfortunately, in the last year we've seen racial inequities in
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health and nutrition worsen as a result of the covid-19 pandemic with black, white gaps in life expectancy widening. this disproportionate can be explained by the high prevalence of nutrition related chronic diseases among blacks as compared to whites. additionally, economic barriers including a greater likelihood of living in racially segregated, disinvested areas, higher rates of the uninsured and underinsured and a wage disparity where black american households earn almost half that as white households also sets the stage for black communities to be more nutritionally vulnerable. for example, although food security rates in the u.s. generally remain unstable from 2019 to 2020, the prevalence of food insecurity for black households increased from 19.1%
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to 29.7%. food insecurity not only contributes to higher chronic disease rates but also increases the risk for maternal depression, developmental delays early in life and lower academic achievement. well, traditionally researchers and practitioners focus attention on individual knowledge and motivation as key drivers of dietary behaviors, science generated for more than three decades highlights the importance of structural determinance of health. for many americans systemic and structural disadvantage moves good health out of their reach. a common scene in public health is that your zip code matters more than your genetic code. black americans are more likely
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to live in neighborhoods that are considered obese, environments that promote oweisety specific characterized by limited access to healthy food options and high availability and in store marketing of low cost, energy dense foods and drinks of minimal nutritional value. it is particularly striking that these black-white inequities in healthy food environments exist at every level of income. the first white house conference on food, nutrition and health resulted in landmark legislation that provided the foundation for the federal, food infrastructure we know today and raise awareness about widespread malnutrition and hunger being experienced by communities throughout america. similar to 1969 the events of 2020 amplified our level of consciousness about the ways in which social, structural and
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political conditions create different experiences and opportunities for people living in the u.s. we did not get here by chance but through policies. policies over centuries and at every level of government such as red lining and yellow lining that restrict access for some but create opportunities for others. in closing, we need to continue to prioritize nutrition security with a lens to racial equity. the time to leverage new policy and programmatic efforts to decrease food hardship is now. thank you for your attention in considering nutrition's pivotal role in promoting our nation's health. i look forward to answering your questions. thank you so much. >> you're very, very welcome. thank you for your testimony. doctor, you are very fortunate because you have one of our more esteemed senators, my colleague
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from north dakota would like to introduce you again. >> thank you, mr. chairman. i appreciate. also i admire your alliteration. >> thank you very much, sir. >> fantastic. thank you. i am very pleased i could take just a minute to introduce the doctor. he's here with us today to share his insight into the health and well-being of american indians and alaskan natives including those of the five federally recognized tribes located in north dakota. he's a member of the -- tribe and director of the indians into medicine program and the public health program at the university of north dakota medical school. and i just have to tell you this is one of the most amazing programs in the country. it encourages native americans to enter the field of medicine as doctors, nurses, vet techs.
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this is just a model of a fabulous program that does that. not only making a difference in the lives of so many young people, young native-americans but think of what they do for all of us who need medical care and attention and when we have such an acute shortage of people in the medical profession. thank you for your leadership in this incredible program. i want to finish up by saying when i chaired the committee last congress i invited the doctor to participate in the round table discussion and i really appreciated the insight you brought to that meeting. again, i very much look forward to your testimony today as well. and with that, i'd like to thank the ranking member. >> thank you very much. doctor, there's a bipartisan divide there. can you help me please with the correct pronunciation of your
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name. it is warne, right? >> yes. but you make it sound cooler. chairman booker, members of the subcommittee, good morning and thank you for the invitation to speak today, and senator, thank you for the kind words. we need to recognize for american indians we have a crisis of nutritional disparities and subsequent health disparities. less access to healthy foods, independence on in expensive processed foods lead to weight gain. according to the cdc 48% of the american indian and alaska native population over age 18 is obese. obesity is a significant risk factor as we know for type 2 diabetes and heart disease. we've seen some modest improvements in recent years
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american indians and alaskan natives have the largest prevalence in the nation. heart disease is the leading cause of death for american indians and alaskan natives, and the presence of coronary heart disease is about 50% greater for indigenous peoples. in my personal experience i served as a physician with the river indian community for several years. this is a community with the highest rates of type 2 diabetes in the world. also i'm originally from kyle, south dakota on the reservation. and the nearest supermarket is 90 miles away in rapid city. as a result my family members contend with inaccess to healthy
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foods. with kidney failure people are automatically eligible for medicare. and in many of our communities people confined to wheelchairs due to amputations have social programs to build a ramp to access their homes. rather than the decreases in quality of life associated with just the complications of diabetes and heart disease would it not make more sense to invest in healthy food in the first place? one major historical consideration is the forced relocation of american indian people from their ancestral homelands. the loss of traditional food sources resulted in dependence on government commodity food programs and included historically the distribution of food such as lard, canned meats,
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white flour, salt and sugar. according to the north dakota department of health, the average age of death in the decade between 2009 and 2019, so the decade before the pandemic, average age of death for american indians was 56.8 years. and average age of death for the white population was over 77 years. so just tremendous disparity by about 20 years average age of death. lack of access to, the american indian alaskan native population has significant health challenges. moving forward a multipronged approach in collaboration with numerous stakeholders and organizations is needed to address the upstream social deterrence of health and access to healthy foods. including one improving existing food programs, two, promoting
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breast-feeding and early childhood nutrition. three, promoting childhood sovereignty, four, expanding locally cultivated foods, and five considering taxing unhealthy foods. food programs that work well in cities or suburbs may not work effectively in traditional tribal communities. in closing we need to recognize we have a crisis of nutritional disparities among american indians and alaskan natives. we need to fundamentally change our approach to nutrition and address new strategies. i applaud the idea of having a second white house conference on nutrition to gather more commune based input regarding potential solutions and to develop action items. we also need a comprehensive policy approach that's well-coordinated and we need to understand the nuances of engaging tribes in these areas.
