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Monday, April 23, 2007

Infant Deaths and Obesity

Brad DeLong posts the dismal statistics about the increasing infant death rate in the South in recent years. When I read the article, I was struck by how much of the blame for the rise in infant mortality was placed on obesity and hence, I thought, on the individuals themselves for making bad food choices. For example, the article says:

In Turnabout, Infant Deaths Climb in South - New York Times: ...[I]n what health experts call an ominous portent, ... the [infant] death rate has risen in Mississippi and several other states.

The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors, and, many doctors say, the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds. ...

Doctors who treat poor women say they are not surprised by the reversal. “I think the rise is real, and it’s going to get worse,” said Dr. Bouldin Marley, an obstetrician at a private clinic in Clarksdale since 1979. “The mothers in general, black or white, are not as healthy,” Dr. Marley said, calling obesity and its complications a main culprit.

Obesity makes it more difficult to do diagnostic tests like ultrasounds and can lead to hypertension and diabetes, which can cause the fetus to be undernourished, he said. ...

Visits with pregnant women and mothers in several Delta towns suggest that many poverty-related factors — including public policies, personal behaviors and health conditions — may contribute to infant deaths.

Krystal Allen ... was 17 when she had her first baby. ... Ms. Allen greeted visitors with breakfast in hand: a bottle of Mountain Dew and a bag of chips. Janice Johnson, a social worker ..., urged her to eat more healthily. “I’m going to change my diet one day,” Ms. Allen replied. ...

I didn't post the article because I thought it placed too much of the blame on personal choices - factors such as obesity - rather than cuts in social programs (which is what Brad focuses on - also, see this accompanying picture to the article which also highlights obesity).

But should we blame personal choices for part of the increase in infant deaths? Did the poor suddenly change their behavior and start eating more and less healthy food, or was the change in the number of overweight people in the poor population a consequence and rational response to cuts in social programs? This helps to put it in perspective and notes that if you are poor, "the most rational economic strategy is to eat badly":

You Are What You Grow, by Michael Pollan, NY Times: A few years ago, an obesity researcher at the University of Washington named Adam Drewnowski ventured into the supermarket to solve a mystery. He wanted to figure out why it is that the most reliable predictor of obesity in America today is a person’s wealth. For most of history, after all, the poor have typically suffered from a shortage of calories, not a surfeit. So how is it that today the people with the least amount of money to spend on food are the ones most likely to be overweight?

Drewnowski gave himself a hypothetical dollar to spend, using it to purchase as many calories as he possibly could. He discovered that he could buy the most calories per dollar in the middle aisles of the supermarket, among the towering canyons of processed food and soft drink. ... Drewnowski found that a dollar could buy 1,200 calories of cookies or potato chips but only 250 calories of carrots. Looking for something to wash down those chips, he discovered that his dollar bought 875 calories of soda but only 170 calories of orange juice.

As a rule, processed foods are more “energy dense” than fresh foods: they contain less water and fiber but more added fat and sugar, which makes them both less filling and more fattening. These particular calories also happen to be the least healthful ones in the marketplace, which is why we call the foods that contain them “junk.” Drewnowski concluded that the rules of the food game in America are organized in such a way that if you are eating on a budget, the most rational economic strategy is to eat badly — and get fat.

This perverse state of affairs is not, as you might think, the inevitable result of the free market. Compared with a bunch of carrots, a package of Twinkies, ... is a highly complicated, high-tech piece of manufacture, involving no fewer than 39 ingredients, many themselves elaborately manufactured, as well as the packaging and a hefty marketing budget. So how can the supermarket possibly sell a pair of these synthetic cream-filled pseudocakes for less than a bunch of roots?

For the answer, you need look no farther than the farm bill. .... Among other things, it determines which crops will be subsidized and which will not, and in the case of the carrot and the Twinkie, the farm bill as currently written offers a lot more support to the cake than to the root. Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat — three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades — indeed, for about as long as the American waistline has been ballooning — U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy. ...

The result? A food system awash in added sugars (derived from corn) and added fats (derived mainly from soy), as well as dirt-cheap meat and milk (derived from both). By comparison, the farm bill does almost nothing to support farmers growing fresh produce. A result of these policy choices is on stark display in your supermarket, where the real price of fruits and vegetables between 1985 and 2000 increased by nearly 40 percent while the real price of soft drinks (a k a liquid corn) declined by 23 percent. The reason the least healthful calories in the supermarket are the cheapest is that those are the ones the farm bill encourages farmers to grow.

A public-health researcher from Mars might legitimately wonder why a nation faced with what its surgeon general has called “an epidemic” of obesity would at the same time be in the business of subsidizing the production of high-fructose corn syrup. But such is the perversity of the farm bill... And the subsidies are only part of the problem. The farm bill helps determine what sort of food your children will have for lunch in school tomorrow. ... The farm bill essentially treats our children as a human Disposall for all the unhealthful calories that the farm bill has encouraged American farmers to overproduce. ...

    Posted by on Monday, April 23, 2007 at 03:32 PM in Economics, Social Insurance | Permalink  TrackBack (0)  Comments (60)

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