Toward an Emerging Public Health Paradigm: Agriculture and Food Production for Health.

An emerging paradigm in public health focuses on enhancing nutrition in existing food staples to reduce chronic disease at the population scale, rather than relying on individuals to change their behavior. This paradigm leverages plant and animal breeding, production practices, and processing to enhance nutrition, whereby foods consumed by millions can be improved at low incremental cost. This article supports and operationalizes this paradigm, illustrating the potential to improve diets through a case study that increases the arabinoxylan fiber content of commodity wheat through classical plant breeding (a non-GMO technology). The approach described in this article proposes to link agricultural and food science with health system implementation to deliver equitable access, improved healthcare outcomes and cost savings, and improved community health. Based on published dose-response relationships, comparative risk modeling indicates that modest fiber increases achieved by the commodity wheat breeding led to reduced population-level risks of 1-3% for cardiovascular disease, 3-4.5% for type 2 diabetes, and 1-3.5% for colorectal cancer, translating into substantial healthcare cost savings when implemented at a national scale. This article outlines possible low-risk pathways for implementing these nutrition increases at the population scale through commodity supply chains and community-level nutrition improvement efforts and evaluates the ranges of potential population-level impacts.