Fruit and vegetable consumption by state

Real Vermonters eat their fruits and vegetables, do their exercises and don’t care much for Big Macs.

At least in comparison with most other Americans.

It isn’t that plenty of people in Vermont don’t swill sugared sodas, eat in fast food restaurants, or chow down on platefuls of fried foods while sitting in front of the TV. But either they do it less, or fewer of them do it, or both, according to figures compiled by the U.S. Department of Agriculture and collected in the Food Environmental Atlas.

Available for free on line, the Atlas contains detailed county-by-county information about where and what people eat, how much they spend on food, how extensively poverty affects their diet, whether they get much exercise, and the extent to which they have diet-related health problems.

On almost all counts, Vermont emerges as one of the healthier states, in part because Vermonters seem to try harder than most other Americans to eat a healthier diet and get some exercise.

The Atlas does not provide exact national or statewide statistics, at least not as could be discovered by your less-than-brilliant on-line operative, who also failed to reach an Agriculture Department spokesperson.

But the maps, with color-coordinated rankings by county, added to the county-by-county statistics, leave little doubt that Vermonters have relatively healthy eating habits.

Take fast-food restaurants.(Please!). In Lamoille County there are (or were in 2008) 21 of them, or 0.855 per thousand residents. That’s on the high side for Vermont. There were 0.738 per thousand in Chittenden County, 0.793 in Windsor, and only 0.393 per thousand residents of Caledonia County.

Most of the rest of the country seems to need a lot more. Far and away the champ fast-food county is San Juan County, Colorado (Silverton is the County seat), where there are 7.117 fast food restaurants for every thousand people. That’s twice the ratio of the runner-up, Norton County, Virginia (yup, the county seat is Norton, too; nope, I don’t know where it is, either) where there are a “mere” (compared with San Juan County) 3.235 fast food joints per thousand folks.

Perhaps because there weren’t that many fast food places, Vermonters spent relatively little in them, less than $400 per person per year, a level of restraint matched only by their fellow-Americans in Idaho, Wisconsin, Iowa, Pennsylvania, New York and New Jersey. The big fast-food spenders. Shelling out more than $500 a head, were in California, the Southwest, the Midwest, the deep South, and – go figure – Massachusetts.

Along with Maine, Wisconsin, and several states in the northern Rockies, Vermont has the highest percentage of adults (more than 70 percent)  deemed to be “exercising enough,” though it was not clear what constituted “enough” or who determined what constituted it.

At any rate, exercise is one of those areas in which Vermont might look good only in relation to the rest of the country. Statewide (because the number was the same for every county) 48 percent of Vermont high school students are physically active. That put Vermont in the top rank, along with North Dakota, Wyoming, Utah, Oklahoma, and Iowa.

But less than half of high school students are physically active?

That’s scary. Throw away their computers, or at least their computer games.

There is too much information in too many categories in every county to deal with it all here. Anyone who is interested can find the Atlas, either at the Agriculture Department site through usa.gov, or just by Googling Food Environment Atlas, and find out all sorts of stuff about his or her county and its eating/spending/exercise habits.

Suffice to say that Vermont comes across as the state whose residents drink less soda, eat less meat and more vegetables, buy food directly from a local farm, and take care of themselves than most other Americans.

Raising some troubling questions: Do Vermonters enjoy themselves? Of are they a bunch of eat-your-spinach, life-is-serious, let’s-find-only-the-nutrition-and-not-the-flavor-in-our-food wimps? Do they spend so much time at the gym (remember, the adults seem to exercise more than the teenagers) that they’ve forgotten the joy of sitting around a fine dinner table covered with a touch of wretched excess (in moderation, to be sure)?

The Food Environment Atlas does not directly answer that question. But the Atlas does contain one hint, and it’s a hopeful one. Vermonters may spend less money than most Americans at fast food joints, but it ranks high in full service restaurants per thousand people, and is one of only 21 states where folks pay more than $500 a year per capita in restaurants.

Where they might actually be enjoying themselves over good food and drink.

Before state boosters get what the late, great boxing trainer Whitey Bimstein used to call “a swelled head,” the Atlas shows that while Vermonters may be less likely to be obese or diabetic than most other Americans, neither are they all that unlikely to be obese and diabetic.