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idaley we'll include stakeholders in discussions moving forward. i'm deeply honored to be here. indigenous voices are not always at the table and i appreciate the opportunity to address each of you. and i look forward to further discussion of questions. thank you so much. >> thank you, doctor warne, for your compelling testimony. i'd now like to recognize dr. stover for five-minute remarks. >> chairman booker, ranking member braun, and members of the subcommittee, thank you for the opportunity to testify before you today. my name is patrick stover and i served as vice-chancellor and dean of research at texas a&m. i am fortunate to lead one of the largest and comprehensive agriculture programs in the nation encompassing 5,000 people
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and a $400 million budget. today i want to provide my perspective on the state of agriculture, the food system and its connection to hunger. i will provide some context to the enormous challenges we face but more importantly give you a sense of the opportunity to reimagine the role of agriculture in transforming our lives. but first a little context. in 1970 norman won the nobel peace prize for sparking the green revolution. his efforts to transform global food systems to be a funded, affordable and high in caloric density. these successful efforts dramatically reduced hunger. today we face a growing crisis of diet related chronic disease which costs the u.s. economy over $1 trillion annually and
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affects nearly half of all adults. we need to build upon his legacy in a revolutionary new way by expanding our mission from simply using food to eliminate hunger and malnutrition by using food to become healthier. this can only be achieved by advancing rigorous science, not only focusing on what seem deem to be healthy foods. with that said, urbanization, historic underinvestment in agriculture research and a deficit in public trust all contribute to the growing disconnect between people and the food they eat. to put it bluntly, that disconnect threatens agriculture, the food supply and the health of our society. fortunately, agriculture is uniquely positioned to be a solution, with current and
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emerging technology we can tailor agriculture and food systems to support any and all desired outcomes. to that end texas a&m agrilife is positioned to lead. i am grateful with the new investments from congress, the state of texas and the usda ars that enabled the launch of two long innovative efforts. it will advance research that connects production agriculture with human, environmental and economic health outcomes. second, the agriculture food and nutrition scientific evidence center will be a global resource for policy makers in providing non-biased comprehensive scientific information concerning the human, environmental and economic effects of any proposed changes to the food system and
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agriculture system. these efforts are now launching and mark an important first step in our collective efforts to solve some of the most pressing problems facing our nation and the world. equally important we must bolster education and earn public trust so individuals can make the best informed decisions for themselves. the land grant university system is a network that is an extraordinary resource that should be playing a much more active role in nutrition education across the nation. these institutions are a national treasure, publicly funded and therefore independent with the mission of improving the quality of life for all members of society. before i conclude i would be remiss if i did not acknowledge the efforts of leaders in this room to convene another white house conference on food, nutrition, hunger and health. as a nutrition scientists who's dedicated my entire career to advancing research on nutrition
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and disease i know these conversations are vitally important. with that said, agriculture must have a seat at the table if we're going to be successful. the cost of the current situation cannot be overstated. diet related chronic diseases place a huge financial burden on individuals, the health care system, the american economy and are crippling quality of life for most americans. while historic efforts to eliminate hunger and food insecurity were important and well-intentioned, hunger cannot be considered in the absence of agriculture and health. with that, thank you for the opportunity to testify, and i look forward to your questions. >> thank you, sir, for that excellent testimony. i'd like to now recognize dr. rashidi for her five minutes. >> chairman booker, ranking member braun, and members of the subcommittee, thank you for the opportunity to testify on the important issue of nutrition in america. and thank you for allowing me to participate in today's hearing
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remotely. my name is angela rashidi and i'm a senior fellow in poverty studies at the american enterprise institute where i spent the past several years researching policies aimed at reducing poverty. where i oversaw the agency's policy research. among other programs that we administered we oversaw snap, which provided benefits to almost 2 million new yorkers each month. my testimony covers three main points. first, poor diet and the over consumption of food have created a major public health crisis in the u.s. with serious health and financial ramifications. second, our nutrition assistance programs have mixed success among supporting nutrition among low income households and in many ways contribute to the problem. third, instead of pursuing bipartisan recommendations to approve the nutrition assistance programs, the federal government's acs over the past
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year have undermined these efforts. problems associated with poor diet afflict millions of americans at a tremendous public cost as we've already heard today. we know from decades of research that obesity and rates of being overweight in the u.s. are at crisis levels. we know poor diet is a leading cause of poor health and creates to high rates of chronic disease. and as we heard the associated costs are staggering. although the aim of our federal food assistance programs was originally to reduce hunger, the public health crisis caused by poor diet and overconsumption of food must now take priority. while the federal government's food nutrition programs can't solve the problem alone they can play an important role. the usda operates 15 nutrition assistance programs with the federal government spending more than $100 billion per year on food assistance to u.s. households. evidence shows these programs effectively reduce hunger, but
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they could do much more to support better nutrition and help address poor health outcomes. one of the main problems with the usda's nutrition assistance programs is that they lack a cohesive nutrition strategy. snap is a prime example. according to my own research the federal government added $50 billion to the program in 2020, i level i predict will remain high for several years to come. we knew hunger among u.s. households held constant during the worst months during the pandemic for the u.s. economy. yet lawmakers continue to expand snap benefits into this year and now permanently without addressing any of the underlying nutrition concerns associated with the program. this was concerning because research shows snap actually contributes to poor diet quality. usda recently increased snap
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benefit levels because they determined u.s. households should consume more calories. with research showing overconsumption of calories was a major contributor to the problem. three of the top five largest expenditure categories among snap households are sweetened beverages, frozen prepared foods and prepared desserts. instead it is to acknowledge the reality that billions of federal dollars earmarked to include nutrition among low income households are primarily being used on foods and beverages that are major contributors to poor health. more than a decade ago in 2010 i was part of an effort by new york city mayor michael bloomberg to power a project restricting sugary beverages. the usda denied our efforts and since then the snap program
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supported sugary products across the country. that is 1 in 5 children in this country are obese. in 2017 i was part of a bipartisan policy center task force on leveraging federal programs to improve nutrition. we developed 15 recommendations that the federal government could implement to improve nutrition among program participants. they all remain relevant today. but the main point i want to make is the federal nutrition assistance programs have a role to play in improving the diets and health of americans. the federal government spends upwards of millions of dollars a year on these programs. it can play a role in helping to address them. this includes a holistic approach that combines restrictions on purchases, incentives for healthy eating and nutrition education. this approach has received bipartisan support in the past
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and should be used as a framework moving forward. thank you and i look forward to answering your questions. >> great testimony in your experiences across the river from the metropolis of new york, new jersey was really helpful to me watching you. so i want to jump right in into question and answer. votes have been called and ranking member and i have worked out a way we can both go vote. so i'm going to read my questions, run to vote, come back and leave him to do the same. but i want to start off, doctor, with some of the staggering data that should appeal to everybody in the senate about as you look out at health care costs, you mention that our nation spends more on health care than any other segment of our economy. as you said nearly 1 in every $5 within our economy, but staggeringly 1 in every $3 government almost. and yet the top cause of poor
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health, our food are largely missing from the health care debate. the health care debate in washington seems to be more about access but why is there so much demand. so can you speak to the impact of food on our nation's health care spending and the current trajectory we're on with that spending if we do nothing different? >> thank you, chairman booker, for that question. i mean, we are on a path to disaster. if 3 in 4 houses in our country were on fire and all we did was build more firehouses and hire more firemen, right, that would not be sensible and the majority of americans are sick and all we're doing is billing systems to treat the downstream causes. we need to figure out what's causing the fires and put them out rather than only focusing on the downstream treatment. a recent study found across the supply chain we spend about $1.1 trillion each year on food,
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at the same time poor diet causes about $1.1 trillion in health care spending and lost productivity from diet related illness. so for every dollar we spend on food our economy loses a dollar due to illness. that is not a winning formula and is just one example of type 2 diabetes, we keep mentioning this and talking about this because it's really the canary in the coal mine. the u.s. government states and federal spend $160 billion each year on direct health care. nationally 1 in 7 health care dollars overall spent on diabetes, just a single diabetes drug can cost $5,000 to $10,000 per year with out-of-pocket costs of more than $2,000 per
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year. this is absolutely nonsustainable. rising health care costs are squeezing every other priority out of the federal budget, state budgets and the balance sheets of u.s. businesses. we have to get these health care costs under control, and we're absolutely not going to do it until we address the top cause which is poor nutrition. >> that is staggering, the fact we have seen spending go up just for one disease, diabetes. and now is more than the entire department of agriculture. and as you said i think just to absorb that, that in five years alone, the last five years our spending on diabetes has gone up 25%. what could the next five years potentially bring if we do nothing? but i think the point that you made there that i want to ask you about is that we have enough evidence that we know some strategies that could interrupt this and make it better, and they're promising strategies. and i wonder, you know, there are strategies like access and i
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think some of the witnesses testified providing access could actually save health care dollars as opposed to what we're seeing now as currently the dollars spent we get a double loss. so i'm wondering if you could maybe speak to some of those strategies that could integrate food and nutrition into our health care system and prevent what is the tidal wave, the tsunami that no one is talking about when they talk about our federal budgets, and the debates here are stuck in these debates about as you said how many more firehouses do we need as opposed to how do we stop the fire. >> well, this is what's really exciting about where we are today. some of the most exciting science has been about integrating food and nutrition into health care to reduce disease, increase equity and lower health care costs. i call that food is medicine, do we get food into the health care
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system. it's really a simple four-part system. the first is medically tailored meals. we have to have medicare, medicaid, these are giving home nutritionally tailored meals with the sickest patients with severe chronic patients. and even accounting the cost of the program actually saves money, up to $10,000 per patient per year. the second part of the formula is prescriptions for people that have diet sensitive diseases but aren't quite that sick and can still shop and cook. a doctor should be able to write a prescription for food, vegetables, beans that are partly covered by insurance. and seem at least as cost-effective as other treatments like cholesterol
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lowering drugs. today in medicare dieticians can only be reimbursed for counseling patients for a very small limited set of diseases like diabetes or kidney disease but not for many, many other diet related conditions in a cardiology clinic i can get reimbursed for having a genetic counselor on my staff but not for having a nutritionist on my staff. it's time to fix this. and part number four is nutrition education for doctors. the vast majority of doctors say in polls that they recognize nutrition is so critical for their patients, they want to learn more and they're not learning enough in their training. the simple way to fix this is to change the tests. we have to change the u.s. medical licensing exams, the education tests every physician takes for the top cause of poor health in our country shouldn't all tests have 5% or 8% on nutrition? change the tests we'll change medical education overnight.
