One nation, ultra-processed

In the era that has brought us a reality-star presidency, it is no surprise that the goal seems to be more about getting visibility and clicks than actual national health improvement. While the cameras were rolling for raw meat smoothies at the White House and RFK Jr. busting out 20 half-rep truly disappointing pull-ups at the airport, Congress allowed Affordable Care Act subsidies to expire, guaranteeing higher premiums for millions of people next year. There are also massive cuts happening to both the SNAP and Medicaid programs that support the most vulnerable in our population - those who cannot access sufficient food or medical care without pubic intervention. A symbolic performance of “wellness” on one side; concrete acts of policy negligence on the other.

In a most nonsensical exploration of how far we can take the concept of “personal responsibility”, we tell people to meditate, hydrate, read labels, log steps, manage stress, overhaul their diets—meanwhile the policies shaping their actual health outcomes are being quietly dismantled or blocked in Congress.

These policy decisions have real consequences for millions of families who sit in that uncomfortable space where they earn too much to qualify for Medicaid but too little to absorb the swelling price of private insurance. Those programs didn’t solve every problem, but they kept millions afloat in a system that grows more expensive by the year. When medical costs rise, people delay care. They skip appointments and stretch medications. They gamble with their lives because they have to. When food costs rise, people gravitate toward the cheapest sources of calories - driving them away from healthier options and toward the ultra-processed foods that fill our hospitals with ballooning rates of cancer, type 2 diabetes, cardiovascular issues and dementia.

Individual behavior accounts for roughly 20 percent of our overall health outcomes. That’s it. The other 80 percent comes from what we call the social determinants of health: whether you have stable housing, safe neighborhoods, reliable transportation, access to quality food, clean air, decent wages, and affordable care. But even that language is too gentle. These conditions don’t fall from the sky; they are shaped by laws, budgets, zoning decisions, subsidies, enforcement priorities, and political will. They are the political determinants of health. We live and die inside policy architecture.

Let me be clear: I am absolutely a proponent of wellness. I believe wholeheartedly in doing everything that empowers you to become the healthiest version of yourself to the extent your genetics, circumstances, and season of life allow. I practice that in my own life, and I encourage it in others. I am a supplement loving, self-care pushing, physical movement touting purveyor of nutrition. All of these things matter so much - but wellness is a complement to a functioning health system, not a replacement for one. You can optimize every habit available to you and still run headfirst into the limits of the environment you live in. Wellness can support a person but policy shapes the population.

If that feels abstract, look closer at our food environment.

Philip Morris, perhaps best known for killing us with tobacco for 175 years, played a major role in creating the ultra processed food system we live with today. In the 1980s, the tobacco giant purchased General Foods and Kraft, and for years it controlled some of the largest packaged food brands in the country. The company brought its cigarette playbook into the grocery aisle. It engineered foods for maximum craveability, pushed aggressive marketing toward children and low income communities, and helped normalize an entire category of products that were built for profit rather than nourishment. Philip Morris eventually spun off its food companies, but the products, formulas, and marketing strategies the company shaped remain embedded in the industry. The modern ultra processed food landscape did not happen by accident. It followed a design created by corporations that understood how to build dependency and demand.

Cedar Rapids’ economic backbone includes major ultra-processed food manufacturers like PepsiCo (Quaker Oats) and General Mills. These companies employ thousands, support local projects, and serve as economic anchors. But they also produce foods engineered for shelf life and hyper-palatability, not nourishment. Studies have linked high intake of ultra-processed foods to increased risks of colorectal, breast, and pancreatic cancers—three of the most common cancers in states like Iowa—as well as obesity, diabetes, and early mortality. These associations aren’t fringe findings; they appear in cohort after cohort, across decades of data.

When a region’s economic security is tied to the success of ultra-processed food production, holding those companies accountable becomes politically inconvenient. Several years ago, I attended the Iowa Governor’s Conference on Public Health. Audience members were aghast when a public health official from a small town stated from the podium that she had to be “careful” when talking about all of the illness, injury, and death related to the local processing plant because they were also the area’s biggest employer and economic engine. Public Health didn’t feel comfortable protecting the PUBLIC from the CORPORATION. That’s not corruption, it’s structural dependence. And it’s exactly how a food system becomes an economic system, becomes a political system, becomes a public-health crisis.

Other cities are beginning to confront this dynamic head-on. San Francisco recently filed a landmark lawsuit against major ultra-processed food corporations including Pepsi and General Mills, arguing that these products have directly contributed to chronic disease burdens and strained public health systems. The case echoes the early tobacco litigation years ago: the moment when the official narrative begins to shift from “this is your fault” to “this was engineered, marketed, and permitted by powerful systems.”

Ultra-processed foods don’t just affect the individual body. They reshape entire communities because they dictate what’s available on shelves, what’s affordable for families, what’s advertised, what kids grow up thinking is normal, and what workers experience inside production plants. They affect energy, cognition, sleep, mood, productivity, and long-term health risks. When an economy becomes ultra-processed, the community eventually does too.

And so we arrive at the heart of the problem: the United States keeps trying to solve structural issues with individual solutions. We tell people to do better, to try harder, to take their health “into their own hands.” But those hands are tied by policy every single day. You cannot willpower your way out of housing insecurity. You cannot journal your way out of environmental toxins. You cannot green-smoothie your way out of unaffordable health care or a food landscape dominated by hyper-processed products - especially if you can’t even afford the spinach.

We have built a country where life expectancy is lower than peer nations, maternal mortality is shockingly high, and chronic disease is widespread- all while we spend more per capita on health care than any other wealthy nation. These outcomes are not accidents. They are legislative, regulatory, economic, and budgetary choices.

Personal wellness has its place. It genuinely matters. But it cannot do the job of health policy. Until we invest in environments that make health possible, no amount of disciplined living will compensate for a system designed to produce illness.

The health of this country will not change until we elect people who acknowledge that health is political, are invested in real outcomes instead of PR, and act accordingly.