In Windsor County, 7.1 percent of adults are diabetic, according to the Atlas, and 22.8 percent obese. Almost ten percent of low-income pre-schoolers are obese. Those numbers are higher in Caledonia County.

And however low Vermont’s obesity and diabetes rates may be compared to other states, they are higher than they used to be, according to figures released last week by the Attorney General’s office and the Department of Health.

There’s nothing peculiar to Vermont about these increases, and according to Kelly Brownell of Yale University’s Rudd Center, who was in Montpelier last week, one reason is that more people are eating more fatty, sugary, processed foods, and for good reason. They’re cheaper.

Between 1985 and 2000, Brownell said, the price of fruits and vegetables rose 117 percent, compared to 46 percent for sugars and sweets and only 20 percent for soft drinks. Markets work. When a commodity’s price goes up, consumption of it goes down. When the price goes down (relative to inflation and alternative prices) consumption goes up.

Markets, but not free markets. Soda is cheap because of government subsidies to agriculture. Having, so to speak, sown, Americans now reap, even Vermonters, if a little less so.

Mt. Mansfield. photo by Jared C. Benedict

Today’s opus will be presented as three un-related chapters, each with its own title, as follows:

1—Vermont the Healthy?

Among Vermont’s other distinctions, it seems to be Number One in health-consciousness.

In the latest Gallup-Healthways Well-Being Index, Vermont scored 69.1 on the “healthy behavior index score,” higher than it did last year and 1.3 clicks ahead of second-place Hawaii.

This does not prove that Vermonters are healthier than anyone else. In fact it doesn’t prove anything; it’s survey research, which provides indications, not incontrovertible fact.

The indications are that Vermonters take care of themselves better than other Americans. They are less likely to smoke, more likely to exercise, most likely to eat lots of fruits and vegetables.

That’s the good news. The not-so-good news is that being best in America does not necessarily men being very good. Overall, the survey found that the “nation as a whole (is) dropping substantively on the Healthy Behavior Sub-Index, from 63.7 in 2008 to 62.6 in the first half of 2009.” In fact, “Mississippi, whose score ranks among the bottom 10, is the only state to record a statistically significant increase in its healthy behavior score.”

So there’s little justification here for Vermonters getting a swelled head about their (relatively) good habits. To begin with, there doesn’t seem to be all that much specifically “Vermontish” in these results. Almost all the states in the Northeast scored reasonably well, as did the Rocky Mountain states and the West Coast (except Washington State and Nevada.). To some extent, then, being health-conscious is a regional habit.

And probably an educational habit. More than 35 percent of adult Vermonters graduated from college, more than in all but five other states. College graduates tend to be more health conscious, not to mention more affluent. Not only do they know that they ought to go to the gym, they can afford the membership.

On the other hand, Vermont is the most rural of the states in the top ten, and there is ample evidence (such as this 2005 study in Pennsylvania) that rural residents don’t have the healthiest habits. They are more likely to smoke, less likely to exercise, and they gobble up lots of fried foods.

Meaning that perhaps it is the residents of Chittenden County and a few others outposts who take good care of themselves. But the survey didn’t get down to the county or town level.

The Gallup survey says it provides “a daily measure of people’s well-being…based on the World Health Organization (WHO) definition of health as not only the absence of infirmity and disease but also a state of physical, mental and social well-being.”

Whereupon we segue, as the TV folks would say, into……

CHAPTER TWO: VERMONT THE GOOD?

One way lots of Vermonters stay healthy is by doing stuff outdoors. That’s not in the Gallup survey, but we know from many sources that people in this state are more likely than most other Americans to hike and camp out, to paddle a kayak or canoe, to work in their gardens or in the woods.

Now comes evidence that all this activity not only helps make a person healthier. It can him or her a better person – kinder, more generous, less selfish. Contact with nature, says a new study “brings individuals closer to others, whereas human-made environments orient goals toward more selfish or self-interested ends.”

A bit of skepticism is in order here. Psychology lacks the precision of physics. Studies such as this one – conducted by psychologists Netta Weinstein, Andrew K. Przybylski, and Richard M. Ryan – sometimes conclude with the conclusions the studiers wanted to find before they started.

But these folks have credentials – Weinstein is a clinical psychologist at the University of Rochester – and their findings sufficiently intrigued the editors at the interesting, lively, new Miller-McCune Magazine that they wrote about them in an article called “Immersion in Nature Makes us Nicer.”