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>> thank you for that. i'm going run and vote and turn it now over to the ranking member and chair. >> thank you. we started this conversation about 50 years ago. 7% gdp. it's nearly tripled in the 50 years we've been having the discussion, and then you hear testimony that what we do through s.n.a.p., through some of our nutrition programs here in the government might actually be adding to the issues of good nutrition, because mostly what gets into diets would be probably highly processed food that may be inexpensive, but would have empty calories. so what a dilemma we are in. i've got this question for dr. rachidi, and mr. stover that
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what do we do to get the health care system to turn away from remediation to prevention, number one, and then what do we do through the usda, the one or two things that might be most salient to where we start actually recommending fooled that's going to help solve the problem, not exacerbate it? start with dr. rachidi. >> sure. thank you for the question. i'll address what our federal nutritional assistance program can do. namely, s.n.a.p. i think the two main things that could happen in s.n.a.p. that could make a dig big difference, is one to implement restrictions on what can be purchased with s.n.a.p. dollars. starting with sugary beverages is a very good step. it will reduce -- likely reduce the amount of those beverages that are purchased by households and i think even more importantly it will send a
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very strong message that s.n.a.p. is serious about nutrition, and serious about households wanting to improved nutrition. i think the second thing, then, that the usda could do within s.n.a.p. is to leverage the restrictions with increases in funding for incentives to purchase fruits and vegetables. i think the combination of those two. so reducing the amount of money available for sweetened beverages and increaing the amount for fruits and vegetables can change the calculus and might increase access to products in those neighborhoods that are low income because there will be more money to purchase them. >> dr. stover. >> thank you for that question. i think that we have to take a systems approach to really connecting through in health. as i mentioned, there's a disconnect right now, a major
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disconnect, between food production and then our expectations around consumer health, and we have to address this across the entire food system. we heard about obese environments. we talked about the relationship between diet and disease. we talked about incentive programs. we talked about other types federal interventions. we need to approach this considering the entire food value chain from farm inputs all the way to consumer behavior and nutrition. we saw during covid-19 that it changed consumer behavior. not eating at restaurants anymore. eating at home. playing havoc on the entire agriculture and food value chain. they are all connected. if we want to set the goal the purpose of the food system to lower health care costs, protect the environment, whatever goals we have, we have to focus on that goal, and we have to take advantage of every opportunity and all the knowledge we have today towards that specific
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goal, and we have to do it in a way that we acknowledge where our research gaps are, and be very transparent about how certain we are the knowledge we have, so we can engender public trust. that's the only way we're going to get true prevention if we deal with all the causes. when you talk about prevention, there were two aspects to that. there is what you eat, and how much you eat. francis collins started the precision nutrition initiative at nih for the sole purpose of trying to understand how individuals interact with food and the diet chronic disease relationship, and we know we are heterogeneous, the data tells us that, we all interact with food differently in terms of chronic disease outcomes. one size doesn't fit all. we need to better understand that science and how to better match people to diets. and, again, consider the agriculture value chain. in terms of dose, we need to
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understand better human behaviors, basic -- you know, these obeseogenick environments. we need to work on dose so people consume less. we have to work on both aspects, the dose of consumption and what people eat. >> thank you. and real quickly. how important relatively is it that the ama lead on this as opposed to try to force solutions through government that always is a little trickier? why are we not hearing more in credentialing and so forth to where that ounce of prevention being worth a pound of cure? to me, if that happens where the rubber meets the road, we see things cascade in a favorable way. how important is it that the ama get on board with this? >> for years, and as president of the american society for nutrition, we spent a lot of
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time trying to focus on getting more nutrition into medical education. that's a tremendous challenge, because every professional society wants more of their type of education in the medical degree. at texas a&m, and we have a paper coming out on this, we are encouraging combined programs of nursing and dietetics. it's nurses who are the front line health care workers who see every patient, especially in our disadvantaged communities. we need to have those frontline workers have that nutrition education because there aren't enough dietitians in these health care facilities to educate about nutrition, and at the same time, we need to expand what we do in the land grant system through extension. people trust us. people trust the information that we give them. we have community health programs. they have not kept up in terms of funding with the growth of population and the diversifying of a population. we need to take advantage of our extension
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system as well. >> thank you. senator warren. >> thank you so very much, ranking member, senator braun, grateful to you and chairman booker for holding this hearing. families across georgia's rural communities are facing barriers to adequate nutrition, including distance to a grocery store. limited transportation options. and the availability of quality fresh products at an affordable price, for example, the second harvest of south georgia estimates that one in five people in south georgia do not know where their next meal will come from. one in five. administrative flexibilities provided by usda have helped provide additional nutrition assistance throughout the pandemic. i'm hearing from the folks in georgia that the guidance coming
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from washington fails to fully reflect the challenges of administering assistance in rural communities. doctor, you both have dedicated your careers to underserved communities. what individuals in rural communities face regarding nutrition, and how can this subcommittee better address those challenges as we look ahead to the 2023 farm bill? >> i appreciate the question very much, senator warnock, the communities i work with in north dakota, are very rural, tribal populations, with the rural communities, we tend to have less access to health care but also less easy access to healthy food. where i'm from originally in kyle, south dakota, for example, if we want to purchase healthy food, it costs more than what you would spend in a city tore a
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suburb. because it's perishable, and it costs money to bring the food out to some of the more rural communities. in public health, we call that a poverty tax. it's not a tax per se where money is being collected by government but people have to pay more money for healthier options when they live in rural and under served populations. so it also links to the need for health education, and one of my challenges that i have seen when i was a full-time clinician, i was a certified diabetes educator, and what i recognized is all of this awareness of education and theory is really not of value if we can't implement it. if people don't have access to the things we're recommending, we're not going to improve outcomes for diseases like diabetes. so when i look at the communities that i work with, there are so many challenges. we need to create opportunities and fundamentally rethink how we're doing this, because we need local, easier access to healthier choices, and we have to develop community champions. it's not easy to change behaviors by changing a program
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or two. we actually have to do a lot of community engagement on the front end to make it more effective. >> thank you so much. in order to serve our rural communities, and i spend a lot of time in my state being moved around these rural communities. it seems to me we have to center their unique concerns in order to get the policy right, and it's great to have folks like you helping us, helping this committee to think about how we best tailor the policy to the particular needs of rural communities. if i may, i want to pivot in my remaining time to another subject. since my first day in the senate i have been laser focused with my colleagues on closing the medicaid coverage gap. in georgia we got 646,000 georgians in the medicaid gap. millions of americans. this is a
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matter of life and death and congress must act immediately. according to the georgia food bank association, approximately 66% of the families they serve have been forced to choose between food and medical care. so this issue affects everything, including nutrition. dr. mozaffarian in your testimony, you discuss how nutrition insecurity and diet related diseases disproportionately impact those who are low income, racial minorities, and how would closing the medicaid coverage gap and expanding health insurance reduce health disparities and improve nutrition for the 646,000 georgians, 2.2 million americans who currently lack access to free and affordable health care? >> well, as a physician, you know, i know and i see the power of the health care system and
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when you get sick. if you get sick and have to use it and don't have insurance, you can be financially devastated. so i think having access to health care insurance as a financial support system is crucial. i'm not convinced that having health insurance per se makes us healthier, and there's lots of evidence that that's not the case. it's a financial incentive, but, you know, to get help, we also have to have health insurance focus on prevention. i think that it would be -- you would get a double win if that policy of addressing the medicaid gap were paired with real programs and policies of medicaid like the ones i mentioned, medically tailored meals, produce prescription programs, dietitians that can actually see patients who need them, and physicians who are trained in nutrition so that those low-income communities, rural communities, you know, communities of color can get their insurance and go and actually get healthier food, get good counseling, get medically tailored meals if they need it and so on.
