Currently browsing posts about: GAO(Government Accountability Office)

II.  The need for nutrition science leadership in promoting policies to prevent and treat disease

Three-quarters of American adults are overweight or obese and at increased chronic disease risk, yet nobody is screaming much about it (except for the MAHA people).

As the Government Accountability Office put it in 2021,  “federal strategy needed to coordinate diet-related efforts.”

Chronic health conditions (like heart disease, diabetes, cancer, and obesity) are costly and deadly—causing over half of U.S. deaths in 2018. They also exacerbated the pandemic: Americans with such conditions were 12 times more likely to die after contracting COVID, according to the CDC.

Yet chronic conditions are largely preventable with a healthy diet and other behaviors like exercise. The federal government leads 200 different efforts, spread across 21 agencies, to improve Americans’ diets. But agency efforts are fragmented and there are gaps in key scientific research, including for children. A strategy for working together could help.

In its recommendations, the GAO says:

Congress should consider identifying and directing a federal entity to lead development and implementation of a federal strategy for diet-related efforts aimed at reducing Americans’ risk of chronic health conditions.

The GAO comments:

The White House sponsored a conference on Hunger, Nutrition, and Health on September 28, 2022. In advance of that event, the White House released a national strategy aimed at ending hunger in America and increasing healthy eating and physical activity by 2030. [Note: I wrote about these events extensively.  For example, here]

However, we do not believe the White House strategy satisfies our matter because it does not contain the necessary information about outcomes and accountability, resources, and leadership. In particular, without designated leadership, it may be difficult to sustain the strategy over time. Therefore, as of March 2024, the matter remains open.

In October 2024, it still remains open.  I see this as an urgent priority.

Tomorrow: Personalized nutrition

While producers of sugar cane celebrated National Real Sugar Day on October 14, the New York City Council voted to require chain restaurants to post warning labels on sodas and other menu items that exceed to-be-defined limits on added sugars.

Mayor Eric Adams signed the Sweet Truth Act, which gives the city until 2024 to set standards and design the icon, and gives chain restaurants until 2025 to comply.

Meals at fast food and fast casual restaurants can be exceedingly high in added sugars, amounts that far exceed the FDA’s daily recommendation for consumption of 50 grams per day. Even most “small” fountain sodas sold at leading fast food chains contain more than a day’s worth of added sugars. Added sugars have been linked to weight gain in children and adults. Sugary drinks may also contribute to type 2 diabetes and heart disease.

In a video, New York City Health Commissioner, Dr. Ashwin Vasan, explains why sugar redction is a good idea.

Where is the FDA in all this?  It held a public meeting on the need for sugar reduction.  What it will do as a result remains to be seen, but the New York City action is surely a nudge.

In the meantime, the Government Accountability Office has some things to say about the U.S. Sugar Program.  It sums up the issues concisely.

The Department of Agriculture administers the U.S. sugar program to support domestic sugar production through tools such as limiting the supply of sugar.

The program creates higher sugar prices, which cost consumers more than producers benefit, at an annual cost to the economy of around $1 billion per year.

The program also restricts the amount of sugar entering the U.S. at a low tariff. The tariff restrictions are applied using a method based on 40-year-old data that doesn’t reflect current market conditions. This has led to fewer sugar imports than expected.

We recommended that USDA evaluate its method for restricting imports.

Comment: Here is a situation in which policies for sugar production and import intersect with policies for sugar and health in peculiar ways.  The objective of import policies is to restrict them in order to keep prices higher as a means to protect domestic sugar producers.

Ordinarily, food policies are designed to keep prices low—but not in this case (chalk this up to effective lobbying by cane and beet sugar producers, and the power of lobbyists in sugar-producing states).

Also ordinarily, higher prices would reduce demand, but sugar prices are nowhere near high enough to influence demand, which is one reason why this system continues.

Current policies are estimated to cost the public as much as $3.5 billion a year; divided by 350 million Americans means that the policies cost you an extra $10 per year for the sugar you buy—nowhere near enough to affect consumption.

Disparate goals for sugar are yet another reason why a single food agency overseeing the entire food system would be useful for reconciling these kinds of problems.

One of the great tragedies of the Trump Administration was its attempt to thoroughly destroy the Economic Research Service by moving it out of Washington DC to Kansas City, Kansas.

I wrote about this repeatedly a few years ago (see links at end)) as did—and does–AgriPulse.

USDA should have planned better for staff attrition when it moved the Economic Research Service and National Institute of Food and Agriculture to Kansas City,  in 2019, the Government Accountability Office says in a new report that notes the department “minimally involved employees, Congress, and other key stakeholders in relocating the agencies.”  The controversial moves during the Trump administration were vocally opposed by many employees and outside groups that said USDA had not adequately justified its decision.

The GAO has now documented exactly what critics predicted.

