Journal of Hunger & Environmental Nutrition, 4:393–408, 2009
Copyright © Taylor & Francis Group, LLC
ISSN: 1932-0248 print/1932-0256 online
WHEN1932-02481932-0256Journal of Hunger & Envir onmental Nutritio n, Vol. 4, No. 3-4, Octo ber 2009: pp. 0–0Journal of Hunger & Environmental Nutrition Agriculture Policy Is Health Policy
Agriculture Policy Is Health PolicyR. J. Jackson et al. RICHARD J. JACKSON, RAY MINJARES, KYRA S. NAUMOFF,
BINA PATEL SHRIMALI, and LISA K. MARTIN
University of California, Los Angeles, School of Public Health, Los Angeles, California, USA
The Farm Bill is meant to supplement and secure farm incomes,
ensure a stable food supply, and support the American farm
economy. Over time, however, it has evolved into a system that
creates substantial health impacts, both directly and indirectly. By
generating more profit for food producers and less for family farmers;
by effectively subsidizing the production of lower-cost fats, sugars,
and oils that intensify the health-destroying obesity epidemic; by
amplifying environmentally destructive agricultural practices that
impact air, water, and other resources, the Farm Bill influences
the health of Americans more than is immediately apparent. In
this article, we outline three major public health issues influenced
by American farm policy. These are (1) rising obesity; (2) food
safety; and (3) environmental health impacts, especially exposure
to toxic substances and pesticides.
KEYWORDS Farm Bill, obesity, environment, health
America is in the grip of a fearsome epidemic. It is an epidemic largely out
of the hands of doctors, nurses and scientists—it is the crush of chronic disease,
highlighted by the epidemic of overweight and obesity. Rising costs of
healthy food and an overall decline in Americans’ fitness make this epidemic
even more troubling. Efforts by health leaders to improve eating habits and
encourage exercise have barely moved the scales. Overwhelmed by the
challenge, increasing numbers of Americans find bariatric and “lap band”
Developed with the support of the Kellogg Foundation.
Address correspondence to Richard J. Jackson, University of California, Los Angeles, School
of Public Health, 650 Charles E Young Dr., Box 56-070 CHS, Los Angeles, CA 90095-1772.
394 R. J. Jackson et al.
surgery more viable options than improving their diets. Arrayed against
their efforts is a far larger force that makes unhealthy foods too tasty, cheap,
and abundant to resist.
This megaforce is US farm policy. How does legislation that determines
what happens on distant farms affect our bodies and our families? We argue
that US farm policy has created a food system that damages our health, our
environment, and our national security.
Much of US farm policy is driven by a complex piece of federal legisla-
tion passed by Congress every 5 to 7 years called the Farm Bill. Its most
recent iterations were the Farm Security and Rural Investment Act of 2002
and the Food, Conservation, and Energy Act of 2008. The Farm Bill is
scheduled to be renewed in 2012 and presents a remarkable opportunity to
shape our food system and our health for generations to come. What we
grow, what we eat, who will profit, the long-term availability of food, and
environmental repercussions will all be affected by the provisions of the
The Farm Bill was envisioned to supplement farm incomes, ensure a
stable food supply, and support the American farm economy. Instead, it
subsidizes the production of cheap fats, sugars, and oils that fuel obesity;
creates profit for food processors and corporate farmers; and supports agri-
cultural practices that damage the environment, with long-term conse-
quences for our health. The upcoming Farm Bill reauthorization requires
that those concerned about health and well-being become involved in this
issue and demand not only good economic policy but also sound health
In this article, we outline 3 major public health issues influenced by
American farm policy. These are (1) rising obesity; (2) food safety; and
(3) environmental health impacts, especially exposure to toxics and pesticides.
FARM POLICY & OBESITY
Two thirds of American adults are overweight and one third are obese.1
Though the prevalence of obesity remained stable through the 1960s and
1970s, America experienced an increase of more than 50% per decade in
the 1980s and 1990s. These trends have significant long-term implications
for our health and quality of life. The three leading causes of death in the
United States (heart disease, cancer, and stroke) are all associated with poor
diet and overweight.