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so i think, you know, the health care system is wonderful if you're sick, but it's very expensive, and it doesn't do a whole lot for prevention. so we need to both expand coverage and change the way we think about health care so that it actually starts to be really focused on prevention more than treatment. >> prevention, affordability, access to good, nutritious food, and access to health care all caught up in a single web. there's no sort of one prescription for all of these things that are caught up. thank you so much for your testimony. >> mr. ranking member, who's up next? >> dr. marshall. >> thank you, sir. chairman booker, i appreciate you holding this hearing. ranking member braun mentioned the cost developed here went from 7% of gdp to 20% of gdp approximately. often when i talk
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about driving the price of health care, i talk about we need more transparency, more innovation, more consumerism, but fourth leg of that stool is better nutrition. that's one of the reasons that the cost of health care has went up is something i can't control as a physician. i can't prepare the diet for the folks that need it. the majority here gives us notice today. currently in the united states, nearly half of our adult population is pre-diabetic or has type ii diabetes. half of our population, that's an epidemic. mr. chairman, in the spring of 2020, i volunteered in southwest kansas at an icu and an er. the covid virus was sweeping across kansas, our packing plants in southwest kansas were just getting devastated. we set up testing stations and did everything we could, but i went to the icu in liberal, kansas. eight icu beds, but there was
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11 patients. and i think they were in their 50s. every one had diabetes or probably pre-diabetes. immediately i called the cdc and said, oh, my gosh. this virus is going to assault this country. and people will ask, why is our morbidity, mortality higher with this virus, than say the african nations? i assume that would be true for our friends in the far east that have better than american diets as well. and i don't know about you all but i've been so frustrated the cdc has not talked more about nutrition, and building your own immunity. we've had a year and a half of this virus, and i thought this might be an awakening for this country, if we had a better, healthy immune system, that's how you fight viruses, and i think i'll start with
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dr. mozaffarian. are you frustrated that the cdc hasn't been doing announcements on how important it is to building a good immune system? >> well i think that this has been a lost opportunity, this last year and a half. obviously we need to work on and successfully developed vaccines, look for treatments, use social distancing other things. >> of course. >> but the huge, huge, you know additional foundational effort should have been to improve our overall metabolic health through nutrition. we published research, we estimated 64% of covid hospitalizations could have been prevented, this year, if we had a metabolically healthy population. every time they talk about social distancing, mask wearing, getting a vaccine, hand washing. >> nutrition. >> why weren't they talking about healthy -- >> yeah. i think that's a great explanation point. i think about my own field of
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obstetrics and the morbidity mortality for this country has gone up over the past decades, and we've done deep dives into, why? how come? but i can share with you that the average starting weight of a patient in my practice from 25 years ago until i left my practice four years ago was up about 20 pounds, and this incidence of diabetes and pre-diabetes, which is exacerbated from the hormones of pregnancy, that has to be contributing to it as well, and it's been frustrating. you know, we have been studying this for decades. i appreciate your comment. we had more education in medical school, that would be helpful, but i'm telling you, i learned everything i need to know about nutrition to address this problem from my mother and my grandmother, and it's not doctors that give the nutrition education. it's the nurses. right? and i think it's just a matter of how do we use those assets and doctors learning more about
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vitamins, a, d, and k, and more fat soluble and why we need to drink whole milk as opposed to just general concepts, and i think the bottom line is this -- when the economy's bad, people don't have a job. when you have some food stamps, whatever it is, carbohydrates are cheaper. processed food is cheaper, and that's why i thought the economy is so important to this issue as well. give a person a job where they can make these healthy choices. one big question i've got for anyone that can help me answer this. we pack food banks with yesterday's doughnuts and yesterday's breads and it's expensive. we're making an effort, doing better today in our food banks than we were a decade ago, trying to get nutritious food in there. there's a multitrillion dollar vitamin industry out there.
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are you all aware of any research that we should be putting vitamins in our food banks? or are vitamins different than, you know, give me whole fruits and vegetables, whole milk and good protein sources over a bottle of vitamins. i think that most of us would agree that mother nature made it better but should we be adding vitamins to those types of situations? i know i'm open for anybody that has any thoughts on that. >> i can comment on that. what we're talking about today diet-related chronic disease is not driven by micronutrient dwirtsies you get out of vile mines. certainly, those do occur for those who do not have the best diet. certainly they can help fill gaps, but what we're talking about today, at least, in all of my experience and working on these dri panels is not related to vitamins. this is a broader question related to the food environment, it is related to health behaviors.
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it is related to public trust. this is another issue where pew people -- pew research did a survey last year, and people don't trust nutrition researchers the way they do other areas of the health care system. and so we have a big challenge, we have the problem with covid in vaccinations. we have the problem in nutrition. >> can i add one comment, dr. marshall, on the cdc. the cdc's division of nutrition and physical activity and obesity. the foundation of health, has $100 million a year budget. the government spends 160 billion on type ii diabetes treatment, and $100 million on prevention and cdc, physical activity, nutrition, and obesity. let's get up up to $1 before, maybe?