Coinciding with the loss of staff in fiscal years 2019 and 2020, ERS produced fewer key reports, and NIFA took longer to process grants…Two years after the relocation, the agencies’ workforce was composed mostly of new employees with less experience at ERS and NIFA than the prior workforce.

In addition, a decline in the number of employees in certain protected groups persisted. For example, the proportion of Black or African American staff at NIFA declined from 47 percent to 19 percent (see fig.).

The report says ERS has recovered.  I disagree.  As far as I can tell, ERS still produces basic reports on farming but is no longer producing the kind of hard-hitting critical analyses of food and farming issues that it used to.  I miss it.  A lot.

Some (not all) previous comments on the ERS move

• We now have a chance to repair the damage done to the Economic Research Service
• One more time: the Economic Research Service tragedy
• The tragic destruction of the Economic Research Service, Continued
• USDA’s destruction of the Economic Research Service: A National Tragedy

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For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

The Government Accountability Office has produced a “snapshot” on Healthy Eating: Government-wide solutions for promoting healthy diets, food safety, and food security.  It’s only two pages; take a look.

As of July 2022, many of our recommendations for developing strategies on healthy eating have not yet been addressed.

1. Strategy Needed to Address Diet-Related Chronic Health Conditions
Three diet-related chronic health conditions (cardiovascular diseases, diabetes, and cancer) were among the 10 leading causes of death in 2018, according to CDC. Men, Black or African Americans, and people living in southern states had disproportionately higher mortality rates from diet related conditions. Dietary changes could have prevented some of these deaths.

Additionally, in 2018, about three in four adults in the U.S. had excess weight, which can be associated with poor diet and lead to cardiovascular diseases, diabetes, and cancer.

The GAO recommends that the federal government establish leadership for strategies:

• On diet-related efforts
• Food-safety oversight
• Nutrition assistance programs to respond to emergencies

Excellent suggestions.  If only they could be implemented.

The Government Accountability Office has just issued this report:  Evidence-Based Policy Making: USDA’s Decision to Relocate Research Agencies to Kansas City Was Not Fully Consistent with an Evidence-Based Approach

You may recall that in October 2019, USDA relocated most Economic Research Service staff positions from Washington DC to Kansas City, MO.  At the time, USDA Secretary Sonny Perdue said the move would save taxpayers more than $300 million over ten years.

This defied credulity.  The real reason had to be that politically appointed USDA officials wanted to destroy the ERS.  Its economists produce reports that tell truths inconvenient for political expediency.

An easy way to destroy an agency is to move it half way across the country.  That way three-quarters of the professional staff would quit or retire.

I considered this move a national tragedy, and said so repeatedly.

• September 21, 2018  USDA’s double-speak proposal to “improve” the ERS: brute-force politics
• May 28, 2019 USDA’s destruction of the Economic Research Service: A National Tragedy
• June 18, 2019 The tragic destruction of the Economic Research Service, continued
• July 10, 2019 One more time: the Economic Research Service tragedy  
• August 6, 2019 The true purpose of moving the ERS out of DC: “Drain the Swamp”
• May 28, 2019  USDA’s destruction of the Economic Research Service: A National Tragedy
• June 18, 2019 The tragic destruction of the Economic Research Service, continued
• September 30, 2020 The Counter investigates: the Economic Research Service’s shameful downfall
• February 17, 2021  We now have a chance to repair the damage done to the Economic Research Service

The GAO is more polite than I am.  Here is a summary excerpt from the report’s Highlights.

USDA’s stated objectives for relocation were to improve its ability to attract and retain highly-qualified staff; place its resources closer to stakeholders and consumers; and reduce costs to taxpayers.

However, GAO found that the economic analysis did not fully align with those objectives. ..USDA omitted critical costs and economic effects from its analysis of taxpayer savings, such as costs related to potential attrition or disruption of activities for a period of time, which may have contributed to an unreliable estimate of savings from relocation.

Overall, GAO found that USDA’s development and usage of evidence had significant limitations… As a result of the weaknesses GAO found, USDA leadership may have made a relocation decision that was not the best choice to accomplish its stated objectives.

But it did achieve its unstated objective: to weaken, if not destroy, ERS.   This agency is still publishing reports, but most of them are uncontroversial estimates of food production and use.  Occasionally I see glimmers of the kinds of reports the agency used to produce.  Let’s hope more of them are on their way.

Chronic (“noncommunicable”) diseases—heart disease, cancer, and diabetes—account for half of annual deaths in the United States at enormous physical and economic cost to individuals and to society.  These conditions are related to diet; obesity is a risk factor for all three.

Despite the widespread prevalence of obesity (the CDC says 73.6% of American adults are overweight or severely overweight) and its associated chronic conditions, no concerted government effort is aimed at prevention.

This is also true on the international level.  The UN’s Sustainable Development Goals barely mention reduction of noncommunicable diseases.  You have to go to the fourth sub-goal of SDG 3, Good Health and Well-Being, to find:

By 2030, reduce by one third premature mortality from non-communicable disaeases through prevention and treatment and promote mental health and well-being.

