A promising new initiative to move the needle on chronic diseases.
“An opportunity to transform how health is experienced in this country.” That’s how Dr. Raj Shah, president of the Rockefeller Foundation, described the potential of the Food Is Medicine Initiative, a partnership between the American Heart Association, the Rockefeller Foundation and the grocery giant Kroger. Dr. Shah was speaking at a planning session to kick off the initiative. We know the choices we make with our food have enormous consequences for nearly every aspect of our health and well-being. So it only makes sense that to truly move the needle on health outcomes, we have to change our relationship with food. As Nancy Brown, CEO of the American Heart Association, said, “At the AHA we know that there’s a clear connection between nutrition and health outcomes. And we also know when patients visit their healthcare providers most don’t walk out with a prescription for better, healthier food even when that might be the most effective treatment for them.” And as Pam Schwartz, executive director of community health at Kaiser Permanente, put it, “I’ve been at Kaiser over 20 years and I haven’t seen anything like this — it’s just a pivotal moment.”
One of the things that’s brought us to this pivotal moment is the growing burden of chronic diseases. Right now, 75% of our healthcare spending is going toward the treatment of chronic diseases, many of which can be prevented with changes in our daily habits, in the food we eat. Of course, it’s essential that everyone has access to quality care when they get sick. That’s the last mile of healthcare. But what we now know is that the only way to truly move the needle on chronic diseases and change the health of our society at scale is to also focus on the first mile — and the proactive lifestyle changes that have a huge impact on our health. To cite just one example, in a program run by the National Institutes of Health, after three years of lifestyle changes the risk of developing type 2 diabetes fell by 58%. And doing that at scale would be transformative. As Dr. Shah put it, “success really is wiping out a huge amount of chronic disease in this country using food that is medicine.”
The Food Is Medicine initiative is connected to the White House Conference on Hunger, Nutrition and Health — the first one in over 50 years. In addition to the goal of ending hunger by improving food access and affordability, the White House Conference included a call to address diet-related diseases by prioritizing “the role of nutrition and food security in overall health — including disease prevention and management” and expand “food is medicine interventions” — and $8 billion in commitments from over 100 organizations. These include mobilizing $250 million from the Rockefeller Foundation and the American Heart Association, in partnership with Kroger, to build a national Food is Medicine Research Initiative.
Reaching People at the Right Moment
The key is to go as upstream as possible. It’s not just about telling people to eat healthier foods, but reaching them in key moments when they’re making choices about what they’re planning to eat. Dani Dudeck, chief corporate affairs officer at Instacart, shared how Instacart uses behavior change technology to make meaningful nudges and interventions at just the right moment. As she put it, by the time people are in the kitchen, it’s too late — better to reach them when they’re planning their meals. “When they’re in the app doing their weekly shop… that’s the time to inspire them with shoppable recipes.” She also noted that, since Instacart now delivers food through SNAP (the Supplemental Nutrition Assistance Program), “the demographics across Instacart match the U.S. socioeconomic map almost exactly.” And Instacart is now able to deliver food to 97% of households across the country and, even more important, to 93% of those living in food deserts.
Aiming at that same early intervention point, one of the tools Kroger CEO Rodney McMullen mentioned that Kroger uses is “OptUp,” which gives customers a nutritional score of their shopping lists and offers suggestions for healthier alternatives. “We’re not gonna get you to go from ice cream to broccoli,” he said, “But if sugar is something you’re worried about, we can give you an ice cream that we think you’ll like equally as well that will be a little bit healthier for you.”
Driving Better Health Outcomes through Behavior Change
Just as we’ve now begun to drill down on the science of how our lifestyles affect our health, we’ve also begun to understand the science of behavior change. As Dr. Kevin Volpp at the University of Pennsylvania said, adoption rates for food programs are often lower than 50% if behavior change isn’t integrated and well understood.