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1/60 the cost of diabetes. >> i understand where you're coming from. my experience is throwing money at it does solve the problem, i want to know very specifically what would they be doing differently than they do today? can i have another minute, nobody else is waiting. >> you can have two more minutes. >> okay. so i think my question for dr. rachidi is, again, i feel like we're just throwing money at things. we tried this. i don't know why we need another conference, to be honest. i think we all know exactly what needs to happen. but much like trying to convince a patient to stop smoking, they know they need to stop smoking, america knows they need to get on a better diet. america knows they need to be exercising more. we certainly know what doesn't work. what would work? what are we not doing now if you were king you would come in here and say, here's something we can do to really impact this problem tomorrow? so dr. rashidi, you're on the line, i think. if you have any comments i'd love to hear your thoughts on that. >> yes, thank you. i couldn't agree more that just
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throwing the money at the problem has not proven to be effective in the past and would not necessarily be effective now. for example, the federal government has increased efforts in spending on nutrition education, for example, in s.n.a.p. and various other programs, and while i think nutrition education can be useful, it certainly has not had a major impact on any of the problems that we have talked about today. so we really need more of a holistic approach that looks at what we are already spending and figures out a better way to spend it, and again, i think the main point that i really want to emphasize today is that we need a cohesive nutrition strategy across all the federal agencies that makes it clear to the american public that this is a crisis, and we have a strategy to try to fix it. and that includes a whole range of things. i mentioned my area of expertise, which is s.n.a.p., and what we could do there, but obviously there's many other ideas just today of what can be done. but the main thing is we have to pull it together.
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and we have to develop a strategy, and then we have to take action as a country and actually implement those strategies. >> thank you so much. mr. chairman, if i would say my experience in 25 years of medicine, wic works. the wic program is great. one of the reasons that wic works is the people participating, they're not just giving them vitamins. they're not just giving them healthy choices but they're coaching them up, and it's that interaction between the real people and the real wic programs and those are what we need to be -- people need to be kind of coached up to what a healthy diet looks like. thank you so much. i yield back. >> before you leave, this is a wonderful forum to engage with colleagues, frankly you're one of the more informed people in the united states senate. you are actually a medical doctor and have tremendous experience with diverse populations. so i agree with you. i'm one of those people that has witnessed a lot of knowledge out there, but it's not getting into our practice. the two things i would say is
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dr. rachidi in her remarks, she said the words "cohesive strategy." we have so much at core, but aren't working together to get it done, and the hope and vision for senator braun and i will and i would love to talk to you more about, private sector, farmers, all around the table, policy makers, to begin to talk, while those evidence-based strategies, why are we not working together? because the reality is what can create change, it has to be folks like you and i coming together, and agreeing on a strategy and executing it. because there clearly are, as dr. rachidi has been saying. things we know work that we're not investing in, and things that are potentially making the the situation worse. so you are somebody i look forward to partnering with, and have your sort of what i would say cred on these issues, that's really great. and maybe before you go, i would like to ask this panel, and then i want to turn to
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dr. odoms-young, because there are evidence-based strategies. my experience is i was mayor of a city. i cut my city government by 25%. i don't know any governor or mayor that cut their size by 25%. one of the two costs i could not control was my health care costs, would go up double digit percentages every year. senator braun, who is a businessman, extraordinary, said he did creative things to bend his cost curve by providing healthier food options to people. so dr. moazffarian, if you can put an exclamation point perhaps on, you were saying earlier that this is not -- this is a fiscally conservative approach, right? we know if we do nothing wrong, we're going to be doubling major increases in government spending, but we could actually invest in programs we know drive down government costs, because if there's anything we can agree on in a bipartisan way, we are
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about to run government into the ground with $1 out of every $3 now being spent on health care costs, as opposed to, and if we do nothing, as you said, diabetes alone costs 25% on that one disease, more money than the entire department of agriculture, and it is going up in a stunning fashion. so maybe -- i know senator marshall, great demand, probably has another hearing and to the florida vote, but if there's one more thing you can say that's evidence-based programs, you are talking to a fiscal conservative, what would you say, hey, these are some of the best dollar investments you can make in changing this nightmare for a lot of families and individuals? >> well, yeah, i consider myself a fisk's conservative as well, and i think we need to invest money where we're going to get a return on our investment. so i think we need to invest money in nutrition science, there's a huge return on investment. lots of great ways to do that.
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i absolute agree, strengthen our federal nutrition program. strengthen school lunch, wic is excellent, improve s.n.a.p. one thing i would love to talk about longer is catalyze business innovation. federal government has a role to play to help nurture and catalyze all of the disruptions going on now from ag to retail to consumer packaged goods. tens of billions of dollars are going into new jobs and businesses to create healthier jobs. the federal government modest areas like that. and i do think we need to expand public health. there's a return on investment for that. expand public health. and then lastly, i agree with you, senator booker a low cost thing to do is convene with the white house conference to get dr. marshall, yourself, others, along with leaders in the obama administration in the same room and say, we're going to fix this. we're not going to leave the room and come up with a plan.
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it's all possible. >> thank you. i want to jump to dr. odoms-young, because this is an issue that affects rural areas, suburban areas, urban areas, everywhere, but there are particular issues going on amongst native communities, black and brown communities, that make this more troubling and compound those problems within those communities. dr. odoms-young, a recent report found that black and hispanic youth are exposed to more food advertising and the media, and their communities, compared to white youth, and that food companies target black and hispanic youth for advertising for their least health products. could you comment on that rudd conclusion? are you familiar with these practices and what impact do you see them having in those communities? >> yes. thank you so much for that question, senator booker. i'm very familiar with the report, and also i've been part of several studies that look at marketing that have been
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conducted through the council on black health. black americans, particularly youth, not only experience higher exposure to unhealthy food marking through television in advertising, but also from social media, print media, and in their communities. the rudd report that you mentioned found that junk food compromised 86% of the spending on black targeted programming, and only 1% of healthy foods were marketed. i think what's particularly striking is that in 2019, the report found that 23 restaurants spent $99 million to advertise on black television, or television that targets predominantly african americans
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as compared to white preschoolers. a black preschooler saw about 72% more fast-food ads, and if you look at teens, they saw about 77 more fast-food ads. so this has serious implications when you look at dietary preferences, and eating behaviors. several studies have shown that immediately after you see these ads, they have a desire for unhealthy foods, junk food and fast food, and if you look at black, indigenous and latinx communities where you have more of that food available, you can actually act on that marketing and that prompting. i think the other issue that comes up is that when youth are exposed to these ads in early life, it creates a lot of brand loyalty.
