Addressing & Questioning Racial Disparities in Health Outcomes

By: Megan Perez, registered dietitian/nutritionist at Nourishing Minds Nutrition

The year 2020 has gotten off to a rough start to say the least, beginning with an international pandemic most of us would never dream of living through. This brought many changes, challenges, and uncertainty into our lives. Most people have had to adapt to new living arrangements, work situations, and adjustments in everyday activities. For several, these changes have been devastating.

During what some people thought was an improvement in the pandemic and when there were signs of “normalcy” to life returning, a horrific event occurred that would lead to an uproar across the country. On May 25th, George Floyd was killed in Minneapolis, Minnesota during a police arrest. Rightfully so, this brought sadness and anger but also a call to action. People of all colors, backgrounds, and ethnicities filled the streets in towns and cities across America, and even other countries, protesting for justice and reform. I write about this today because I have spent the last month educating myself in hopes of becoming a better white person and human. Despite my perfectionist tendencies, I will never be perfect. Even putting these words to paper bring up uncomfortable feelings. While this may be the first time I write about race in a public forum, it will not be my last. I accept all constructive criticism and opportunities to learn and grow.

My eyes have been opened to the incredibly large amount of racism that exists everywhere today, and especially in the areas of health and nutrition. I have identified many times I turned a blind eye or did not question the status quo in regards to information I learned in school or heard in the media. A particular piece of information I never questioned includes health outcomes and race. As a dietetics student, I was taught that people of color and specifically Black people have higher rates of chronic illness than white people. Why is this? And why did I never ask how the color of a person’s skin could increase their likelihood of developing diabetes?

I understand now that I was okay with being naive back then. I’m not anymore.

This topic is of great interest to me because my passion lies in helping people. How can I help ALL people when I don't fully understand them? Because the dietetics field is made up predominantly of white women, there are likely many dietitians out there just like me, who accepted the information they were given, and who want to do better now.

Let’s address the question “why do Black people have higher rates of chronic disease?” Here are a few statistics from a research article by Cunningham published in 2017:

“At ages 18–34 years, blacks had higher death rates than whites for eight of the 10 leading causes of death (heart disease; cancer; cerebrovascular disease; diabetes mellitus; homicide; HIV disease; and conditions resulting from pregnancy and childbirth). At ages 35–49 years, blacks had higher death rates than whites for heart disease; cancer; cerebrovascular disease; diabetes mellitus; homicide; nephritis, nephrotic syndrome, and nephrosis; septicemia; and HIV disease. At ages 50–64 years, blacks had higher death rates than whites for leading chronic diseases (heart disease, cancer; cerebrovascular disease; diabetes mellitus; and nephritis, nephrotic syndrome, and nephrosis) as well as for unintentional injury, septicemia, and HIV disease. Death rates from heart disease, cancer, cerebrovascular disease, diabetes mellitus, and homicide began increasing at earlier ages among blacks than among whites.”

There are many, many reasons for this statistic including economic and environmental factors, socioeconomic status, access to healthcare, food insecurity, and deeper systemic issues with racism. The economic and social conditions that play a part in poor outcomes are more common among Black communities. A large number of Black Americans live in towns or neighborhoods with less access to healthful food choices. Not to mention, “healthy” foods are often more expensive than fast and processed foods. Black Americans may not be provided the same opportunities for education and jobs as white Americans, which is another issue with systemic racism that should be discussed more. This may lead to Black Americans having less access to healthcare and health insurance, making it much more difficult to prevent health issues and diseases from silently worsening. 

I also want to mention an area I’ve been learning more about recently. In order to “practice wellness” or benefit from healthy behaviors, a person must first have their basic needs met. One must feel safe in their own body. I don’t want to speak for anyone, but I am assuming this is difficult when someone feels attacked in the media for having a body that looks different from the white, thin ideal that diet culture consistently displays. It must also feel incredibly stressful to worry on a regular basis about being treated or judged unfairly or even getting arrested because of the color of your skin. We KNOW that stress is a significant factor in health and can increase inflammation and risk of chronic illness. As a health practitioner, I preach about the benefits of a self-care routine or a daily stress management practice. Meditation and yoga are luxuries and indicate a certain level of privilege that I am much more aware of now.

The health disparities among races are very relevant with the current pandemic. Black communities are being disproportionately affected by the Corona virus and death rates are much higher for Blacks than whites in several states. We know that pre-existing conditions can worsen COVID-19 symptoms and outcomes, so this makes sense (due to the above reasons). But it does not make it fair.

Knowing this information, is there anything we can do to help?

As a dietitian or health care provider, here are a few ways to start making a difference:

-I encourage you to ALWAYS question and ask “why?” when it comes to what we were taught in our training. If I had asked “why” back in my nutrition classes, I may have gotten started on this work a long time ago.

-Investigate your client’s whole story. Learn about their background, their stressors, their financial status (I know this can be uncomfortable), their cultural food preferences, where they grew up, how their parents/caregivers cooked or provided food, their living situations, where they grocery shop, how they feel about food, and if they feel safe in their bodies.

-Learn about cultural norms when it comes to healthy behaviors and food in BIPOC populations.

-Look upstream for root causes of poor outcomes. Don’t just accept them as they are or look for surface level solutions. How can we fix the source of the problem?

-Provide tele-health services so those in rural areas can seek out health care providers.

-You may consider offering discounted or sliding scale services to those who are economically disadvantaged.

-Donate your time to low income, BIPOC communities. Maybe offer a monthly nutrition group at a church or YMCA.

-Be a role model, teacher, or preceptor to your colleagues and coworkers by talking about health disparities and ways to help.

-Donate time or money to Diversify Dietetics.

-Treat all clients and patients with respect.

For others who want to help:

-Spread the word! Talk to family members, friends, neighbors, coworkers, and anyone else about how racism exists and that there are plenty of ways to start doing your part.

-Donate, if you can, money or time. Some organizations include The Loveland Foundation and Black Lives Matter.

-Listen. Don’t judge. Acknowledge your privilege.

-Volunteer at a pantry or soup kitchen

Thank you for reading this post and giving me grace and patience while I work on my own insecurities and biases around race. I acknowledge my privilege as a white, thin, cis-gendered, and able bodied woman. My goal is to learn, to become a better human, to help ALL people and ALL bodies, and to do my part to improve the statistics I quoted above.

Reference:

Cunningham, Timothy J et al. “Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans - United States, 1999-2015.” MMWR. Morbidity and mortality weekly report vol. 66,17 444-456. 5 May. 2017, doi:10.15585/mmwr.mm6617e1'

Thank you for this blog post Megan! You can learn more about Megan and her work at Nourishing Minds Nutrition.