The Democratic debate on health care has todate centred around who should be covered and who should pay the bill. Thatdebate, which has been going on for decades, has no clear answers and cannot beeasily resolved because of two fundamental realities: Health care is expensive,and Americans are sick.

Instead of debating who should pay for allthese, no one is asking the far more simple and imperative question: What ismaking us so sick, and how can we reverse this so we need less health care? Theanswer is staring us in the face, on average three times a day: our food.

Poor diet is the leading cause of mortalityin the United States, causing more than half a million deaths per year. Just 10dietary factors are estimated to cause nearly 1,000 deaths every day from heartdisease(心血管疾病), stroke and diabetes alone. Theseconditions are dizzyingly expensive. Cardiovascular disease costs $351 billionannually in health care spending and lost productivity, while diabetes costs$327 billion annually. The total economic cost of obesity is estimated at $1.72trillion per year, or 9.3 per cent of gross domestic product.

Fortunately, advances in nutrition scienceand policy now provide a road map for addressing this national nutritioncrisis. The \"Food Is Medicine\" solutions are win－win, promoting better well－being, lowerhealth care costs, greater sustainability, reduced disparities among populationgroups, improved economic competitiveness and greater national security.

Some simple, measurable improvements can bemade in several health and related areas. For example, Medicare, Medicaid,private insurers and hospitals should include nutrition in any electronichealth record; update medical training, licensing and continuing educationguidelines to put an emphasis on nutrition; offer patient prescription programmesfor healthy produce; and, for the sickest patients, cover home－delivered, medically－tailored meals. Justthe last action, for example, can save a net $9，000 inhealth care costs per patient per year.

Taxes on sugary beverages and junk food canbe paired with subsidies on protective foods like fruits, nuts, vegetables,beans, plant oils, whole grains, yogurt and fish. Emphasizing protective foodsrepresents an important positive message for the public and food industry thatcelebrates and rewards good nutrition. Levels of harmful additives like sodium,added sugar and trans fat can be lowered through voluntary industry targets orregulatory safety standards.

The private sector can also play a keyrole. Changes in shareholder criteria and new investor coalitions shouldfinancially reward companies for tackling obesity, diabetes and other diet－related illness. Public－private partnershipsshould emphasize research and development on best agricultural and food－processing practices. All work sites should demand healthy food whennegotiating with cafeteria vendors and include incentives for healthy eating intheir wellness benefits.

Government plays a crucial role. Thesignificant impacts of the food system on well－being,health care spending, the economy and the environment—together with mountingpublic and industry awareness of these issues—have created an opportunity forgovernment leaders to champion real solutions.

Yet with rare exceptions, the currentpresidential candidates are not being asked about these critical nationalissues. Every candidate should have a food platform, and every debate shouldexplore these positions. A new emphasis on the problems and promise ofnutrition to improve health and lower health care costs is long overdue for thepresidential primary debates and should be prominent in the 2020 generalelection and the next administration.