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and also you associate these foods with experiences. so it's not just selling food. it's selling experiences. it's selling value. a happiness. socialation. so these have major implications for obesity and chronic disease in these communities. >> i guess it's neuroasoeshtive conditioning. it's like you think of a meal, like i may have thought about my grandmother's cooking, which was very different than often you see in black communities today. and that was the happiness, but now as i think the only senator that lives in a predominantly african american latino low-income america, i'm struck with the messaging folks receive. and maybe, dr. odoms-young, you can comment on this for a second. it's that compounded with the fact that you don't have the ease and availability and the kinds of foods when i talk to the elders in my community that they used to cook with. i live in a neighborhood with a corner bodega, and you have very
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limited option, and because of the way we subsidize certain foods and not others, 98% of our ag subsidies are foods that are hyper processed, low nutrition, you know, you see kids walking into bodegas and with kind of change and a twinkie product, that product costs less than an apple. you have the double hit, right? the advertising and the availability. would you agree with that? >> definitely. i have spent much of my career working on the south side of chicago with several community-based organizations where we work alongside corner stores to change the availability. and part of the big issue, as you mentioned, it's not only availability, but also prizing. so unhealthy food products cost lower. i was just in a corner story. it's funny that you mention
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that. this week, and not only were unhealthy products marketed, and this is in a store where we have a partnership, we also found that there's a lot of ultraprocessed foods in stores. not only corner stories but also grocery stores. and it makes it's difficult because the prices, as compared to healthier food options make them more desirable, particularly when you have a limited budget to spend on food. so i think that is very important, and if we can try to address and look at affordability as well as accessibility, that is where we can see a reduction in dietary disparities, and improved nutrition. >> maybe, doctor, coming back to the desk. the ranking member warnock is
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coming back to the desk. you mentioned in your testimony that for you growing up and for many of the family members still living on the pine ridge indian reservations in south dakota that the nearest supermarket was 90 miles away, and can you speak to that, that combination of access issues to get healthy foods and how that's a disproportionately reality? >> we see this across multiple, not just my own. as food deserts, we don't have local access to healthy choices. if there are perishable items, they're more expensive when we have to purchase those in our communities. we make it untenable to make healthy choices. that's where investment has to occur, make the healthier choices, and i think that's where investment really needs to occur, it's to make the healthier choice the easier choice, and there's been discussion about sugar sweetened beverages, for example, i have worked with a tribe in minnesota where at their wellness center,
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the bottled water is 25 cents and soda is $1.25. guess what? water consumption went way up. soda consumption went way down. there's ways to invest in healthier options and make them easily accessible and inexpensive. because right now even if we put the food there, and we provide education regarding the value of healthy food, if people can't afford to purchase it, they are we're not going to implement the changes that we need. >> programs like, done this in my city, new york, giving people access to make their s.n.a.p. dollars go further. spend it for processed food in a supermarket one thing, spend in a farmer's market you get double s.n.a.p. benefits. those were the kind of things you think would work? >> that would be very important, and also engaging tribes, looking at the value of traditional foods and locally cultivated foods, that's one thing that the food distribution program in indian reservations has done better in recent years is to incorporate more culturally appropriate and traditional foods.
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so i would want to work with each community individually. again, because the one size does not fit all, but find those local preferences and develop local champions to do that. that would be a very important step. >> i'll yield to the ranking member if you have any questions. >> thank you, mr. chairman. so we covered a lot of territory today about the fact that health care system is almost triple what it was 50 years ago when we started the conversation. prior to becoming a senator, and it was roughly 13 years ago, as a ceo of a company that just had 300 employees. now 1,200, i could put two and two together that i needed to change my own health care system. i always believed in covering preexisting conditions with no caps on coverage, my main interest is reducing health care costs, and making my own employees health care consumers. i know we have two doctors, mds
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on the panel here, and when i brought it into the c suite, that was very unusual. because most individuals running companies, paying for remediation when it cost a lot less, even 13 years ago. so for the two mds on the panel, how important is it to foster a new paradigm based upon an engaged health care consumer, not one that's atrophied, very little skin in the game. just wants government to either remid yate your bad behavior or illness or accident, and you got an industry that is based upon the business remediation. and to me, knowledge and transparency are the two things that have to drive all markets and then you've got to have things like competition, full transparency. from an md's point of view, what do we do to fix the system from
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the bottom up before we maybe turn it into a one pair system out of frustration, and even if the government pays for more, wouldn't it make sense to reform health care first regardless of what we do through nutrition, through usda? would love to hear your thoughts, each, on that. >> and i can go ahead and go first. i appreciate the question, and i also appreciate it in your opening remarks, again, a holistic approach to doing this work. i think from a physician's perspective, at least many any my own experience working with tribal communities, and recognizing that i have all of this knowledge of patho physiology and the understanding of things like diabetes education. one of my biggest challenges really at that ground level was that even if my patients wanted to make healthier choices, they didn't have the means to make those choices, purchase the healthier foods.
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so we just have to recognize that each population is different, and we'll need unique strategies with each population that we are engengaging, but on thing i do know is that our populations as diverse as they are, they want to be healthier, they really do. i think that having a community engaged approach and recognizing that each group of patients in each population will have their own strategies, and we need to be flexible enough within that. we talked a lot about evidence-based practices, which are wonderful as a physician, but also training in public health, i recognize the need for evidence-based practices. but my question is always, whose evidence is it? if a program worked effectively in boston or new york city, it may not work effectively in pine ridge, south dakota. so as we're building the evidence base from a physician's perspective, we need diversity in the groups from which we're building the evidence. >> and i would add senator braun, your instinct 13 years ago was spot-on, and it's spot-on today.
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it's really clear that we need to reimagine the health care system as a preventive health care system that pays for value and prevention just as much if not more as it pays for remediation as you put it. and this is happening, happening in private health care systems across the country are really starting to think about food is medicine, prevention, social determinants of health. but they're doing in in sort of fragmented fashion, piece by piece, and bit by bit learning, and i think the federal government has an important role to play. the cmi, cmi's mandate is to test interventions that improve health and reduce cost. so i think congress asking cmmi to really focus on nutrition and prevention integrating food and nutrition into the system in a way that empowers educated knowledgeable consumers gives them systems resources to purchase healthy food is absolutely the way to go. and i'll give the example of john hancock life insurance in boston, one of the great oldest life insurance companies in the nation, about five years ago, they launched an insurance program called john hancock
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vitality, which rewarded their life insurance clients for physical activity, not smoking and for healthier eating. all kinds of gamifications and incentives and rewards for healthier eating, including pay up to $50 a month. john hancock pays up to $50 a month for purchasing healthier food. their science partner to be sure everything john hancock is doing is credible science. john hancock says we'll spend $ 00 on food because we'll make money. they'll live longer, they'll be healthier. that's a model of health insurance for the future. most of our work site wellness programs today will pay for belonging to a gym or even buying equipment, buying tennis shoes or a treadmill. if you get your steps, many programs give you rewards and other things. we need to do the same thing for food. i think your model is exactly right, and you know, cmmi is an excellent place to start. i would hope it would be investing heavily in this kind of innovation testing to figure
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out what works best. >> thank you. one final comment. when you've got a podium like this, for as long as i've been asking the health care industry to reform itself, and you've got bad stats like costing three times as much as a part of our economy as it did five decades ago. that soul searching and looking at how you might do a better job for the most important part of our economy, and agriculture and agriculture and food processing to boot, see what you can do before you're in a pickle to where you're maybe forced by government to do things that you're not happy with, and i especially aim that at the health care industry. embrace competition, transparency. get the health care consumer engaged, and maybe less attention will be paid to it through government. thank you. >> well, and, senator braun. just for sake of conversation,
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i love how you align as a a business person, your, the bottom line. you saw that you had to find out different ways to use creative ways to reduce costs. i'm wondering a question for dr. mozaffarian, and also for you to the extent that you and i engage, do we have incentives in government as opposed to the clarity that the senator had that we could do some changes to our policy that align incentives because right now it makes no sense. if you and i were running this with the goal of lowering costs, which these are -- and i've heard speeches on both sides of the aisle to the untenable skyrocketing costs of health care, but again, the debate really has been in providing health care and not why do we have such a high demand, and that's what i'm wondering. how do we get alining incentives in government that you had so clearly as a business person that resulted in quicker success?