Diabetes—America’s 6th leading cause of death—is also dramatically
rising. The term adult-onset diabetes has become Type II diabetes as more
young people develop the disease.2 If obesity trends continue, the lifetime
risk of developing diabetes will be 1 in 3 for children born in 2000.3 There is
increasing likelihood that for the first time in American history this generation
Agriculture Policy Is Health Policy 395
of children will live shorter lives than their parents.4 The young and poor
are most affected by rising obesity, but these trends hold for both sexes, all
major racial and ethnic categories, geographic regions, and socioeconomic
As Americans loosen their belts, they must also open their pocketbooks,
because poor diets create additional costs to society. Not only is poor diet
linked to the major causes of death and increased medical spending, but it
also carries other costs: overweight persons retire earlier, go into nursing
homes at younger ages, have higher absenteeism rates, and are more likely
to be disabled.5 The costs of obesity are borne not just by obese individuals
but also by the public who supports their care: half of obesity-related medi-
cal costs are borne by public systems funded by taxpayers—Medicare and
Public health professionals have achieved limited success in reversing
obesity trends. Their main efforts focus on educating the public about the
importance of individual behaviors and by supporting legislation to alter
food and physical activity environments, especially in schools. But an
unavoidable obstacle to success is the American food supply, which continues
to provide an overabundance of cheap fats, oils, and sugars.7
Typical supermarkets and convenience stores contain an abundance of
cheap, unhealthy food items. If tomorrow every American woke up and
refused to consume anything but the foods recommended by the US
Department of Agriculture (USDA) Dietary Guidelines for Americans, there
would be a catastrophic food shortage. Although the USDA guidelines rec-
ommend the consumption of fruits and vegetables as part of a balanced
diet, the food system falls drastically short of providing enough fresh fruits
and vegetables to meet their recommendations.7
The public health community has been slow to examine the link
between food policy and public health. Until now, most attempts to reverse
the American obesity epidemic have focused on changing consumer behaviors,
but the results are depressingly inadequate. Little attention has been focused
on examining the “upstream determinants”; namely, the food supply. Just as
Americans have failed to ask why there is not enough healthy and affordable
food, the public health community has failed to adequately consider what
policies are driving the obesity epidemic. By following the pathway of public
funds to what and how Americans choose to eat, one finds that American
farm and food policies are major vectors of diet-related disease.
GOVERNMENT POLICIES AFFECT WHAT CROPS ARE GROWN
ON AMERICAN FARMLAND
Fruits and vegetables are good for us. They lower the incidence and mortality
of the most common chronic diseases in America.8 Yet less than 4% of total
396 R. J. Jackson et al.
US cropland in 2004 was planted with fruits and vegetables.9 What is happen-
ing on the rest of our farmland? These acres are dominated by the 8 main
“commodity” crops (corn, wheat, cotton, soybeans, rice, barley, oats, and
sorghum). Why is this the case?
Farmers’ crop choices are influenced by a portion of the Farm Bill that
rewards certain crops over others. Government agricultural policies extend
from the 1930s when federal policy-makers passed laws to create price
stability and ensure the long-term economic viability of farming, particularly
for family farmers. But in the 1970s, farm policy shifted away from maintain-
ing stable prices to maintaining low prices and maximizing production of
certain commodity crops that could be bought and sold on the international
market. Direct payments were established to encourage competition and
increase production, thereby lowering the price of these commodities.
