In 1336, on the cusp of war with France, England’s King Edward III passed a law ordering that “No one, whatever estate or condition he happens to be in, shall cause himself to be served in his house or elsewhere… more than two courses.”

Two centuries later, King Henry VIII decided that the restrictions of his predecessor were outdated—at least for some. While The Sumptuary Law of May 31, 1517, made no mention of partridges in pear trees, it did allocate nine courses per meal to cardinals; seven to dukes, marquises, bishops, and earls; six to lower-ranking lords; and three to the gentry class. The rest of the population retained the two-course restriction—except, of course, for the king and other royals, who faced no restrictions.

In our own time, when seed oils, beef tallow, and ultra-processed foods are front-page news, this history reminds us that governments have long set diet-related policies. While those earlier English laws were largely aimed at conserving scarce resources—and reinforcing class divisions—our larger challenge today is helping people eat wisely from an abundance of choices.

Contemporary efforts include not only the food pyramid and the FDA’s requirements for food labels to provide ingredient and nutrition information, but also tax policies that incentivize healthy habits. In Boulder, Colorado, distributors of sugar-sweetened beverages pay an additional 2-cent-per-ounce excise tax, which funds coupons for needy individuals and families to buy fresh fruits and vegetables.

While the rise of effective obesity treatments, especially GLP-1 medications, may go a long way toward improving health, they should not lead us to say, “Problem solved.” They should, instead, inspire us to build on that success. I see an opportunity for bigger, bolder thinking concerning diet, similar to the kind of problem-solving governments bring to highways, clear water, or electric grid issues.

Making People Healthier

To do so, consider Japan, where the average life expectancy is 84 years (compared to 78 in the U.S.). Japan has mandated universal health coverage for all legal residents, but what I’m especially interested in is the country’s “Health Japan 21.” This ambitious, decades-long commitment to improving health outcomes focuses on the reality that only half of the country’s population is within the working-age demographic, creating increased pressures on a “superaged” society.

Among many goals, the government has set national targets for alcohol, vegetable, and salt consumption. Specifically, that means reducing average daily salt or sodium intake to about 1 teaspoon per day, increasing daily vegetable intake to about 4-5 servings or more per day, and decreasing the percentage of the population that engages in “high-risk” alcohol consumption (defined as about two alcoholic beverages daily for men and one daily for women). Mandatory health checkups track biomarkers and data to determine the effectiveness of these efforts.

I can imagine the uproar in the U.S. if an ambitious official proposed this approach to making America healthier. But we may be paying a very high price for our fierce dedication to personal freedom at the expense of population health, and it’s a price that’s increasingly being paid by those at the lower end of the economic spectrum.

It’s not a surprise that higher-income individuals live longer and healthier lives, but it’s important to emphasize that we’re not talking about the difference between a few months or even a few years. The richest men—the true 1 percent—live an average of 14.6 years longer than the poorest men in this country, and that gap is growing.

While some of the gap is due to access to expensive care, much of it involves diet, exercise, and lifestyle. Even if we don’t embrace interventions as robust as Japan’s, we can make a significant difference by going into vulnerable communities, emphasizing preventive medicine, expanding telehealth and remote monitoring, and increasing the number of primary care providers.

I’m concerned that, unless we think bigger, we’ll find ourselves with the twenty-first century equivalent of the Tudor sumptuary law, restricting not only access to multi-course meals, but also health and well-being, to the wealthiest Americans.