Why would it? Writer Tom Jacobs reports that “Weinstein and her colleagues suggest the answer lies in an enhanced sense of personal autonomy. ‘Nature affords individuals the chance to follow their interests and reduces pressures, fears, introjects and social expectations,’ they write.

Introjects? A term the meaning of which seems to be in dispute but is related to making too big a deal of oneself.

If both un-confirmable and un-refutable, the notion does seem to make some sense. Not there aren’t some very nice couch potatoes and a few avid white-water paddlers who are real stinkos, but connecting with the natural world (and this includes spending time with your house plants)would seem to reduce stress, encourage a contemplative outlook, and keep one on an even keel (except, literally, in that kayak in white-water).

And speaking of even keels, we segue to….

CHAPTER THREE: ET TU JACOBE?

Did everybody note that even Gov. Jim Douglas would not come right out and say what he (almost surely) knows is true: that this business about “death panels” in the proposed health care legislation is some combination of dishonesty and insanity?

Asked about it at his press conference last week, the Governor, as reported by Terri Hallenbeck of the Burlington Free Press in the paper’s Vermont Buzz blog, would only note that the argument was “an example of the kind of rhetoric that’s distracting us from fundamental reform.”

“But he did not come out and denounce the death-panel debate nor would he say he felt confident the proposed legislation didn’t include death panels,” Hallenbeck wrote. “He said that like most members of Congress he had not read every word of the legislation.”

No condemnation here of Douglas, who was doing what he had to do. Oh, it would have been admirable for him to have said (in somewhat more diplomatic language), “this stuff is crazy.”

But that would have been dangerous, and what is interesting is why it would have been dangerous.

In the latest polling on the subjects (NBC News/Wall Street Journal), 45 percent of the respondents said they thought the health care proposals before Congress “Will allow the government to make decisions about when to stop providing medical care to the elderly.”

Those proposals will allow no such thing.

Checking the polls’ “internals, “ it’s reasonable to conclude that the percentage in Vermont is smaller, probably closer to a third, roughly the percentage of Vermonters who voted for John McCain last year.

In other words, that third is Douglas’s base. A politician can not afford to tell his base that they are (not to put too fine a point on it and using the term in its colloquial rather than its clinical context) out of their minds.

Or, more gently, that they have allowed themselves to believe outright lies.

But maybe “allowed is less accurate than “affirmatively chosen” to believe outright lies, which leads to the question of why so many people would so choose.

A complicated question, perhaps pursued another time. Meanwhile ponder what it means that a sane and responsible governor fears to suggest that some of his constituents are acting in a manner neither sane nor responsible.

Adam Smith

It’s the State Senate’s turn this week to try to raise money, and among other revenue sources, the senators have their eyes on soda pop and candy bars.

The money that would be raised from making those two items subject to the state sales tax would not be huge. But these days, every penny counts, and besides, in this case money isn’t the only object. This is a tax designed to change the way people behave.

It’s simple market economics. Make a product more expensive (by levying a tax) and fewer people will consume it. And at least according to many doctors and nutritionists, less consumption of snack foods and sodas means less obesity, less heart disease, less diabetes, and therefore lower health care costs all around.

It’s a win-win-win.

Except for those in the soda, candy, and other snack food business, of course. And except for those – which in this state is a lot of people – who bristle at the idea of government trying to meddle in peoples personal lives. If your house is your castle, isn’t your digestive system your inner courtyard, into which you may admit whatever you choose?

Whereupon we return to the discussion of last week (April 14, Doing What We Wanta) about just what the state should and should not do to influence what its citizens do and do not do.

It is a discussion in which (and in this it is hardly unique, or even unusual) partisans on both sides often descend into silliness, making exaggerated claims and proclaiming broad truths which turn out to be…well, neither broad nor truthful.

Consider, for instance, the claim of some economists that the only legitimate purpose of taxation is to raise government revenue. This is obviously nonsense. It is arguably the wisest policy that taxation only be used to finance the government. But a democracy may choose to use the tax system for any purpose it pleases, and this society has always used it to create incentives for what it deems socially desirable behavior.

The biggest of those incentives probably benefit everybody reading this. Those are the tax deduction for home mortgage interest and local property taxes. They were designed to encourage home ownership. They do. One reason so many Americans own their homes is that home ownership is subsidized.

