- Speech by
Robert M. Califf, M.D., MACC
(Remarks as prepared for delivery)
Thank you. I’m delighted to be here with Dr. Susan Mayne for this important conference.
This organization, through the advocacy, research, education, and service of its more than 250 member groups, plays an important role in virtually every aspect of consumer life affecting Americans today.
The FDA shares much of the same focus and emphasis in our work to protect patients and consumers and to fulfill our mission to protect and promote public health. Certainly, the focus of this conference – including the issues of nutrition and access to quality food are central to the FDA’s work and mission. There’s a reason why the “F” in FDA comes first, and we are focused on food during my tenure.
Today, we stand at an inflection point in our approach to food policy. We have the technological know-how to ensure that all Americans have access to safe and nutritious food, yet we have ample evidence that we are falling short of our capabilities. Can we agree on policies that will meet this achievable goal?
As President Biden noted at the recent White House Conference on Hunger, Nutrition and Public Health -- the first such meeting convened in over 50 years – our nation has been a part of a profound transformation in what we eat, how we acquire and distribute food, and our understanding of the benefits that come from wise nutrition and eating healthy food. It is a revolution based in science and medicine, aided by the advent of new technologies.
But the power of this revolution has only partially been realized, as the nutritional status and upsurge in chronic diseases like diabetes and cardiovascular disease bely incomplete translation of our knowledge and capability into practice. And now, we’re entering an unprecedented era of global climate change, international strife, and stress on our supply chains, at least in part driven by “just in time” thinking, leading to inadequate resilience in the system. We need to develop policies that meet the challenges of this era. But the good news is that our understanding of agriculture, engineering, biology and health offers solutions to these issues if we can improve our translation of knowledge to action.
Of course, the understanding that nutrition plays a key role in our health is far from a new idea. Hippocrates himself is often credited with saying, “Let food be thy medicine and medicine be thy food.” While he may not have said those exact words, there is little question that Hippocrates understood nutrition is one of the main tools a doctor can, and should, use to treat patients. And he certainly understood the importance of healthy eating and how nutrients in various foods can have an important impact on preventing diseases that are directly diet-related and how many chronic diseases are related to long-term dietary patterns.
Like most doctors, my basic education lacked the type of specificity that could have optimized my effectiveness in dealing with diet and nutrition. But in my work as a busy clinical cardiologist, whether in treating patients, conducting research, playing an executive role in a major health system or teaching students, I have long appreciated the understanding that “food is medicine,” and the fact that nutrition offers some of the greatest opportunities for improved health. It has been enormously satisfying to be a part of a societal and scientific transformation that has helped millions of Americans live healthier lives through the advances in scientific research and medicine.
And yet, even with the many scientific and medical advances and our greater understanding of the benefits of nutrition, we still face enormous and perplexing challenges as a nation in the types of foods we eat and, for many, access to those foods that are better for our health. We all know that these challenges are having an impact on our nation’s health.
Indeed, it’s all too obvious that we are in the midst of a backsliding in the progress we’ve made in many areas. For instance, for almost a decade now, the U.S. has experienced a flattening or down-trend in life expectancy, and for the past two years we’ve seen a truly dramatic decline. Just this year China passed us in life expectancy … and our average life expectancy is now five years shorter than the average of other high-income countries. Unfortunately, these differences are expanding, not declining.
In addition to the larger-than-average impact of Covid 19 in the US, the critical issue in our decline in health status is that we have been losing ground in fighting chronic diseases. Today, six in 10 adults in the U.S. have a chronic disease. And four in 10 have two or more. And these numbers are growing.
Now there are plenty of reasons for the increase in these diseases, but many of these illnesses, including type 2 diabetes, obesity, hypertension, certain cancers, heart disease, and chronic kidney disease, have a basis in, or can be directly related poor nutrition, all too often with a basis in hunger. It is disturbing, to say the least, that in a nation as knowledgeable and wealthy as ours, millions of Americans continue to suffer from diet-related disease and lack the basic nutrients for a healthy diet. For example, 75% percent of people in the U.S. don’t eat enough fruit, vegetables, or dairy. And most people consume too much added sugar, saturated fat, and sodium.
Of course, this impact is not evenly distributed, but finds higher prevalence and more far-reaching impacts in underserved communities. The enormous differences in our nation related to health as a function of demographics – including factors such as race, ethnicity, wealth, and education have been exacerbated during the pandemic. And the gap between the life expectancy of women and men is once again growing, with more than a five-year advantage for women—something we don’t discuss enough, and I believe much of this difference may be related to diet.
While these factors are multidimensional the large impact of geography — where we live—offers a chance to think about systematic intervention. People in rural settings in general are experiencing a dramatic decline in health and life expectancy compared to people who live in cities and university towns.
