Abstract
John Weeks has been active as a writer, organizer, executive, consultant, and speaker in the movement for integrative health and medicine for more than 30 years. His leadership-focused Integrator Blog News and Reports (theintegratorblog.com) and now his Global Integrator Blog are go-to sources on breaking developments in policy, business, academics, and interprofessional activity.
In the United States during the past year, a profound debate has erupted over an issue that suggests that this adage, expanded, is becoming a powerful portal to a whole-systems approach to the health of the planet: Let food sustainability be our guidance and let policy in related areas be guided by food sustainability.
This direction could serve as a global rallying cry for those who are part of, or aligned with, the growing integrative health and medicine community. Such a commitment would have double impact strategically. The campaign for food sustainability's yet minor health professional voice would gain power. At the same time, such action is opportunistic for integrative health professionals wishing to shed their unfortunate profile as servants of well-to-do health hobbyists. The field can instead declare itself as the whole-systems change agent most of these practitioners consider themselves to be.
The issue emerged in the United States via a recommendation made by a federal advisory panel in a revisitation of governmental recommendations for individual and family eating choices. The process, engaged twice per decade, begins with an investigation by a set of scientific advisors. The 2015 body fertilized a seed planted but not yet germinated in the 2010 iteration. Multiple European countries have already begun blazing this path 1 : the members of the 2015 Dietary Guidelines Advisory Committee linked diet recommendations with the concept of sustainability (Figure).
The message in a chapter entitled “Food Sustainability and Safety” has a neat ring: “Sustainable diets are a pattern of eating that promotes health and well-being and provides food security for the present population while sustaining human and natural resources for future generations.”
That in fact the committee fused 2 elements that together create an incendiary device in the dominant, global industrial models is immediately clear. The background: “The global production of food is responsible for 80 percent of deforestation, more than 70 percent of fresh water use, and up to 30 percent of human-generated greenhouse gas (GHG) emissions. It also is the largest cause of species biodiversity loss.” 2 Myopia is required to funnel all the implications on a single industry. Few areas of policy are not touched by the whole system of the agricultural industrial complex.
These facts of the impact are not the area of major dispute. It's the “where do we go from here” that sets off the rumbling. The Advisory Committee expands on advice from Frances Moore Lappe's wakeup call of more than 40 years ago, Diet for a Small Plant. 3 Her treatise showed that the inputs for 1 lb of beef protein are many multiples of those required to produce similar food value from grains or legumes. Environmental science has come a long way since, and as the panel notes, is in an escalating period of confirmatory evolution. Here is the panel's conclusion:
Consistent evidence indicates that, in general, a dietary pattern that is higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in animal-based foods is more health promoting and is associated with lesser environmental impact (GHG emissions and energy, land, and water use) than is the current average US diet. 1
In response, the dominant food industry dodged the facts and related values implications. Instead, they chose a tack of procedural obstruction. Multiple letters from the cattle and related industries during a public comment period argued that sustainability considerations are an overreach of the panel's authority and thus should be truncated from the document. The Meat Institute fostered a “Hands Off My Hot Dog” campaign, arguing that “the dietitians and nutritionists who make up the Committee overstepped their bounds by not focusing on nutrition and instead wandering into environmental issues.” 4
Figure Elements needed for sustainable diets. 1 Reprinted from: Scientific report of the 2015 Dietary Guidelines Advisory Committee. Part D.
In an unfortunate move by the administration of President Barack Obama, 2 department secretaries, Tom Vilsack from the US Department of Agriculture and Sylvia Burwell from the US Department of Health and Human Services, stuck the administration's head in the same sand. Here are the two in a joint blog posting: “The final 2015 Guidelines are still being drafted, but because this is a matter of scope, we do not believe that the 2015 DGAs are the appropriate vehicle for this important policy conversation about sustainability.” 5
The sustainability theme was significantly responsible for an outpouring of over 29,000 letters, pro and con, in a public comment period. Advocates for the linkage included virtually all major environmental organizations. A dozen of these joined to send a submission with 150,000 signatures attached. 6 An overlapping group ran a full-page ad in The New York Times. 7
The most outspoken health professional voice for sustainability considerations was the American Public Health Association. The organization supported “setting a priority of sustainability as an important component of the 2015 federal dietary guidance.” 8 A letter from the American Medical Association offered what appears to be an oblique affirmation of the new direction: “We want to underscore the significance of the Scientific Report's recommendations for policies and environments that support and improve public health.” The group Physicians for Social Responsibility added its name to one of the joint endeavors. 9
Organizations associated with the integrative health community, for which dietary choices are core approaches, offered a range of responses. Neither of the major integrative academic consortia appear to have formally weighed in. Two policy-active organizations representing professionals who also prioritize the central value of food as medicine, the American Association of Naturopathic Physicians and American Chiropractic Association, were also absentee, as was the nutrition-centric Institute for Functional Medicine.