Why is so little attention focused on diet-related conditions?  To prevent them, people have to eat more of healthier foods and less of unhealthier foods—public health measures strongly opposed by the food industry.  [For detailed evidence on this point, see Swinburn BA, et al.  The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report.  Lancet. 2019;393:791-846].

Representatives Rosa DeLauro and Tim Ryan have the same question.  They asked the Government Accountability Office (GAO) to look into government efforts to prevent chronic disease.

The result: Chronic Health Conditions:Federal Strategy Needed to Coordinate Diet-Related Efforts.

It’s not that the US government ignores chronic disease; on the contrary.  The GAO identified an astounding 200 federal efforts to reduce these conditions—but fragmented among an even more astounding 21 federal agencies.

Most of these are focused on research.

These programs are all over the place, and nobody is in charge.

Agency Officials Say They Lack Authority to Lead a Federal Strategy on Diet:  Despite their support for a federal strategy to coordinate diet-related efforts, no agency officials we interviewed asserted that their agencies had the authority to lead a federal strategy that would have reasonable assurance of being sustained across administrations. Officials from six agencies said they would not have the authority, and officials from the remaining 10 agencies said they did not know or were not in a position to comment. Some officials stated that they would have the authority to lead a strategy for their agency alone but not for the entire federal government.

The GAO came to the obvious conclusion.

Congress should consider identifying and directing a federal entity to lead the development and implementation of a federal strategy to coordinate diet-related efforts that aim to reduce Americans’ risk of chronic health conditions. The strategy could incorporate elements from the 2011 National Prevention Strategy and should address outcomes and accountability, resources, and leadership.

Leadership!  Here’s my list.

• Say what a healthy diet is in plain English.
• Tell the public to avoid or minimize ultra-processed foods.
• Establish policies—from agriculture to public health—to promote healthful diets and discourage unhealthful diets.

This will take courage.  Hence: Leadership.

Food safety seems very much on the agenda this week.

The Government Accountability Office (GAO) has released its latest biennial High Risk list of programs “vulnerable to fraud, waste, abuse, and mismanagement, or that need transformation.”

Of interest is this listing: Improving Federal Oversight of Food Safety. The report finds not much change from goals set two years ago; the goal for an action plan is still not met:

Without a government-wide performance plan for food safety, Congress, program managers, and other decision makers are hampered in their ability to identify agencies and programs addressing similar missions and to set priorities, allocate resources, and restructure federal efforts, as needed, to achieve long-term goals. Moreover, without a centralized collaborative mechanism—like the FSWG [Food Safety Working Group]—to address food safety, there is no forum for agencies to reach agreement on a set of broad-based food safety goals and objectives that could be articulated in a government-wide performance plan on food safety.

The GAO explains why inadequate federal oversight of food safety poses a high risk.  Safety issues, it says,

are governed by a highly complex system stemming from at least 30 federal laws that are collectively administered by 15 federal agencies. For more than four decades, we have reported on the fragmented federal food safety oversight system, which has caused inconsistent oversight, ineffective coordination, and inefficient use of resources. We added federal oversight of food safety to the High-Risk List in 2007. In recent years, moreover, we have made recommendations aimed at helping to reduce fragmentation in federal food safety oversight. As of November 2018, two of three recommendations related to this high-risk area had not been implemented.

In 2017, I wrote about how the GAO has been calling for decades—more than 40 years—for better coordination of food-safety oversight, and my post lists a selection of GAO reports dating back to 1970.

The GAO is still at it.

We should not give up either.

The Government Accountability Office (GAO) has a new report out calling for better federal oversight of memory supplements.

These are a growing market with sales estimated at $643 million in 2015, almost double since 2006.

FDA and FTC share oversight of memory supplement labeling and advertising, respectively, but neither approves claims in advance.  For this, thank the Dietary Supplement Health and Education Act of 1994 which pretty much lets supplement makers claim whatever they like for their products, as long as they word the claims carefully.

GAO found ads for memory supplements claiming that they would boost, enhance, improve, increase, or maintain a healthy memory.  They also made claims related to general brain health, cognitive function, and well-being.

Amazon sells these things. It advertises them like this:

Brain and Memory Booster – All Natural Formula- Brain supplement helps improve memory, mood, clarity and focus and protect against mental decline, depression, anxiety.

Do they work?

Alas, no, according to Consumer Reports.  But that doesn’t stop Americans from spending $91 million on them in 2015.

Really, something needs to be done about DSHEA.

Here’s the GAO report: Memory Supplements: Clarifying FDA and FTC Roles Could Strengthen Oversight and Enhance Consumer Awareness.
GAO-17-416.

• Report: http://www.gao.gov/products/GAO-17-416
• Highlights: http://www.gao.gov/assets/690/684621.pdf
• Podcast: http://www.gao.gov/multimedia/podcasts/684501