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>> and real quickly, i talked to chairman widen, if you're a problem solver like you've got to be to run a successful company, you're looking ahead rather than being in a cul-de-sac where you're forced to do it. and my belief is that, if you reform the system first, that even folks on your side of the aisle should be for more transparency, more competition. make the system better regardless of whether the government pays for the health care or it's done through the privet sector, and so much is involved to have a broken system almost like an unregulated utility out there on the health care provision side. so i'm asking, as someone that believes in free markets that maybe we need to pay more attention to creating the paradigm of competition, transparency. changing an atrophied consumer into one that is interested in his or her own well-being, and then if it's
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not moving in a way that we see things evolving in a different direction, then i think it will cascade into the other option. as so many on my side of the aisle, bemoan, but where were we when we were defending some of the stuff that wasn't working in the health care system and we have no answer like i'm trying to provide. >> and there's so much agreement up here which i think is a rare thing in washington, and might rush us in to stop talking to one another. bit i want to ask, maybe, because i believe in free market, too, and what i think government is doing right now is picking winners and losers. 98% of our ag subsidies, 98% of our ago subsidies are lowering the costs of the very foods another part of the government tells you not to eat. only 2% of ag subsidies are going to the things we tell us -- i've seen it go from the food peer mid-to the food plate,
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all along, saying, eat mostly these foods, but yet ouring a subsidies are completely aligned, picking winners and losers, and not allowing the free market to decide, and consumers. again, i live surrounded by fast food restaurants, and i'm not having it my way. and i'm not having happiness in my meals. i'm having fast access to foods, that when you go in and you see that dollar meal, it is, that is heavily subsidized by the government. meanwhile if i want to get a salad, the places that make them available, you walk in and there's a place down the street. charged like 20 bucks for a healthy salad with just vegetables. that's my frustration. i think we're aligned on values. i believe in the free market. that i believe government needs to cut costs. i said to senator marshall, i'm the only person here who ran a government that cut its by 25%. i couldn't control my health care costs, and so i'm
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wondering, could you speak and make dr. stover, dr. mozaffarian, could you speak to this problem that i see where we're not letting the free market rule, we're investing heavily dramatically on the things that are making us sick, and those small pilot programs that come in the farm bills, tiny amounts to try to start to incentivize the things that are making us well. it just seems like a misalignment of government. we're not investing in getting returns. we're investing in compounding the problem. >> i mean, certainly i understand what you're saying. let me first state again that our farmers and ranchers are some of the most devoted, hardest working people in the country. they feed america and are very proud of what they do. they respond to what the consumer demands, and with all of the things we have heard about influencing, advertisement, all of that, they
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respond to what the market, you know, is telling them to produce. we have the opportunity to change that. and that we have to look at all opportunities to do that. everything from nutrition education. everything from the frameworks we use in terms of what we subsidize, what we grow. how we process. how we, then, work within the cultural context of food system, and not alienate people from their food but improve those food systems within the cultural context. there's no magic bullet to this. we need to take a systematic approach. if we knew what to do, if we had the evidence right now, there would be complete consensus, and we could fix this tomorrow. we know some things work and they work at the margins. we need to address this systemically, again, looking at everything we do. from what we grow in the field to how we are educating consumers and affecting behavior.
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>> dr. mozaffarian? >> yeah, i think it's no doubt that the, you know, subsidy portion of the farm bill is really important for risk management, for, you know, farmers across the country. it's all going to five crops. if we took that away, farmers would go out of business, and we would have severe problems. so we have to figure out how to shift without hurting those farmers. shift their profits and their productivity towards healthier crops, and i agree, farms produce what the buyers buy. they're producing those crops because that's where the market is. we have to both increase the market opportunities for those farmers, and then find ways to help them shift towards healthier crops, while still providing risk insurance, crop insurance for you know, increasing threats from changes in climate and other things. and we've talked about it a little bit, we
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need to leverage the power of our nutrition dollars, particularly s.n.a.p. to buy healthier food. leverage the health care system, that will change the markets for farmers, give them incentives to make locally grown specialty crops, organic crops, healthier foods as well. we also need to catalyze business innovation and entrepreneurships in this area. we work with many start ups who are trying to make healthier foods, and they're actually, you know, at a disadvantage compared to their competitors, because they're buying more expensive ingredients, doing more to make the foods healthier, more authentic from local sources. that costs them more money. so rather than having them be at a disadvantage i think the government should really think about the policy to help catalyze small businesses and entrepreneurs for creating more nutritious food and that also creates demand for the farmer. i think, senator booker, it's complicated but at 30 billion f nothing else is opportunity cost that we could be spending better. i don't know that it actually lowers the price of those
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products, because we have global commodities market and a lot of complexity, but it's certainly opportunity cost. we could be doing more with the 30 billion than we're doing now, and i think that's a serious conversation about how we support our farmers and ranchers who are, again, champions in the united states. support them, make sure they're going to be successful while letting them switch to healthier crops, and create the market for those crops. >> i don't know if you want to respond to what was said? so i agree with what both of you said. i have strange alliances in the senate. senator chuck grassley and i are partners, for example, on some challenges within the cattle industry, because what cattle affirms are worried as is they're going to go the way of the dramatic changes in the chicken and pig industry, for example. they are raised so differently than they were just 50 years ago. the way they're being raised is causing real concern for public health. the overuse of antibiotics is
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necessary, because of the concentration of these industries and the growth of kfos and frankly, the farmers if you talk to them, the contract farmers are living in deep debt and in real crisis. i was stunned in the hearing we had in the ag community on the cattle industry that i was being praised by a guy on conservative radio in alabama as being this northeast democrat that was talking to the concerns that the farmers have. so i agree with both of you that the farmers are my hope in america. i've gone out to the midwest to meet with republican farmers and i told dr. stover, and was amazed at the concern they have, because they know that the system as it's designed right now is benefitting more and more corporate concentration that farmers, their inputs are going up. instead of having one republican farmer from western illinois, if i remember correctly, was telling me that their father had five people to sell their cattle to. now one person. and it's a system that's no
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longer working. the frarmers's -- farmers' share of that consumer dollar, my folks in my city go to supermarket from their beef to their broccoli, the farmers' share of that consumer dollar has gone down 50%. it is a food system where everyone is losing. we talked about the health of our country right now. they're losing. we've talked about the challenges with farmers right now. the disappearance of family member es. they're losing. you talk about food workers. talk about animals. environmental issues now going on. we have a system that's not only making end users unhealthy, this is a nutrition conversation, but we are as government using tax dollars incentivize behaviors that are driving pandemic like conditions and driving health. i understand what you're talking about. let's not be fooled.
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this is not a free market. we are investing dramatically in our own death. farmers, yes, right now, they're being forced to respond to the way we have structured the market. i agree with you. we're changing -- one of my alliances -- one senator is an organic farmer who gist says i'my i am more profitable to move to regenerative things but there's no incentive to do that. people are stuck in the monocropping producing foods that are making us sick. so d mozdr. mozaffarian, i want you to one more time -- i mean, we are an agrarian body in the senate, we love farmers. they are not the problems. i believe the decision by policy makers, i don't mean to to vilify people. we were concerned in the 1940s and 50s about food scarcity. the thought back then was make as many low-cost calories possibly available, and we
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transformed american farm systems to deliver towards that idea of cheap food, get it to people as much as possible. but when you know better, you should do better. we know america right now, the crisis isn't simply food availability. the crisis is that we are getting so sick, and so i share the values of a lot of my conservative friends. i actually have to run something, a government, and i tell you, we have to figure out a way to align incentives with policy decisions, because it is so out of whack right now, we have the virtual equivalent, the metaphor of a frog in boiling water right now, and we are killing ourselves, but nobody seems to recognize the state and the degree of the crisis. >> mr. chairman. >> yes, sir. so i think we do have a good conversation going here. and, to me, in running a business, i always looked to where i was going to try to implement the solution on where
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you're spending the most money. there's a big distinction between food and health care. food is a bargain. we just need to reconstitute the quality of the calories. and it's in a paradigm that has kplodty markets. we're the breadbasket of the world. so that is going to be easier to do than a system that we've created to remediate health care issues when you enter the health care system. so i think the task is going to be where we get better return on our investment by changing the health care side of it, because all of a sudden when they go from remediation to prevention, part of the strategy will be to eat better, to have a better lifestyle, and until we change the remediation paradigm, meaning health care, we're spending 20% of our gdp on that.