Action was taken by the Academy of Integrative Health and Medicine, which joined with 40 organizations in a letter to the two agency heads. 9 The organization's director of ecological health and community engagement, Jamie Harvie, PE, connected the subject with complexity thinking. Harvie wrote, in part, “The arguments that individual health is somehow isolated from the health (or sustainability) of our food system are the frantic, specious, cries of a failing industrial food industry.” 10
The outstanding example of advocacy associated with the integrative health movement was organized by Yale integrative and public health leader David Katz, MD, MPH, through the American College of Lifestyle Medicine. Katz linked with Dean Ornish, MD, and drove a campaign that attracted 700 signatures to an opinion statement. 11 The group asserts that “the nation's leading medical doctors, nutritionists, nurses, and public health professionals say federal dietary guidelines should incorporate sustainability for our health and future food security.” 11
At this writing, the US government has not yet issued the final 2015 dietary guidelines. In a private conversation, a leader of an environmental group active on the topic suggested that lobbying continues. A query to a panelist at the 2015 meeting of the American Public Health Association netted a response that strategy is informally being developed toward the 2020 campaign.
Remarkably, the Obama administration's decision to suppress a suggested whole-systems direction came from an administration that launched an agency meant to wrap such a perspective in health promotion efforts. The National Prevention, Health Promotion, and Public Health Council forced department heads from energy, transportation, education, housing, revenue, and a dozen other departments including health to routinely meet. Their mission: explore the health impacts of each of their actions. The Council's integrative health infused delineation of duties begins, “Provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States.” 12
Might this elevation of whole system problem solving seep back into the guidelines before they are promulgated? Only time will tell.
The administration's hesitation is not surprising. The Dietary Guidelines Committee notes that policies on sustainability move well beyond those related to dietary choices. Others are “developing agricultural and production practices that reduce environmental impacts and conserve resources.” This statement only hints at the explosive impact of food sustainability in industrial practices. “Food sustainability” could almost be substituted for “health” in the “Health in All Policies” campaign of the American Public Health Association. 13 Pull on the thread of the sustainability-diet link and one is immediately entangled in the universe of the new Council's multiple agencies, and beyond. Forty-five years ago, Lappe's research led her from Diet for a Small Planet to her disconcerting Aid as Obstacle: international aid and foreign relations are also caught in the web.
This controversy is a place where the rubber blisters the road in a first-order paradigm shift. The responsibility of human beings turns from ruling, using and and controlling nature and its processes toward close listening to nature's rhythms and an assertive stewardship.
The alignment of integrative health philosophy and clinical thinking with this shift is profound. Dominant modalities in regular medicine—pharmaceutical agents and surgeries—seek to suppress and control, supplanting and replacing natural processes. Integrative practice, as captured succinctly in naturopathic medical principles, urge professionals and patients to first “remove the obstacles to cure” then enhance the healing power of nature. 14 Sustainability considerations are thus a priority in good health. Allopathic modalities are optimally utilized later in this therapeutic order. 15
For the growing integrative health and medicine community, the benefits from active, visible, ongoing engagement in policy battles regarding food and sustainability are many. The first is simply to better fulfill on the core mission of health creation in the individuals and populations served. A second would be to lead in bringing the food sustainability message into clinical practice, whether one-on-one or through group-delivered services and education. Such a role will not be without its challenges, especially given the preference for meat-focused diets in the recommendations of some integrative care practitioners. In addition, responsible activism by the integrative health community in what will certainly be ever-expanding circles of impact of ongoing engagement would yield the opportunistic gain of increased recognition and respect as health professional allies of the environmental movement.
Finally, as policy leaders connect the dots to take on the transformative practices that will create a healthier, sustainable food future, an additional outcome dear to the integrative health community might also come to pass. Nutrition education is notably underrepresented in health professional education. Success in putting food sustainability in all policies will finally implant in all health professionals—from medicine to nursing to mental health and more—that foundation for health: Let food be our medicine, and medicine our food.