Farmers rely on government payments for economic stability, so they
plant the crops that farm policy encourages them to grow. Seventy to 80%
of all farm subsidies are directed toward the 8 commodity crops, which
together cover 74% of US cropland. Farmers growing “specialty crops” such
as fruits and vegetables are not eligible for direct subsidies and are
penalized if they have received federal farm payments for other crops. In
addition, large farms, which make up only 7% of the total, receive 45% of all
federal payments. Meanwhile, small farms, which are 76% of the total,
receive just 14% of the payments.10 The end result is a government-structured
food supply that heavily favors just a few crops, grown by large-scale
farming operations that fail to satisfy the healthy dietary needs of Americans
FIGURE 1 The American food supply contains too many fats and sugars and not enough
fruits and vegetables.11
Food Supply Servings compared to 2005 Dietary Guidelines for Americans
01 234 5 678 9
Vegetables - starchy (cups)
Vegetables - excluding starchy
Whole Grains (oz equivalent)
Total Grains (oz equivalent)
Servings Recommended by 2005 Dietary Guidelines for Americans
Loss-Adjusted Servings Available in Food Supply
Agriculture Policy Is Health Policy 397
Certain subsidies provide a critical safety net to family farmers, but
food processors are among those who gain the most from government
payments. Processors have profited from the conversion of these subsidized
commodities into processed foods sold at ever higher prices despite lower
nutritional content. Between 1980 and 2000, consumer food expenditures in
the United States increased two and a half times to $661 million, while the
farm value of these foods increased only one and a half times. During this
period, the proportion of each food dollar that went to farmers dropped
from 31% to 19%, meaning that 81 cents of each dollar spent on food in
2000 went to non-farm-related activities, including labor, packaging, trans-
portation, and marketing (Figure 2).12 Our food system provides greater
rewards to those who process, market, and distribute food than to those
who actually grow it.
Food processors, with proportionally more of their funds available for
marketing, have been successful at creating new foods with desirable char-
acteristics: low cost, convenience, high energy density, and appealing taste
(via added fats, sugars, salt, and artificial flavoring).13 With the additional
support of government-sponsored product and processing research at land
grant universities, these innovations use cheap agricultural inputs to make
tastier and longer lasting foods with higher profit margins. Processed grocery
foods dominate supermarket sales (Figure 3), and simultaneously the
consumption of added fats and sugars has increased (Figure 4).
Americans are eating more food, most of which is unhealthy. Between
1970 and 2000 the average consumption per person of added fats increased
FIGURE 2 From 1980 to 2000, food marketing costs increased 57% and farm value
398 R. J. Jackson et al.
38% and average consumption of added sugars increased 20% (Figure 5).
Researchers estimate that if we acted rationally and in our best interest, the
average person over age 4 would consume about 2350 calories each day.15
Yet our food supply makes available 3800 calories per person each day.
The price of fresh fruits and vegetables increased 118% from 1985 to 2000,
and the price of fats and oils increased only 35%. Consumers are price
sensitive, such that even small changes in the price of healthy foods affect
FIGURE 3 Processed grocery food sales compose the majority of supermarket sales, 2000.14
FIGURE 4 Consumption of fats, oils, and sugars has increased from 1970 to 2000.14
Agriculture Policy Is Health Policy 399
Not surprisingly, when ingredients are cheap, producers also compete by
increasing portion sizes (Figure 6).20 The cost of the food itself is small relative
to the price of preparing, packaging, shipping, and advertising, so the cost of
increasing portion size is small relative to the perceived value of larger sizes.
Cheap food inputs make it possible for food retailers to double the calories in
an item while selling it for only cents more. This profitable strategy offers con-
sumers short-term bargains but staggering long-term costs.16 While $21 billion
dollars were spent under the Farm Bill to support commodity crop production
in 2005,17 Americans are spending $147 billion a year on obesity-related ill-
nesses, not to mention the costs of time, productivity, and quality of life lost.18
Agricultural policy subsidies come at a cost to public health. The system
provides all consumers with excess fats and sugars, but especially vulnerable
are children and the poor. Lifetime dietary patterns—healthful or not—are
generally set early in life. Unhealthful patterns are important; obese children
are likely to remain obese into adulthood.20,21 Poor families who live in
FIGURE 5 The real cost of fruits and vegetables has increased and the real cost of fats, oils,
and soda has decreased.7
FIGURE 6 Overall calorie intake has increased with portion size.20
400 R. J. Jackson et al.
low-income communities often find themselves living in food deserts,
where healthy food options are unavailable but fast food abounds. Many
older citizens who live on fixed incomes must choose between medicine
and vegetables. Freedom of choice for consumers is desirable, yet we have
a food system that increasingly limits healthy choices for large segments of
the population, making unhealthy eating the default option.