What’s truly disappointing is that these trends and consequences are largely preventable. We have the tools and the knowledge to provide access to healthy foods and food choices that lead to improved health for individuals and groups of people.
As you know, this topic was a focus of the recent White House conference. Many of you heard the President outline some of the actions he is taking to support prioritizing access to nutritious, healthy food. And you saw how he advocated for mobilization of so many different parts of our society -- what he called a whole-of-government approach and a whole-of-society effort.
The FDA plays a number of important roles in this overall effort, not only in terms of nutrition, but concerning food safety, and the food supply. As a science and research-based organization, one of the most important areas we need to focus on is building a greater capacity for evidence generation within the food ecosystem. Although we generally understand the positive impact that nutritious foods have on our health, we need to do a better and more complete job collecting evidence and evaluating this data.
We have enormous potential as the world enters the 4th industrial revolution in which digital information is available at scale in real time with potentially unlimited storage capacity. The kinds of large-scale nutritional studies and evaluations of policy interventions that have been limited by cost and logistics are now possible. And rather than talking about matching nutrition to the needs of the individual and family-based health impact, we can now do it.
It’s essential that we strengthen the study of diet and nutrition and broaden the collection of data in this area, including more effective use of electronic health records, or other real world evidence that can give us greater insights into topics such as the impact of genetics or personalized diets on health. The possibilities are truly limitless, and we must build this capacity.
One of the most important aspects of the FDA’s work to improve access to safe and nutritious food is to provide Americans with the information and knowledge they need to make effective food and healthy dietary choices. We have an enormous education effort that involves not only the public, but also members of the health professions.
Physicians and the entire team of clinicians have a significant influence on people’s views of nutrition, and yet clinician education has been inadequate. That’s why, in collaboration with the American Medical Association (AMA), we have developed an education program to help physicians and other healthcare professionals understand the Nutrition Facts label and counsel adult patients about using the label to make informed food choices that support healthy dietary practices and can help reduce the risk of developing some health conditions.
While I’m on the topic of reliable information and our ability to disseminate it, let me mention one related issue before I close, which both presents an enormous challenge for all of us, and an opportunity for each of you to play an important role.
The challenge I’m talking about applies not just to our work on nutrition and food policy, but every area of public health. It is the rampant misinformation and disinformation that is destabilizing communication, undermining confidence in science and the work we do and, and weakening faith in governmental and other institutions, including the FDA.
This kind of misinformation, spread largely through social media, is leading people to make plainly uninformed and adverse choices regarding their health. We see this across the spectrum -- from the continuing use of tobacco products or vaping, to spurning effective and lifesaving medicines such as vaccines, to continuing to eat an unhealthy diet. Each of these decisions is made in the face of definitive facts that make clear these actions are harmful to your health.
Often when I speak about the impact of misinformation, I focus on COVID and other illnesses and the vaccines and other treatments that are being targeted, and leading people to not take these medications, which quite literally threatens their lives.
Misinformation about what foods fit within a health dietary pattern is a different, but important category of misinformation. It can confuse consumers who have many other issues to focus on in their daily lives, leaving them susceptible to influences that lead them to make uninformed food choices for themselves and their families. And, I’m sorry to say, too often the marketing of unhealthy foods is targeted at our children and specific racial or ethnic groups.
Now make no mistake. Every American has the right to choose what they want to eat, healthy or not. Our role at the FDA is to give people access to the facts so that they can make informed choices. But some companies that are selling unhealthy products may use claims on their food products in a way that may be misleading to consumers, trying to give a health halo to products that may be excessively high in sodium, added sugar, or saturated fat—nutrients we know Americans should limit.
So how can we combat this massive amount of misinformation, both in the food arena as well as in other areas? In my mind it poses perhaps the greatest challenge we face in public health today.
For a start, it will require a true collaborative effort that goes well beyond the FDA – one that involves the development of a proactive network that includes not just government partners, but industry, health systems, clinicians and universities, and of course public health and advocacy groups such as the Consumer Federation of America.
This organization and the networks that each of your member groups bring to the table can provide an important tool in this battle for the truth. One thing we know is that misinformation thrives on promoting distrust of official sources, such as government. To defeat it requires personal outreach and the use of individual connections. By engaging and connecting people across the consumer and health care continuum – through connections of your work, family, communities, and on social media -- you can help break through the disinformation echo chamber.
We have an enormous opportunity to use the knowledge and technology at our disposal to increase access to safe, healthy, and nutritious food for all Americans and to provide them with information that can help them make healthy food choices.
I look forward to working with all of you to achieve these important goals.