At Thrive, we’re driving behavior change in three ways. First, through Microsteps. What’s most exciting about this moment is that, as big as the possibilities are for our health and our healthcare system, the best way to get there is by making the changes as small as possible. That’s the proven power of Microsteps — make the changes too-small-to-fail.
Dr. Brad Moore, co-director of the Lifestyle Medicine Program at George Washington Medical School, said he prescribes food as medicine all the time. And when he does, he says that in addition to the knowledge of why the change will be meaningful for their health, his patients need “practical knowledge about how to lower the bar and make it easier.” That’s where Microsteps come in. It’s why the behavioral science chair of Thrive’s Scientific Advisory Board is BJ Fogg, PhD, the founder and director of Stanford’s Behavior Design Lab and the author of Tiny Habits. The emphasis is on not judging ourselves — but knowing we’re all works in progress and we can make a better choice and a different swap the next day.
Second, through our partners we’re using workplaces as transmission mechanisms. While others at the conference spoke about using the government, the grocery store, the doctor’s office and community groups to bring about this culture shift — and all are necessary — the workplace is also an essential driver of change. At Walmart, we’ve brought the Thrive Challenge to their associates. By simply asking them to make one small better choice for 21 days, the results have been extraordinary — using Microsteps to change medical outcomes, including people reversing diabetes, pre-diabetes and hypertension.
And third is using the power of storytelling. On top of Microsteps, we ask people to write and share their stories. We’re social creatures and our behaviors and habits are deeply influenced by our social network and our hard-wired need to connect. By using the power of storytelling, we help create a network effect to inspire others to take Microsteps and begin changing their lives.
And we’re also building programs for our partners that show their employees how the food choices they make are directly connected with all other aspects of their well-being and their mental health. With Accenture, we created Nourish to Thrive, a cognitive nutrition program led by Thrive’s cognitive nutrition director, Tess Bredesen, and launched to Accenture’s 700,000 global employees. Through science and simple healthy eating Microsteps, we’re using the workplace as a means to help people use food as the building block of better health.
“Food Is the Greatest Bridge Builder”
One of the other themes of the discussion was the lag in the culture catching up to the science on using food as medicine. As exciting as it is to see all of this activity on intervention points like the supermarket and the workplace, one area that needs more awareness is actually the doctor’s office. As Dr. Brad Moore noted, many physicians “don’t necessarily know the power of food and lifestyle.” And when they do bring attention to food, it’s often just giving generic advice, like “try to eat better and exercise.” And medical school curricula lag behind the latest research.
It won’t come as a shock that our health insurance hasn’t caught up, either. Often, preventative services are only covered if they save money in the short term, a double standard that leads to over-coverage of low-value care and under-coverage of prevention, according to The New England Journal of Medicine. And changing that is also part of the Food is Medicine initiative. As Nancy Brown said, “We know that for Food is Medicine to become a reality, public and private insurers have to make these interventions a covered benefit, and to provide that coverage we know that insurers must have definitive scientific proof that food is medicine interventions work just as they do for traditional medications.” However, the dominant theme that ran through the entire day of lively discussion and brainstorming was what an exciting time this is. As Mikelle Moore, chief community health officer at Intermountain Healthcare, put it, “food is the greatest bridge builder.” And we can use it to travel upstream and take action on the root causes of so many chronic diseases. Or, as another prescient doctor, Hippocrates, said, “Let food be thy medicine, and let medicine be thy food.” What’s so powerful about the Food Is Medicine initiative is how it’s connecting this ancient wisdom with modern science. We know how powerful food can be in terms of shaping what the ancient Greeks called “a good life.” And we know the science behind food’s connection to our physical, mental, and cognitive health. Our challenge — and our opportunity — is to take this knowledge and turn it into action. And because the stakes are so high, let’s do it sooner rather than later. As Dr. Shah said in his closing remarks, “Let’s not let this take 10 years before we study data, think about what data means, advocate for data-driven solutions and then implement them slowly.”