FARM POLICY & FOOD SAFETY
Foodborne pathogens cause approximately 76 million illnesses, 325,000 hospi-
talizations, and 5000 deaths in the United States each year.22 This too is related
to the Farm Bill. Current US farm policies encourage a system that is both
highly centralized and relies on large amounts of imported foods. American
food travels through several stages and many miles as it journeys from farm to
table—each link presents an opportunity for food contamination. Poorly moni-
tored food imports, the threat of agro-terrorism, and our system of highly cen-
tralized food production put the safety of our food system at risk.23,24
Though foodborne pathogens most often affect raw foods of animal
origin, the 2006 Escherischia coli spinach outbreak demonstrates the vulner-
ability of our entire food system to contamination. Despite comprehensive
food safety regulations and consistent food sanitation surveillance nation-
wide, a batch of contaminated fresh spinach from a single farm in Monterey
County, California, infected 205 persons across at least 26 states in a
2-month period.25 This outbreak resulted in 102 hospitalizations and 3
deaths. How does contaminated spinach from one farm infect people all
over the country?
Spinach from California travels the country as a result of the large-scale
centralized production and distribution of our food. When American farm
policy changed in the 1970s to encourage low prices and competition
between farmers, many went out of business. The farmers who survived
were the ones who successfully increased their overall size and their investment
in technology. Since 1900, the number of farms has fallen 63% and the size
of farms has increased 67% (Figure 7).26
To reduce costs, large-scale farmers typically use highly centralized and
mechanized production practices, including confined animal feedlot opera-
tions (CAFOs) and monocultures. Though these methods are efficient, they
create conditions that put plants and animals at risk of disease and micro-
bial contamination and harm the environment. Monoculture techniques
increase the risk of crop disease and deplete nutrients in soil, requiring the
use of artificial fertilizers which evaporate, descend as acid rain, contami-
nate the water supply, and contribute to global warming.27 To promote
rapid growth, cattle are frequently fattened with large quantities of grains that
change the acidity of their digestive systems making them more vulnerable
Agriculture Policy Is Health Policy 401
to pathogenic strains of E. coli.28 Increased shedding of such pathogens in
animal waste occurs with the decline in the state of an animal’s health and
an increase in its stress levels,29 both of which are exacerbated in CAFOs.31
Inadequate manure treatment, contamination of nearby fields and water,
and contamination of slaughtered livestock are a frequently suspected
sources of contaminated foods.29,31 To maintain the animals’ health, many
producers dose the animals with antibiotics,32 a practice that poses its own
set of problems (see next section).
Centralization also creates large distribution channels through which
contaminated foods may easily spread without aggressive vigilance. Though
centralization may make detection of contaminated foods easier, potentially
more individuals are at risk if contamination goes undetected. The conse-
quences of a breach in food safety are much greater in this type of system.
This is illustrated by the recent salmonella-tainted peanut butter scare,
which sickened hundreds of people, caused several deaths, and put the
Peanut Corporation of America out of business. Smaller, more isolated food
systems are inherently less vulnerable to large-scale contamination.33 A
highly centralized structure also increases the risks of harm from deliberate
attacks. Biological agents introduced undetected into the system could
result in a major disruption of our food supply. Additionally, high-speed,
automated methods of slaughtering and food processing may make contam-
ination both more likely and more difficult to detect.34,35
New threats to food safety have also arisen from global food trade. In
2007, Food and Drug Administration officials advised consumers to discard
toothpaste manufactured in China after discovering it contained ethylene
FIGURE 7 The number of farms has declined and the average size of farms has increased.26
402 R. J. Jackson et al.
glycol, a chemical agent used in antifreeze.36 In China, the toxic ingredient
melamine found its way into milk, infant formula, and pet food, sickening
294,000 children and causing at least 6 deaths.37 Ingredients are entering the
United States from more than 100 countries with the dollar value doubling
over the past decade to $80 billion in 2006. Once these ingredients are incor-
porated into processed foods, it is difficult and often impossible to trace them
back to their source.38 As American food policies encourage the production
of few crops and rely heavily on global imports for the rest, more cases of
contamination are likely without aggressive policing and controls.
