What is the inter-relationship between food and medicine? At various points in history, such as in the Byzantine empire, food and medicine were seen as almost the same thing. The basic idea was that medicine and food both performed the same function of balancing bodily humors. In contemporary countries, such as the US, many people are aware that food has a significant impact on health. But, I think that it’s fair to say, food and medicine are increasingly construed as very different things. Crudely speaking, medicine is a public good that requires great scientific expertise; food is a private affair that depends on different people’s cultures, whims, and private financial resources.
I want to discuss a new policy development that raises questions about what the inter-relationship between food and medicine could and should be. This policy development has largely been overlooked by philosophers. But, I will argue, it raises interesting theoretical questions about the framing of public policies, feasibility, and justice.
California recently piloted a program called “Food is Medicine” that will run from 2018-2021. It provides free healthy meals to 1,000 Medicaid patients with the chronic healthcare condition of congestive heart disorder. The program was inspired by a study that was done by a nonprofit organization in Philadelphia called the Metropolitan Area Neighborhood Nutrition Alliance (MANNA). This study tried to determine the health impact of providing three healthy meals a day to a sample group of chronically ill Medicaid recipients over a 12-month period. The diet provided was optimal for their health condition which requires, amongst other things, having a low sodium diet. When compared to the control group, the sample group’s average monthly healthcare costs were approximately $13,000 less per month, and they had 50% less hospital visits and these visits were 37% shorter.
The Food is Medicine program will cost Californian tax pays $6 million. One of its aims, however, is to reduce healthcare costs to tax-payers particularly those resulting from the hospitalization of Medicaid patients with congestive heart disorder—a healthcare condition that has one of the highest rates of hospital readmissions within 30 days. The evidence from the MANNA pilot study very strongly suggests that providing free healthy food to certain patients on Medicaid with congestive heart disorder, would reduce health care costs and produce at least as good health outcomes.
Casting the argument for providing access to healthy food as a means of reducing health costs and improving healthcare outcomes has a number of appeals. In a political context it is rhetorically powerful because many people, of different ideological persuasions, are motivated to reduce healthcare costs. Relatedly, from a more theoretical perspective, it would be appealing to political philosophers, working broadly in the post-Rawlsian tradition of Public Reason, who think that public policies should be compatible with reasonable pluralism: the policy is one that people with different comprehensive conceptions of justice (e.g., Rawlsians, Utilitarians, etc.) can reach a consensus about or at least converge on for different reasons. Even certain libertarians who don’t think that the state should provide free healthcare could agree that the policy is better than the status quo in so far as it reduces healthcare costs.
More generally, the Food is Medicine program suggests that there might be certain advantages of casting food polices within a medical paradigm. Access to food has increasingly been politicized. For instance, in the UK it has been argued that more and more people’s increasing dependence on food banks demonstrates the inadequacies of conservative politics. When access to free food is provided through institutions such as food banks it is conceptualized as a discretionary act that is provided by a group of people to help another group of people in need. Consequently, it is often viewed as stigmatizing or demeaning. In contrast providing access to healthy food through medical institutions, allows us to conceptualize the provision of food as a type of communal or public good. Accordingly, it holds out the promise that some of the stigma surrounding policies that promote access to healthy food can be eroded. For access to such food can be conceptualized as a public good that people are owed—rather than merely given.