These subsidies are not entirely equitable. More than 80 percent of the $160 billion in the revenues lost from these deductions goes to the richest 20 percent of the taxpayers. That means if your income is something like $60,000 or $70,000 you’re helping subsidize the home ownership of somebody earning $300,000 or so. And the mortgage interest deduction might have been one cause of the housing “bubble” partly responsible for the recession. Either way, it is tax policy with a social purpose.

But that’s still not the same as using tax policy to influence whether or not a person ingests a legal substance into his or her body. If the state is going to  follow that policy, is it not introducing a new intrusion into the realm of individual choice?

No. First of all, nobody is proposing actually to limit choice. Candies and colas would remain legal and available, just a few cents more expensive. Besides, Vermont already levies a tax on something many of its citizens regularly ingest, and one purpose of that tax is to minimize said ingestion. That’s the tax on alcoholic beverages. Most states tax beer, wine, and liquor both to raise revenue and limit consumption. But not all do.

Vermont is one of only ten states that levies a sales tax on neither soda nor candies. Many states tax both of them.

There is, of course, an inherent contradiction involved in levying a tax in hopes of reducing demand for the product being taxed. In theory, at least, the more successful the tax is at discouraging consumption, the less revenue the tax will bring in.

That is not what has happened with higher tobacco taxes. As cigarette taxes have gone up, smoking has gone down, especially among young people . But the tax revenue has increased. In Vermont, for instance (this is from an anti-smoking outfit, but based on government statistics) , since the cigarette tax went up 60 cents a pack in 2006, cigarette consumption is down by 14.6 percent  (from education and persuasion, as well as higher taxes) ,but revenue from the tax is up by 30 percent.

But tobacco taxes have gone up a lot. The tax bills before the Vermont Legislature (H.149 for sodas; H392 for sodas and snack foods; access to all bills here) would simply end the sales tax exemption for sodas and “snack foods” (potato and corn chips, cheese puffs, pork rinds, processed fruit snacks et al). That’s six cents on the dollar.

Still, if this is a matter of principle, the money would be irrelevant. If this is a question of the autonomy of the individual to make his or her own decisions in the free market, who among the champions of individual autonomy and the free market could approve of such taxation?

Uhhh, how about Adam Smith?  ”Sugar, rum, and tobacco,” wrote the first great champion of capitalism, “are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.”

Prescient, wasn’t he?

The interesting question in this debate is just how individual these consumption decisions really are, and here is where both sides go to extremes. The anti-sugar campaigners (“food police,” or perhaps just “busybodies”) suggest that corporate villains are duping children into eating and drinking stuff that’s bad for them. The other side scoffs that no one is forced to eat or drink anything, and that people are responsible for their own decisions.

But why does this have to be an either/or situation? Obviously no one is prying open anyone’s throat and pouring colored corn syrup down his gullet, and everybody bears some responsibility for deciding what to eat or drink.

On the other hand, there is little doubt that the soda and candy industries target their marketing to children and young teenagers, who are not entirely responsible for their own decisions. As an article in the New England Journal of Medicine (NEJM) pointed out, there is an “information asymmetry between the parties to a transaction. In the case of sugared beverages, marketers commonly make health claims (e.g., that such beverages provide energy or vitamins) and use techniques that exploit the cognitive vulnerabilities of young children, who often cannot distinguish a television program from an advertisement.”

Besides, it turns out that more people drink sodas because they’re actually cheaper than they used to be, and one reason they’re cheaper is government policy. It was Richard Nixon’s agricultural policy that inspired farmers to grown corn “fence row to fence row.” All that corn made high fructose corn syrup cheap. High fructose corn syrup, which in the view of some nutritionists is especially unhealthy (more unhealthy than getting the same number of calories from another product; see here) is the main sweetener used in sodas and many other sweets.

So government farm policy could be partially responsible for  what Kelly D. Brownell and Dr. Thomas R. Frieden, call the “obesity epidemic” in their NEJM article. Just how responsible is open to debate. So, perhaps, is the designation of the current obesity situation as an “epidemic.”  But some connection is hard to deny. When it comes to eating and drinking in this country, Perhaps all of us are not quite the autonommous individuals we like to think we are.