FARM POLICY & ENVIRONMENTAL HEALTH
Farm policies encouraging mass production have resulted in highly centralized
farm practices that are more likely to result in environmental degradation.
For example, fossil fuels are used to manufacture and transport fertilizer and
pesticides over long distances; the raw and then finished products are then
further transported, often back to their original locations; source water is
also transported for agriculture use; and used water is commonly contami-
nated by chemical fertilizers and pesticides with resulting downstream
“dead zones.” Ground and surface waters can also be polluted by antibiotics
from CAFOs and by antibiotic-resistant bacteria, and soil is depleted
through overuse and lack of crop rotation.
CAFOs generate enormous amounts of waste and air pollution, and
they are perhaps the most egregious example of environmental degradation
exacerbated by US farm policies. The savings to large livestock producers
feeding their animals cheap subsidized grains have driven down the price of
meats, resulting in consolidation of livestock operations. Diversified farmers,
using their own farm products and labor to raise livestock, are unable to
compete with concentrated livestock industries that benefit from cheap
inputs and economies of scale without regard to resulting environmental
CAFOs lack sewage treatment plants, yet, because a pig produces
about 4 times as much solid waste as a human, a typical CAFO of 5000
swine produces waste equivalent to a city of 20,000 people.39 This waste is
expensive to transport, store, and dispose. Storage pits for livestock or poultry
manure can leak into groundwater and streams; such pits become even
more problematic if sited in a flood plain or below the water table. CAFOs
generally produce more waste than can be used on nearby fields as fertilizer.39
Levels of phosphorus and nitrogen in the waste often exceed what the
crops can utilize or the soil can retain. Correspondingly, excess nutrients
contaminate surface waters and streams, causing algal overgrowth in nearby
water bodies that devastate underwater ecological systems. Many feed
ingredients used in CAFOs pass directly through the animal into manure,
Agriculture Policy Is Health Policy 403
including carcinogenic heavy metals (such as arsenic), antibiotics, nitrogen,
and phosphorus. The manure also contains dust, mold, pathogenic bacteria,
and bacterial endotoxins that contaminate air and water. Generally accepted
livestock waste management practices do not adequately or effectively pro-
tect water resources from contamination with excessive nutrients, microbial
pathogens, and pharmaceuticals present in the waste.40
Additionally, toxic gases, vapors, and particles are emitted from CAFOs
into the environment, including ammonia, hydrogen sulfide, carbon dioxide,
malodorous vapors, and particles contaminated with a wide range of
microorganisms.41 The negative impact of CAFOs on nearby communities is
a frequently voiced concern and is being increasingly documented.
Finally, CAFOs contribute to the health threat of antibiotic resistance.
Because large numbers of animals are kept in crowded conditions,
microbes spread easily. Though physicians receive negative attention for
contributing to antibiotic resistance by overprescribing antibiotics, antibiotics
used to produce livestock account for the largest portion of antibiotic usage
in the United States—between 60% and 80% of total nontherapeutic anti-
microbials produced in the United States are used in US livestock opera-
The World Health Organization (WHO) recently called for phasing out
the use of antimicrobial growth stimulants for livestock and fish production.43
WHO recommended that therapeutic antimicrobial agents be available only
by prescription for human and veterinary use. Additionally, concern about
the risk of an influenza pandemic led WHO to recommend that regulations
be promulgated to restrict the colocation of swine and poultry CAFOs on
the same site and to set substantial separation distances.
Aware that CAFOs present significant environmental and health risks,
legislators have addressed them in recent Farm Bills. But rather than discour-
aging their practices, the Farm Bill directed hundreds of millions of dollars
to CAFOs through the conservation title and rejected amendments, such as
the Farm Ranch Equity Stewardship and Health (FRESH) Act, that would
increase support for farmer’s using environmentally friendly practices.
