Introduction
Over 9 billion land animals are slaughtered for
food annually in the U.S.,1,2 approximately 1
million per hour. The U.S. is home to only
about 5% of the global population but produces nearly
15%of the world’s meat supply,3 and the average American
consumes 110 pounds of red meat and 74 pounds
of poultry per year.4 Global demand for meat has
increased substantially in recent decades. Between 1975
and 1990, per capita meat consumption increased an
estimated 1.4% per year.5 World meat production is
expected to double by 2020 in part due to national
and international regulations that allow animal agribusiness
to externalize costs and to aggressive corporate
marketing campaigns.7–10 For example, the U.S.
Federal Government subsidy system and food assistance
programs heavily promote the production and distribution
of meat and dairy products,11–17 over plant-based
foods.
Recently an investigation of a California dairy cow
slaughter plant by the Humane Society of the U.S.
(HSUS) documented the abuse and slaughter of cows
too sick or injured to walk, leading to the recall of 143
million pounds of beef in February 2008, the largest in
U.S. history.18 The investigation raised considerable
concern about the safety of the meat supply, including
inadequate regulatory oversight by the U.S. Department
of Agriculture (USDA), partly due to the high
throughput of animals slaughtered for food.
Climate Change and Environmental Degradation
As a result of the steady rise in animal-product promotion
and demand, traditional farming practices in the
latter half of the last century were replaced in the U.S.
largely by immense, intensive animal operations; in the
developing world, they are being replaced at a rate of
more than 4% a year.6 The industrialization of animal
agriculture is an important contributor to global environmental
degradation and climate change.19
Animal agriculture accounts for 37%, 65%, and 64%
of anthropogenic methane, nitrous oxide, and ammonia
emissions, respectively, from ruminant fermentation,
livestock waste, fertilizer use and other factors.20
Methane and nitrous oxide have 23 and 296 times,
respectively, the global warming potential of CO2.20 In
2006, the UN Food and Agriculture Organization
(FAO) declared that animal agriculture contributes
18% of annual anthropogenic greenhouse gas emissions,
measured in CO2-equivalents, more than that of
the worldwide transportation sector.20 The public
health effects of climate change are already being felt
around the world and the UN Intergovernmental Panel
on Climate Change projects that they will worsen
considerably.21–26
Animal agriculture constitutes 30% of the total land
surface, the largest use of land by humans.20 Thirtythree
percent of total arable land is used to produce
feedcrops,20 with energy input that far outweighs the
output. Approximately 70% of previously forested land
in the Latin American Amazon is used as grazing
pastures, with the remainder being used largely for
feedcrop production.20 Annually in the U.S., 45 milliontons of plant protein are used to produce 7.5 million
tons of animal protein.27 Most of this plant protein
could instead be consumed directly by humans and
could, in part, alleviate some growing concerns about a
global food shortage.
Animal agriculture consumes 70% of the fresh water
and contributes extensively to land, air, and water
pollution.20 Pesticides and fertilizers, including manure,
may contaminate waterways. In the U.S., animal
agriculture is responsible for 37% of pesticide use and
32% and 33%, respectively, of the nitrogen and phosphorus
loads found in fresh water sources.20 Surveys in
North Carolina and Iowa found substantial increases in
asthma symptoms in children residing near industrial
pig operations and decreased quality of life measures in
surrounding communities.28–30 The combined environmental
impact of animal agriculture has led the
FAO to declare in 2006 that “the livestock sector
emerges as one of the top two or three most significant
contributors to the most serious environmental problems,
at every scale from local to global.”20
Emerging and Re-Emerging Infectious Diseases
In 2004, the WHO, the World Organization for Animal
Health, and the FAO reported that the increasing
global demand for animal protein in the human diet,
associated with the expansion and intensification of
animal agriculture, long-distance live-animal transport
and other factors, were in part responsible for the
emergence of zoonotic diseases.31 Industrial agriculture
practices have been blamed for the emergence of
bovine spongiform encephalopathy, multidrug-resistant
foodborne bacteria, and highly pathogenic strains of
avian influenza.32
An estimated 76 million Americans are stricken with
a foodborne illness every year.33 Worldwide, foodborne
microbial disease kills an estimated 20 million people
annually, with animal products topping the list of
causes.34 The global rise in the incidence of foodborne
diseases is attributed to greater consumption of animal
products, the intensification of farm operations, and
rising temperatures.35,36
Annually, more than a ton of farm-animal manure is
produced per capita in the U. S.37 Farm-animal manure
is the source of more than 100 zoonotic pathogens,38
which may contaminate food and water supplies.
