In light of recent events stemming from the murder of George Floyd, I wanted to comment on the relationship between race, health and access to healthy food. The issue of race pervades all aspects of life in the US and in access to quality food and quality healthcare, the issue is no different. Even in Canada, where healthcare is mandated for all, black and indigenous populations bear the scars of systemic racism, direct and inadvertent. Evidence of “degraded” health care access for indigenous peoples is well-documented and is also linked to the widespread destruction of natural ecosystems and alienation from their lands and traditional economies.
People of color face much higher rates of chronic diseases such as diabetes, cardiovascular disease, stroke, obesity and cancer. African Americans are 77% more likely to be diagnosed with Type 2 diabetes than their white cohorts. They also have double the risk of Alzheimer’s than whites. Breast cancer mortality is 40% higher in African American women than white women. The former are also three times more likely to die from pregnancy-related issues than their white counterparts. In Canada, blacks are more likely to be diagnosed with hypertension and poorer mental health, both of which are attributable to lower income levels than their white cohorts. One of the most troubling statistics I came across documents that African Americans are three times more likely to lose their limbs as a result of amputations than whites. These are all alarming figures. Coupled with lower incomes, which also often means insufficient or non-existent health coverage, people of color are limited in their access to quality health care, sufficient treatment, and the luxury of being able to take time off for being ill. And if that wasn’t enough, minorities with chronic disease have far lower earning ability, up to 18% lower, perpetuating a vicious cycle that further reduces their access to quality care.
"Your zip code is more important than your genetic code in determining your risk of disease and death." Dr. Mark Hyman
The issue is even broader than this as it is also related to the environment in which people live. According to Dr. Mark Hyman, a Functional Medicine doctor, and one of my fave voices in this field, a person’s zip code can have a greater impact on their health outcomes than their genetic code. Many poor neighborhoods are witness to food deserts, which are areas where individuals have limited access to a variety of healthy and affordable food. Supermarket chains tend to avoid low-income neighborhoods. And even government mandates to encourage them to establish themselves in food deserts haven’t worked. Food deserts are directly tied to poorer diets and worse health. Proximity to a grocery store has a huge, and obvious impact on what people eat. Smaller convenience stores and dollar stores, which don’t stock any fresh produce or meats, instead, become the source for groceries for many families in these neighborhoods. Not only do convenience stores price their goods at a premium (because you’re paying for the ‘convenience’), but research also shows that they stock foods higher in sugar, salt and unhealthy fats. According to the USDA, food deserts tend to exist in areas where poverty is high, education levels are low, and/or where there are higher concentrations of minority populations. But poverty is not the only issue here.
Even a wealthy black neighborhood will have less access to a supermarket than a poor, white neighborhood... Race, in this instance, is independent of poverty.
It’s been long obvious that poor neighborhoods have fewer supermarkets than wealthier neighborhoods. However, there is an added race component as well. Even a wealthy, black neighborhood will have less access to a supermarket than a poor, white one, highlighting that race in this instance is independent of poverty. Therefore, if you are both poor and black, you are at a double disadvantage both on account of poverty and race. This is unjust and intolerable.
Black kids are exposed to 86% more junk food ads, featuring unhealthy, high-sugar, high-salt foods than their white peers.
Finally, as if this wasn’t enough, the sugar and junk food industries work hard to keep their products cheap so that they can continue to market effectively to poor and minority populations. Soda consumption is associated with lower education levels, minority status, and lower incomes. Opponents of policies like a “soda tax” effectively argue that it is unfair to poor neighborhoods, thereby keeping their best customers supplied with cheap and ready sugar. Food and beverage TV ads airing during “black targeted programs” increased by 50% from 2013 to 2017, while decreasing for white programs during the same period. Black kids saw 86% more (junk) food ads, highlighting unhealthy high-sugar, high-salt foods than their white peers. And all of this was during a time when the importance of healthy foods was gaining buzz.
Health care needs to have a social justice component. Various organizations, including the National Institutes of Health, are implementing policies and programs to bridge the disparities and address the high rates of chronic disease in African American populations. Public Health initiatives in the US are focusing on some of these issues as well, such as reducing violence in high-risk areas, and improving cancer screenings in low-income areas. However, a more holistic, grass roots approach will be necessary to address the multitude of issues that race touches on in our communities. The unwillingness of supermarket chains to invest in food deserts, the targeted marketing of unhealthy foods to minorities by the sugar industry, the inaccessibility of fresh produce outside of supermarkets in poor areas, healthcare illiteracy among minority populations, and a general distrust of the medical system amongst the black population because of historic medical abuse and racism that actually spans centuries (sadly, it goes far beyond the Tuskegee syphilis experiment), are all different facets of this problem that need to be overcome.
Grass roots activists are making efforts to correct some of these glaring inequities. However, it will take a village. And it needs policy-backing so that funding can be directed to areas that need it. Moreover, these inequities are tied to socioeconomic disparities. Therefore, as the income gap between the rich and poor continues to widen in the US, the health disparities will continue to widen as well, creating an uphill battle of activists and policy-makers alike.
There is not just one crease to iron out here. This needs a multi-faceted approach from various levels and sectors of society. To end on a hopeful note, the work of the following individuals and organizations is promising, uplifting and worthy of your support. Check them out:
@foodempowermentproject
@southcentralfarms
@urbanharveststl
@southcentralfarm
@foodforward
@sustainabledish
In the meanwhile, we all need to listen, learn, and be aware. Eat well and with good health, Lubna.
References:
Barr, D. A. (2014). Health disparities in the United States: Social class, race, ethnicity, and health. JHU Press.
How Race and Ethnicity Impact Health Outcomes. https://drhyman.com/blog/2020/01/21/how-race-and-ethnicity-impact-health-outcomes/
Bor, S., Cohen, G., and Galea, S. (2017, April 8). Population health in an era of rising income inequality: USA, 1980–2015. The Lancet. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30571-8/fulltext?rss%3Dyes
Shi, L., & Stevens, G. D. (2005). Disparities in access to care and satisfaction among US children: the roles of race/ethnicity and poverty status. Public health reports, 120(4), 431-441.
Thorpe, K. et al (2017). The United States Can Reduce Socioeconomic Disparities By Focusing On Chronic Diseases. https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/
Dutko, P., Ver Ploeg, M., Farrigan, T. (2012, August). Characteristics and Influential Factors of Food Deserts. Economic Research Report Number 140, USDA. Retrieved from: https://www.ers.usda.gov/webdocs/publications/45014/30940_err140.pdf
Reyes, E. (2013, October 13). Poor, mostly black areas face supermarket ‘double jeopardy.’ Los Angeles Times. Retrieved from: https://www.latimes.com/science/sciencenow/la-xpm-2013-oct-30-la-sci-sn-poor-black-neighborhoods-supermarkets-20131029-story.html
Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: understanding mistrust about research participation. Journal of health care for the poor and underserved, 21(3), 879–897. https://doi.org/10.1353/hpu.0.0323
Nix, E. (2019, July 29). Tuskegee Experiment: The Infamous Syphilis Study. https://www.history.com/news/the-infamous-40-year-tuskegee-study
Veenstra, G. (2017). Black, White, Black and White: mixed race and health in Canada. Ethnicity & Health, 24:2, 113-124. https://www.tandfonline.com/doi/abs/10.1080/13557858.2017.1315374
Racism and Public Health (2018). Canadian Public Health Association. https://www.cpha.ca/racism-and-public-health
Comments