Under the Environmental Quality Incentives Program, CAFOs are eligible for
up to $450,000 (75% of operating costs) to build storage facilities for animal
sewage.44 Though 3 out of 4 farmers interested in Farm Bill conservation
programs are rejected for lack of funds, it is antithetical to the protection of
the environment and health to provide funds that enable the current oper-
ation of CAFOs rather than providing incentives for them to shift toward
The price of food to consumers does not contain the true costs of its
production. The true costs include the cost of environmental cleanup, the
costs to human health of toxic exposure and a lack of clean water sources,
the costs of overusing fossil fuels, as well as the cost to future generations
of growing food with the loss of severely depleted agricultural land.
404 R. J. Jackson et al.
ENVISIONING A HEALTHY FOOD SYSTEM
Our current farm policy is contrary to our nutritional, environmental, and
economic needs. Agricultural policy should not undermine the public’s
health, especially our children’s health. Nor should it promote or allow con-
tinued degradation of our natural environment. A healthy food system
should ensure the well-being of consumers and of farmers, in addition to
the producers, processors, and distributors upon whom they depend.
Organic and regional food production are promising examples of change.
RECOMMENDATIONS: HOW CAN PUBLIC HEALTH
PROFESSIONALS TAKE ACTION?
Unhealthy people in unhealthy places cannot produce healthy food. The
health community has the responsibility to assure the conditions in which
people can be healthy. This means getting involved with agricultural policy
to influence a better food supply.
Recommendations for Personal Action
•Direct policy-makers’ and the public’s focus on the taxpayer-supported
food system; become a vocal participant in efforts to reform the Farm Bill
by writing stories, editorials, and arranging visits with policy-makers.
•Advocate more effectively for sustainable food policies, in part by providing
testimony at local, state, and congressional hearings related to these issues.
•Model “food literate” behavior by purchasing sustainably grown foods.
•Communicate the expense of our current food system in terms of taxes, ill
health, and environmental costs.
•Promote further research on health issues stemming from our current food
system, including health impact assessments and cost-benefit analyses.
•Develop case studies to identify sustainable, successful food systems.
•Support efforts to maintain strong organic certification qualifications.
•Support the labeling of dairy and meat products grown without antibiotics,
growth hormones, endocrine disruptors, and other agents of concern.
Recommendations for Institutional Action
•Promote the consumption of locally grown, humane, and sustainably
produced, healthy foods at schools and health care institutions.
•Establish comprehensive food policies on health care premises, as done at
Kaiser Permanente, to promote healthy food choices in inpatient food
Agriculture Policy Is Health Policy 405
services, cafeterias, vending machines, food carts, and catered meals; and
to support agricultural practices that are ecologically sound, culturally
appropriate, and socially responsible.
•Provide informational material on the steps an individual can take to buy
and use sustainably grown food along with other preventive health literature
in waiting rooms or on the Internet.
•Learn from the success of organizational and governmental policies that
limited contracts to facilities that were nonsmoking and disability
accessible. We suggest that all health and professional organizations try
to utilize sustainably produced foods at their meetings and lodging
Recommendations for State Agriculture Departments
•Create a multidisciplinary leadership team to lead discussions about creating
sustainable food systems and instituting incentives to develop them.
•Advocate for a “regional food system report card” and require that this
information be made available to the public.
•Develop a life cycle approach with “all cost accounting” to agricultural
decisions. Add environmental and health perspectives into all major
reports and programming.
•Make explicit and public all input in agricultural decisions, including
participation from lobbyists.
Recommendations for Policy & Regulatory Action
•Make increasing the affordability and quality of nutritious foods the goal
of farm policy.
•Revise the current Farm Bill subsidy structure to equally support naturally
grown specialty crops and cap farm payments to large operations to
support family farms.
•Focus federal research on various types of production systems that incor-
porate sustainable and healthful agricultural production.
•Increase federal research on structural interventions that reduce the health
impact of current food production systems and increase access to healthy
calories. Good models are “edible schoolyards,” community-supported
agriculture, and farmers’ markets.
•Support research into the health effects of agricultural production, including
antibiotic resistance, pesticides, toxins, hormones, corn sweeteners, grain-fed
livestock, and the true costs of “traveled” foods.
•Evaluate the costs and benefits of changes to the food system on health
care costs related to chronic disease.