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we're spending probably just one-third of that on food production. i think someone earlier mentioned maybe 1.5 trillion. it's a lot less. so i think that you get a two-fer when you take on the health care industry, by making them competitive, transparent, and selling wellness and prevention. it's going to bring the food system along with it. would be my global view of how that works. >> dr. mozaffarian, i'm trying to read your body language, because i wanted to ask dr. warren about specific dr. warren about specific related issues to trauma, but you seem to be chomping at the bit if i'm reading your facial expressions right that you wanted to comment on something i said that ticked you off? >> no, no. i agree with you. my body language has been just thrilled that you guys are holding this hearing. i mean, you're sitting on the legacy of 50 years ago, the senate select committee on nutrition with george mcgovern
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and bob dole, and i think this committee can have that same transformative impact. no. i just wanted to agree with you, and everything you said. i think you perfectly summarized the current system, and the point i wanted to just emphasize is that we literally have a legacy food system that was built for 20th century goals, and 21st century problems. our 20th century goals were starchy, shelf calories that didn't have food borne bacteria and fortified with a handful of vitamins, and that was enormously successful. we don't want to under emphasize the success of those goals. we probably prevented a billion people from starving on the planet in the last century, and we, you know, pretty much have eliminated endemic deficiency, like scurvy and rickets, and other diseases fairly common. but now we have 21st century problems, and we have this 20th century food system, and then we
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have legacy players who have a vested interest in keeping that system. we have a lot of disruption going on, and new players coming in. i want to agree with you that we have a system set up for 20th century goals, and we need to really sit down together as a nation and say, how do we want to stein our food system? because the food system we have today, we consciously created, very successfully. it was designed. not a free market. we designed the food system to be what it is today. we can do that again. and leverage the power of private innovation, science, and academic institutions, the power of public and private health and really redesign this in a pretty short amount of time if we set our minds to it. >> to further indulge my ranking member who has been extraordinary in this hearing, i have a question for dr. warren a question for dr. odoms-young about minorities and specific strateies and my last question, mr. ranking member, any advance the panel has for us for what our, the white house strategy
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should be if we have this great summit meetingis that okay with you? >> that will be fine i. want to just start with dr. warren, because i read a lot about historic trauma and the impact it has on communities that have endured extraordinary trauma, and trauma associated illnesses. i know that you've studied that a lot, and spoken to that a lot. i just think there are many opportunities, perhaps through food, to bring healing of not just body but also addressing those historic traumas. so based on your work, what do you feel are the most effective solutions to address these larger issues within the indigenous community through nutrition? >> really appreciate the question, and university of north dakota i am principle investigators for indigenous trauma and resilience center through age and looking at these exact questions and issues related to nutritional genetics. one of the things we've seen
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historically and have to recognize these populations is unique, but there were policies in the past like the indian removal act. which removed tribal members from homelands to other parts of the country, and in that process, they lost access to food sovereignty and to traditional food systems. in a very direct way, seen disruption of food systems based on some of those historic policies. in terms of historical trauma there is compelling evidence that looks how a population that endures a significant amount of psychological and emotional trauma can hand health disparities to the next generation. we see an intergenerational impact studied in the jewish pop langss after world war ii and study in american indian populations here. seen direct loss of territory because of historical relations and unresolved trauma and childhood experiences tend to see more poverty in those
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populations, does impact on foond access and those self-medicated. not always self-medicated with drugs or che but some with food as well. we have to look at the holistically and recognize that each population is different, but the impact from a social determinance can have ripple effects we don't see right away. in terms of next steps, so lightsly important to have diverse voices and experience at the table and really pleased and honored to be a part of these discussions. >> i'm honored that you are here, and we are honored that you are here. quickly, dr. odoms-young, we talked already about the challenges unique to lower income african american larks tino communities in terms of levels of advertising targeted to them, disproportionate to the population as a whole. the general question i want to end with, asking you is, what types of policies do you think would best address the specific
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nutrition challenges in black and latino communities? >> thank you so much, senator booker. as dr. warren mentioned, it's important that we insure that all efforts take a comprehensive strategy to improve health outcomes and diets of black populations, and also that focus on increasing economic development as well as community cohesion. i think first, if we think about equity in food security, it needs to start in pregnancy and infancy. black babies die at three times the rate of white babies. and if you -- if you look at the quote of kimberly seals allers that says first through justice is food justice. we need to first think about how do we expand those supports for breast and human milk feeding. i know wic is a key program, but i think we could do more to think about breast and human
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milk feeding, because this is really at the root of the health of our nation. i think also, policies to support and empower those voices in the center of communities. and also leadership of those with the lived experience. dr. warne mentioned food sovereignty, which is also an important piece in the black community as well. i think what's particularly striking if we look at the traditional diet, which is rooted in vegetables and legumes and now we look at the intake where black americans have the lowest intake of fiber, we have seen that these environmental exposures have actually shifted the traditional diet. and although we have some negative aspects of the diet that always highlight it, there were always a lot of positive aspects of those diets. i'm from chicago, as i mentioned, but of course, by way of mississippi. so i know what it's like to be in a community where you have
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food that's produced. and i think we need to continue to support that. we need people of color, businesses that are developed, and also policies that help with scale of these businesses. and creating new market opportunities for black, indigenous, and latinx businesses. we also have to tailor our nutrition education to what dr. warne mentioned, because we have massive nutrition education programs, which are doing excellent work, but the need for trauma informed culturally specific nutrition education is a place where i think that we could do more within our land grant system, because this is really the backbone of educating our communities. also, we have the possibility of engaging youth of color through something like nutrition security corps, where we educate black, indigenous, and latinx
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youth, and put them in leadership roles, and then also, and i know that this has been at the center of many of the policies that you have implemented, is that we need to focus on black farmers. and black farmers and indigenous farmers provide an opportunity for us to expand, produce cultural foods, but we also have to make sure those farmers are supported. >> i am grateful, and have been yelled at by my staff that even though my ranking member is kind and generous, my staff is not. they're saying i need to wrap. so i'm going to do that. and i'm going to say that first of all, thank you for the witnesses. this is an extraordinary group. i think you all have the richest of perspectives and experiences, not to mention more degrees than a thermometer between you all. but i want to say to my fellow members and their staffs for those members who are not here, we're going to welcome additional statements or questions that you may have for
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the record to be submitted to the committee clerk in five business days, or by 5:00 p.m. that we can put to the panel. the one question for the record i will ask is for advice for us as we look towards hopefully having a white house conference. but in the meantime, i want to thank everybody. there's lot going on in washington today. a lot that's dominating the headlines of our various 24-hour cable news networks, but in reality, i don't think anybody is dealing with any issue in america right now that is of greater urgency than the one we have been talking about. i'm just grateful to my ranking member one more time for the common ground we found and both of our commitment to do something about the problem. so with that, this hearing is adjourned. [ gavel ]
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