Around the world, people are developing non-communicable diseases linked to poor diets, at alarming rates. Evidence suggests this has led to a significant increase in the lethality of COVID-19 and the cost of the pandemic to people, institutions, economies, and to society as a whole. It is important to note: It is not the person who is ill that is at fault. Structural incentives and direct public investment have created unhealthy food systems, where consumers often do not have enough good information or enough good options.

Sarah Bosely, writing in The Guardian, reports:

The failure of governments to tackle a three-decade rise in preventable diseases such as obesity and type 2 diabetes has fuelled the Covid-19 pandemic and is stalling life expectancy around the world, a comprehensive study has found.

The latest data from the Global Burden of Disease study, published in the Lancet medical journal, is from 2019, before Covid, but helps explain the world’s vulnerability to the virus.

The Lancet article itself finds:

What GBD 2019 does suggest is that the global health community needs to radically rethink its vision. An exclusive focus on health care is a mistake. Health is created from a broader prospectus that includes the quality of education (primary to tertiary), economic growth, gender equality, and migration policy.

This conclusion is immediately relevant to national strategies to address COVID-19. Although attention should be given to controlling community transmission of severe acute respiratory syndrome coronavirus 2 and protecting those most vulnerable to its consequences, success will require a more capacious strategy. COVID-19 is a syndemic of coronavirus infection combined with an epidemic of non-communicable diseases, both interacting on a social substrate of poverty and inequality. The message of GBD is that unless deeply embedded structural inequities in society are tackled and unless a more liberal approach to immigration policies is adopted, communities will not be protected from future infectious outbreaks and population health will not achieve the gains that global health advocates seek. It’s time for the global health community to change direction.

Structural inequities built into the integrated economic, industrial, agricultural, and trade systems, create heightened vulnerability for people without the means to avoid certain threats. This human health crisis is also a threat to the stability of economies, financial systems, and nation states. The COVID-19 pandemic emergency has also shown this syndemic of converging threats—NCDs, the Novel Coronavirus, structural inequities, and degraded resilience strategies—is far more costly in life and wellbeing than it needs to be.

Governments have a responsibility to shift incentives away from practices that degrade wellbeing and resilience at both the macro and micro scales, and to invest in strategies that build resilience for people, for public health broadly, and for humanity’s relationship with natural systems.

The United States is suffering a particularly high toll of infection and death, in part from the slow and inconsistent federal response, but also likely as a result of enhanced vulnerability due to a national non-communicable disease crisis.

In August, Akash Goel, Michel Nischan, Bill Frist and Tom Colicchio published an article titled “The US food system is killing Americans“. They cited a 2018 study that found only 12% of Americans are metabolically healthy. Among the findings:

less than 1 percent of obese adults are metabolically healthy. On the other hand, people who exercise more appear to have higher levels of metabolic health.

There is clear and mounting scientific evidence that the massive projected costs of COVID-19—projected lost economic opportunity of up to $82 trillion over 5 years—would have been significantly reduced if more people were surrounded with better, healthier food options and structural incentives conducive to metabolic health and overall resilience.

A recent article in the Journal of the American Medical Association describes the SARS-CoV-2 or COVID-19 pandemic as “the greatest threat to prosperity and well-being the US has encountered since the Great Depression”. It also found:

The total cost is estimated at more than $16 trillion, or approximately 90% of the annual gross domestic product of the US. For a family of 4, the estimated loss would be nearly $200 000. Approximately half of this amount is the lost income from the COVID-19–induced recession; the remainder is the economic effects of shorter and less healthy life.

This is in addition to the more than $6 trillion spent by the US Treasury and the Federal Reserve Bank in April to stave off economic collapse and mitigate those costs.

The shocking resilience costs—multifaceted, compounding costs of degraded resilience—of widespread diet-related chronic disease and the “syndemic” or perfect storm of converging disease threats points to an urgent need to shift national policy to create better local outcomes. The costs of business as usual are too high. We need a food system where healthy, sustainably grown food is available, and affordable, for everyone.