406 R. J. Jackson et al.
•Allow school food programs to tailor meals to the nutritional needs of
•Support human body burden biomonitoring of antibiotics and food toxicants.
•Support transparency in food production.
•Ensure access to information or reports by communities and governments
regarding use of agricultural inputs such as pesticides (as required in
California), antibiotics, and fertilizers.
•Ensure access to information or reports on off-migration of pollutants,
antibiotics, resistant organisms, and air and water pollutants from CAFOs.
•Eliminate or revise regulations that prevent small-scale livestock operations.
•Consider the benefits of supporting small farmers, including job growth
and environmental stewardship benefits.
1. Wang Y, Beydoun MA. The obesity epidemic in the United States—gender, age,
socioeconomic, racial/ethnic, and geographic characteristics: a systematic
review and meta-regression analysis. Epidemiol Rev. 2007; 29:6–28.
2. Centers for Disease Control and Prevention. National Diabetes Fact Sheet:
General Information and National Estimates on Diabetes in the United States,
2005. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease
Control and Prevention; 2005.
3. Narayan KMV, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime
risk for diabetes mellitus in the United States. JAMA. 2003;290:1884–1890.
4. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expect-
ancy in the United States in the 21st century. N Engl J Med. 2005;352:1138–1145.
5. Popkin BM, Kim S, Rusev ER, Du S, Zizza, C. Measuring the full economic costs
of diet, physical activity and obesity-related chronic diseases. Obes Rev. 2006;7:
6. Kim S, Popkin BM. Understanding the epidemiology of overweight and obesity—
a real global public health concern. Int J Epidemiol. 2006;35:60–67.
7. Putnam J, Alshouse J, Kantor LS. US per capita food supply trends: more calories,
refined carbohydrates, and fats. Food Rev. 2002;25(3):2–15.
8. Bazzano LA. The high cost of not consuming fruits and vegetables. J Am Diet
9. Muller M, Schoonover H, Wallinga D. Considering the Contribution of US Food
and Agriculture Policy to the Obesity Epidemic: Overview and Opportunities.
Minneapolis, Minn: Institute for Agriculture and Trade Policy; 2007.
10. United States General Accounting Office. Farm programs: information on recipients
of federal payments. June 2001. Available at: http://www.gao.gov/new.items/
d01606.pdf. Accessed June 10, 2009.
11. Buzby JC, Wells HF, Vocke G. Possible Implications for US Agriculture From
Adoption of Select Dietary Guidelines. Washington, DC: Economic Research
Service, United States Dept of Agriculture; 2006.
12. Elitzak H. Food marketing costs at a glance. Food Rev. 2001;24(3):47–48.
Agriculture Policy Is Health Policy 407
13. Tillotson JE. America’s obesity: conflicting public policies, industrial economic devel-
opment, and unintended human consequences. Annu Rev Nutr. 2004;24:617–643.
14. Schoonover H, Muller M, eds. Food Without Thought: How US Farm Policy Contrib-
utes to Obesity. Minneapolis, MN: Institute for Agriculture and Trade Policy; 2006.
15. Center for Science in the Public Interest. Why it’s hard to eat well and be active
in America today. Available at: http://www.cspinet.org/nutritionpolicy/food_
advertising.html. Accessed August 30, 2009.
16. National Alliance for Nutrition and Physical Activity. From wallet to waistline: the
hidden costs of “super sizing.” Available at: http://www.preventioninstitute.org/
portionsizerept.html#summary. Accessed August 30, 2009.
17. Environmental Working Group. Total USDA subsidies in the United States.
Available at: http://farm.ewg.org/farm/progdetail.php?fips=00000&progcode=total.
Accessed August 30, 2009.
18. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending
attributable to obesity: payer- and service-specific estimates. Health Aff
19. Young MR, Nestle M. The contribution of expanding portion sizes to the US
obesity epidemic. Am J Pubic Health. 2002;92:246–249.
20. Engeland A, Bjorge T, Tverdal A, Sogaard AJ. Obesity in adolescence and adult-
hood and the risk of adult mortality. Epidemiology. 2004;15:79–85.