Manure-contaminated irrigation water, for example,
was likely the source of the largest recorded outbreak of
Escherichia coli O157:H7, affecting more than 7000
schoolchildren in Japan.39
Under conditions ripe for zoonotic pathogen emergence
and transmission, such as the high-density confinement
of farm animals under unhygienic conditions,
6 farm animal growth rates may be impaired in
light of the infectious load to which they are exposed.
This may be mitigated by a constant influx of growthpromoting
antibiotics.40 Half of all U.S. antimicrobials
are fed to farm animals.41,42 The mass use of clinically
significant antibiotics in animal agriculture selects for
drug-resistant pathogens and mobile genetic elements
carrying resistance determinants that may be responsible
for the majority of the increases in antibioticresistant
human isolates reported.43,44
Chronic Diseases
Historically, chronic diseases, including obesity, have
plagued the developed world, whereas developing
countries have been more affected by communicable
diseases. However, obesity and chronic diseases are
increasingly a concern in developing nations.10 An
estimated 65% of U.S. adults are overweight or obese,45
and globally, more than 1 billion adults are overweight.
46 Especially concerning is the increasing global
prevalence of childhood obesity.46 Obesity increases
the risk for diabetes, arthritis, asthma, hypertension,
and hypercholesterolemia.47Worldwide, cardiovascular
disease, cancer, and diabetes are three of the four main
causes of death.48
The worldwide transition from a predominantly
plant-based diet to a diet high in meat has been
identified as a noteworthy contributor to the rise in
chronic disease.10,49 Animal products are the main
source of saturated fats that promote cardiovascular
disease49 and the sole source of cholesterol intake.
Comparative studies reveal that those who follow plantbased
diets generally have lower weights than those who
do not,50,51 even across ethnic groups.50 While not
conclusive, evidence suggests that the increase in worldwide
obesity and diabetes may in part be associated with
increased animal-product consumption, in addition to
decreased exercise and other factors.10
The classic study by Armstrong and Doll52 revealed
significant association between meat consumption and
colon cancer incidence in over 25 countries. Studies in
Japan revealed a rising incidence in colorectal cancer
with greater adoption of Western dietary habits and
consumption of meat, milk, eggs, and fats and oils.53,54
Other studies revealed similar associations between
rising meat consumption in Asian countries and colon
cancer incidence and/or mortality.55,56 Although confounding
factors must also be considered, these and
other studies collectively provide strong evidence of the
causal link between meat and colorectal cancer.57–59 In
2007, the World Cancer Research Fund and the American
Institute for Cancer Research panel report concluded
that there was convincing evidence to limit red
meat intake, completely avoid processed meat, and
follow a plant-based diet to reduce the overall risk for
cancer.59
Consumption of various animal products is also
associated with increased risk for other cancers. Endometrial
cancer risk is associated with increased intake oftotal energy, fat, and protein from animal sources.60 A
meta-analysis found an increased endometrial cancer
risk with increased meat, particularly red meat, consumption.
61 Dairy-product consumption has been associated
with prostate cancer62–64; the European Prospective
Investigation into Cancer and Nutrition study of
142,251 men found that high intake of dairy calcium
and protein increased the risk of prostate cancer.65
Calcium from nondairy foods was not associated with
increased cancer risk. In recent studies, breast cancer
risk has been associated with higher intake of processed
meat, total meat, and/or red meat,66–69 and with
higher intakes of total and saturated fats.69
Healthcare costs attributable to meat consumption
are substantial, estimated in the U.S. at between $29
billion and $61 billion per year, in 1992 dollars.70 In
contrast, many studies suggest that those who consume
plant-based diets have decreased risk, mortality, and/or
progression of cardiovascular disease,71–73 diabetes,74
certain cancers,75–77 and obesity.78,79 Diets high in
legumes, whole grains, fruits, and vegetables appear to
be protective against these chronic diseases.80–82
What Healthcare Providers Can Do
Physicians and other healthcare providers can play a
critical role in promoting healthier food options and
reversing the trend toward greater livestock production.
Healthcare providers can help accomplish this in
three main ways: as advocates, as providers, and as role
models.
