5 A Day Wake up Call

We, as an industry, must question our assumptions about 5 A Day – if it works, how it works and what can make it work better. That is the implication of the data contained in the release of the latest update of the California Dietary Practices Survey, published by the California Department of Health Services.

The numbers, for those who wish to see increased produce consumption, are pretty grim. In 1997, on a typical summer or early autumn day – a time of year when produce consumption is apt to be highest – California adults were eating only 3.8 servings of fruits and vegetables a day. This brought consumption back to the levels achieved in 1989 – the first year in which the state survey was conducted.

Only one-third of adults hit the 5 servings-per-day level, and another one-third ate 2 servings or fewer.

The report is significant because it is in California that the 5 A Day program was born. Long before it was launched nationally, it was humming in California. So, the fact that per capita consumption is down where the 5 A Day message has been promoted longer and more thoroughly than in other states should serve as an important industry wake-up call. The industry puts not only time but also intellectual energy into the 5 A Day program. If it is not working, we need to figure out why and revamp our efforts.

The California report offers an important clue as to where the problem may lie: “Adults from households with an annual income less than $15,000 reported very low fruit and vegetable consumption. In fact, their intake was almost a half serving lower than in 1989.”

This point is enlightening. If overall consumption is back at the levels experienced in 1989, but those with incomes under $15,000 per annum are down from 1989 levels, that means that, as a group, the rest of the population is up.

Normal year-to-year fluctuations are not really of great concern. I never believe the studies to begin with when they show dramatic one-year increases. Dietary habits change slowly, and anyone who expects otherwise is setting the 5 A Day program – or for that matter, any produce marketing program – up for failure. This being said, consumption patterns can change over a decade, and if they are not changing our way, we need to look carefully at the reasons why.

The population living in households with incomes of less than $15,000 is not a random selection. In some cases the lower consumption numbers may not be a consequence of poverty, but a cause. Perhaps people who do not eat in a healthy manner, including those with low produce consumption, fall ill frequently. Being ill they find it difficult to work consistently and, thus, have low incomes.

In an effort to help meet the nutritional needs of the poor, the federal government established the Women, Infants and Children (WIC) program. WIC supplements the diets of children and mothers with healthful foods. The irony of the program, however, is that fresh produce, an inexpensive and invaluable source of good nutrition, is not included. Perhaps here is an opportunity to make the consumption of fresh produce habitual among low-income consumers.

Equally persuasive, however, is the possibility that just as F. Scott Fitzgerald claimed the rich are different from you and me, so may be the poor. In fact, in our highly mobile society, poverty can be a consequence of one’s inability to process information. Some people have difficulty learning the “rules” which help one avoid poverty: stay in school, show up for work, etc. It is possible that the booming economy of late 1997 had pulled out of this low-income group those most able to absorb information, leaving behind a group of people tremendously handicapped by poor information-processing abilities. Reaching these individuals and changing their behavior is an enormous challenge. But we ought to take advantage of established opportunities, such as WIC, as well as to look at more innovative ways to change behavior among the poor.

Furthermore, it may also be where we can do the most good. The report contains a number of recommendations for addressing the consumption decline. Most of these are unobjectionable: fast food establishments should push produce, the industry should advertise more, etc. From a public health standpoint, however, a new, much more intensive intervention is required to reach low-income households.

It goes much beyond produce: the best way to reduce the problem of poverty is to prevent people from becoming poor in the first place. Our collective experience with welfare has shown how difficult this is to do. It is difficult because people with poor information-processing abilities tend to respond best to messages communicated over a lifetime. So strong families that teach their children the right things to do, go to school, don’t have children out of wedlock and, yes, eat your vegetables, are the key to reducing poverty and improving the health of the poorest of Americans.

If I take issue with the report’s recommendations, it is its failure to address these issues. The notion that children can grow up in families in which drug addiction, teenage pregnancy and idleness are the norm but somehow they will remember to eat their broccoli simply boggles the mind.