21. Parker Pope T. Watching food ads on TV may program kids to overeat. Wall
Street Journal. D1. July 10, 2007.
22. Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United
States. Emerg Infect Dis. 1999;5:607–625.
23. Barrionuevo A. Food imports often escape scrutiny. New York Times. May 1,
2007. Available at: http://www.nytimes.com/2007/05/01/business/01food.html.
Accessed August 30, 2009.
24. Government Accountability Office. Federal Oversight of Food Safety, Testimony
of Lisa Shames, Acting Director, Natural Resources and the Environment,
Government Accountability Office. 2007.
25. Brackett RE. FDA Statement Before the Committee on Health, Education, Labor,
and Pensions, United States Senate. Wednesday, November 15, 2006.
26. Dimitri C, Effland A, Conklin N. The 20th Century Transformation of US Agriculture
and Farm Policy. Available at: http://www.ers.usda.gov. Accessed August 30,
27. Pollan M. The Omnivore’s Dilemma. New York, NY: Penguin Press, 2006.
28. Russell JB, Rychlik JL. Factors that alter rumen ecology. Science. 2001;292:1119.
29. US Food and Drug Administration Center for Food Safety and Applied Nutrition.
The use of indicators and surrogate microorganisms for the evaluation of patho-
gens in fresh and fresh-cut produce. Available at: http://www.fda.gov/Food/
Accessed August 30, 2009.
30. D’Silva J. Adverse impact of industrial animal agriculture on the health and welfare
of farmed animals. Int Zool. 2006;1:53–58.
31. Armstrong GL, Hollingsworth J, Glen Morris J. Emerging foodborne pathogens:
Escherichia coli O157:H7 as a model of entry of a new pathogen into the food
supply of the developed world. Epidemiol Rev. 1996;18:29–51.
408 R. J. Jackson et al.
32. Wegener HC. Antibiotics in animal feed and their role in resistance development.
Curr Opin Microbiol. 2003;6:439–445.
33. Bryant J. Systems theory, survival, and the back-to-nature movement. Technol
34. Horrigan L, Lawrence R, Walker P. How sustainable agriculture can address the
environmental and human health harms of industrial agriculture. Environ
Health Perspect. 2002;110:445–456.
35. Schlosser E. Fast Food Nation. 1st ed. Boston: Houghton Mifflin; 2001.
36. Bogdanich W. Toxic toothpaste made in China is found in US. New York
Times. June 2, 2007. Available at: http://www.nytimes.com. Accessed August
37. Gossner CME, Schlundt J, Embarek PB, et al. The melamine incident: implica-
tions for international food and feed safety. Environ Health Perspect [serial
online]. Available at: www.ehponline.org/members/2009/0900949/0900949.pdf.
Accessed August 30, 2009.
38. Barrionuevo A. Globalization in every loaf. New York Times. June 16, 2007.
39. Walker P, Rhubart-Berg P, McKenzie S, Kelling K, Lawrence RS. Public health
implications of meat production and consumption. Public Health Nutr. 2005;8:
40. Burkholder J, Libra B, Weyer P, et al. Impacts of waste from concentrated
animal feeding operations on water quality. Environ Health Perspect. 2007;115:
41. Heederik D, Sigsgaard T, Thorne PS, et al. Health effects of airborne exposures
from concentrated animal feeding operations. Environ Health Perspect.
42. Chapin A, Rule A, Gibson K, Buckley T, Schwab K. Airborne multidrug-resistant
bacteria isolated from a concentrated swine feeding operation. Environ Health
43. Gilchrist MJ, Greko C, Wallinga DB, Beran GW, Riley DG, Thorne PS. The
potential role of concentrated animal feeding operations in infectious dis-
ease epidemics and antibiotic resistance. Environ Health Perspect. 2007;115:
44. United States Department of Agriculture, Natural Resources Conservation Service.
At a glance: environmental quality incentives program. Available at: http://www.
Accessed August 30, 2009.
45. Imhoff D. Food Fight: The Citizen’s Guide to a Food and Farm Bill. 1st ed. Healds-
burg, Calif: Watershed Media; 2007.