Obesity, diabesity, food deserts and food swamps co-exist across America, factors that cost the U.S. economy over $327 billion a year just in the costs of diagnosed diabetes. In addition, America’s overweight and obesity epidemic results in lost worker productivity, mental health and sleep challenges, and lower quality of life for millions of Americans.
Food — healthy, accessible, fairly-priced — is a key social determinant of individual health, wellness, and a public’s ability to pursue happiness.
There’s a lot the U.S. can learn from the food culture, policy and economy of Italy when it comes to health.
This week, I have the honor of being a part of a contingent of Italian friends in Philadelphia welcoming two esteemed members of Italy’s medical community to my hometown: Dr. Walter Ricciardi, who leads the Istituto Superiore di Sanità (Italy’s National Institute of Health); and, Dr. Cesar Faldini, president of the Istituto Ortopedico Rizzoli in Bologna, a top hospital, academic and research center for orthopedics and trauma.
Anticipating this meeting, I wrote this appreciation about what I believe American healthcare can learn from Italy in terms of how Italians make health via a key social determinant that bolsters public and individual wellness and resilience: good food, and especially Slow Food.
First, some health-economic context: note Italy’s health system performance compared with other OECD countries, pictured in the first image. Italy scores above-the-OECD-average for life expectancy, fewer deaths from heart disease, healthy weight (measured by obesity rate), and universal health insurance coverage via a national health service. [Health insurance coverage is also an important social determinant of health, but for this post, I’ll forgo that discussion — albeit a key pillar of a healthy community].
Now look out image #2: the proportion of GDP spent on healthcare by OECD nation. In 2016, the U.S. ranked as the biggest spender, allocating 17.8% of national spending on healthcare. Italy spent 8.9% of its GDP on healthcare.
The simple math is that Italy devoted 50% less as a proportion of its national economy on healthcare as America did.
Yet Italians lived longer, healthier lives than Americans. In fact, life expectancy in Italy was the second highest among all the EU countries right after Spain, the OECD noted in this report on the state of health in the European Union.
Of the many social determinants of health that make a healthy citizenry, food systems play a primary role in Italians’ health and quality of life…and especially, Slow Food.
The third image depicts an illustration drawn during the Florentine Renaissance for De medicina, a text of Cornelius Celsus who lived between 14 BC and AD 37 and as a broad-thinking Renaissance Man, researched agriculture, medicine, and philosophy among his many intellectual interests. Celsus composed De medicina largely based on the teachings of Hippocrates.
Book I of the eight volumes Celsus wrote covered diet, hygiene, and the benefits of exercise.
Fast-forward two thousand years, and we’re still preaching the benefits of nutrition and physical activity. The Slow Food movement grew out of this understanding, beginning in Italy in 1986 in response to a McDonald’s franchise opening in Rome.
Carlo Petrini, a journalist, organized a group of people to greet passersby near the Spanish Steps where the fast-food restaurant was planning to open, passing out bowls of penne pasta.
“We don’t want fast food,” they said. “We want slow food.”
Thus the Slow Food organization was born, inspiring branches around the world, from towns from “A” to “Z” — from Adelaide, Australia, to Zagreb, Croatia. In fact, there are over 1,500 Slow Food “convivia,” or chapters, around the world.
Back to Italy, the birthplace of Slow Food, then inspired another “slow” phenomenon that can profoundly impact good health: Slow Medicine.
The first mention of Slow Medicine was in an Italian medical journal on cardiology, published sixteen years after the birth of Slow Food.
Dr. Alberto Dolara, an Italian cardiologist, wrote in the Italian Heart Journal (translated into English), “In clinical practice, hyperactivity is often unnecessary. Adopting a strategy of ‘slow medicine’ may be more rewarding in many situations. Such an approach would allow health professionals and in particular doctors and nurses, to have sufficient time to evaluate the personal, familial and social problems of the patient extensively, to reduce anxiety whilst waiting for non-urgent diagnostic and therapeutic procedures, to evaluate new methods and technologies carefully, to prevent premature dismissals from hospital and finally to offer an adequate emotional support to the terminal patient and their families.”
Note the three Italian words below the snails in the Slow Medicine image: “Sobria, Rispettosa, Giusta.” In English, these are,
– Respectful, and
Imagine if…in the U.S. doctor-patient relationship, we adopted “measured” medicine, in not over-treating or wasting resources, but using the right therapy and technology in the right patient at the right time? What if we baked respect into our system, between physicians and patients, between professionals at-work, where individuals’ values and desires were given voice? What if the U.S. health system embraced equity, first being honest about our health disparities and implementing policies and practices to eliminate those disparities, realizing quality, affordable care for all?
Health Populi’s Hot Points: In full transparency, while I hold a U.S. passport as an American citizen, I am also a citizen of Italy. As such, I am a citizen of the EU. In the EU, people who live in the community are also known as “health citizens.”
We are not really health citizens in America. We don’t have what Dr. Ricciardi recently spoke about in this video — “la salute e uguale per tutti” — health and equality for all.
Dr. Ricciardi’s remarks were part of this campaign, shown here. Translated into English, the two sentences say:
Health is the same for everyone, and a right to be spread through Italy.
Do it with a kiss, like a virus that is good for our country and an appeal that cannot be stopped.
Would that we in America could embrace such a public health message for all.