As evidence-based advocates, healthcare providers
can provide medical input into federal policies that
affect nutrition and health. The American Public
Health Association (APHA), the American Medical
Association, and the President’s Cancer Panel of the
National Cancer Institute have highlighted the importance
to the obesity epidemic of federal food policy, as
well as the importance of physician and public health
leadership in federal nutrition policy reform.8,83,84 Currently,
U.S. agricultural policy disparately promotes
animal products, in contradiction with the U.S. Dietary
Guideline’s emphasis on plant-based foods. A calculated
73% of over $60 billion in federal commodities
payments for domestic food consumption between
1995 and 2005 supported the production of meat, eggs,
and dairy, either directly or indirectly through feedcrop
supports.11–17 Less than 0.5% of federal subsidies
is allocated to fruits and vegetables.
After the California slaughter plant investigation and
meat recall of February 2008, public food safety concerns
were especially heightened, since a large fraction
of the meat that was recalled had already been distributed
to school lunch programs.18 Surplus agricultural
products, largely animal products high in fat and
cholesterol, are distributed through school lunch and
other food assistance programs. An estimated 100,000
schools receive these commodities, possibly contributing
to the fact that approximately 80% of elementary
and secondary schools violate limits on total and saturated
fat content.85,86
International studies have demonstrated that
changes in agricultural subsidy policy can mitigate
rising chronic disease rates. In Poland, the withdrawal
of large animal-product subsidies led to decreased
saturated fat intake and increased fruit and vegetable
intake, followed by a subsequent decrease in ischemic
heart disease mortality.87 After long periods of increases,
mortality from heart disease and stroke decreased
by 25% and 10%, respectively, between 1991
and 1994 among those aged 45–64. Between 1986 to
1990 and 1994, there was a 23% decrease in animal fat
availability, 48% increase in vegetable fat availability,
and an almost 50% increase in importation of certain
fruits. In Eastern European countries in 2002, substantial
decline in cardiovascular mortality was associated
with increased consumption of plant oils rich in alphalinolenic
acid.88
In addition to involvement in food policy, healthcare
providers should have a coordinated voice in environmental
policy. The APHA has a policy calling for a
moratorium on factory farms. Other physician and
healthcare groups could follow suit. Recently, the U.S.
Environmental Protection Agency proposed that livestock
farms be exempt from reporting emissions of
ammonia, hydrogen sulfide and other pollutants.90
Input from healthcare providers is needed to prevent
such regressions in environmental protections that may
otherwise pose adverse public health consequences.
As healthcare providers, all physicians, nurses, and
physicians assistants can incorporate nutrition counseling
into routine care. When physicians advise their
patients about nutrition, incidence of chronic diseases
may decline.91–94 Despite the potential of counseling to
improve dietary practices, many primary care physicians
never include nutrition or dietary counseling in
their patient visits, or include only perfunctory counseling.
95–98 Medical societies can facilitate the incorporation
of routine nutrition counseling by advocating for
greater physician reimbursement for such care.
Finally, as individuals, healthcare providers can serve
as examples and leaders when they alter their own
lifestyle behaviors. One of the least exploited and most
significant and consistent counseling predictors is the
positive effect of a physician’s healthy personal practices
on his or her clinical prevention-related practices.99–103
Specifically, physicians’ healthy dietary practices positively
affect their clinical nutrition counseling attitudes99
and practices91,99,102,103; and U.S. medical students
find nutrition counseling more relevant if they
consume more fruits and vegetables.104
Health professionals can set an example by consuming
fewer animal products at home and at work, and by
demanding healthier plant-based options in hospitalcafeterias, doctors’ and nurses’ lounges, and at professional
conferences and meetings. The APHA and the
Johns Hopkins Center for a Livable Future offer prime
examples of how meatless meals can be promoted.
105,106 Through the work of Health Care Without
Harm coalition, over 122 hospitals in the U.S. have
signed a pledge to offer healthier food items to visitors,
patients, and staff.107 Health professionals can also
stress nutrition education in Continuing Medical Education
courses.
Given the animal agriculture sector’s considerable
role in environmental degradation, zoonotic disease
emergence, and chronic disease promotion, reducing
livestock production and promoting healthy plantbased
diets should be a global health priority. Healthcare
providers can, individually and collectively, play a
significant role in ensuring healthy and environmentally
sustainable nutrition policies and practices.
The authors thank Kyle Ash for his thoughtful input on
federal food policies. There was no external funding for this
manuscript
No financial disclosures were reported by the authors of
this paper.
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