Did you know April is National Minority Health Month in the United States? This month, the Office of Minority Health will be raising awareness of the health disparities in the United States, and celebrating some of the work that is being done to improve healthcare for all.
What is a health disparity? There are two types: access to health care and health status. The first focuses on the differences groups of people may have to healthcare resources, like doctors, hospitals, and nutrition education. The second covers the differences between groups in health outcomes like disease and disabilities.
Unfortunately, even though the US is a developed nation, health disparities do exist here, and minority communities tend to be in the bubbles where health disparities take effect. From my standpoint, having access nutritious food and education could be considered healthcare disparities.
Our dietary patterns can have a direct impact on our health outcomes throughout life. Accessibility to nutritious food and nutrition education can have an impact on those outcomes, especially for sensitive communities who are disproportionately affected by chronic disease.
For example, African American people are more likely to develop high blood pressure, but are also less likely to receive the proper treatment for it than their white counterparts (1). Type II diabetes is an epidemic amongst those of Native American descent, and obesity, heart disease, and type II diabetes are all prevalent in Hispanic populations, as well (1).
Proper nutrition is incredibly important for everyone to have access to, as it works as preventive health care for these diseases. However, according to the Center for Disease Control’s Health Disparities and Inequalities Report, access to grocers is most limited in rural, low-income, and minority-heavy communities (2).
Food deserts are a concept that people are becoming more aware of, and there are several movements in place now to try to serve areas where access to good food is scarce. There are mobile food trucks bringing fresh produce to urban and rural areas across the nation, community gardens are becoming more and more popular, and there are programs incentivizing grocers who build in underserved areas. However, simply having access to healthful food isn't the only thing that needs to happen for these communities.
There are lots of factors that contribute to our food choices. Accessibility is a big one, but a person’s social and cultural surroundings, environment, language barriers, disabilities, age, gender, employment, and level of education all effect what they do with that accessibility (3).
One study showed that although two different neighborhoods - one wealthier and with a better educated, majority white population, the other low-income with more minority groups who on average hadn't received the same level of education - had similar foods in their local grocers, the choices people in each neighborhood made reflected access disparities (3). While there were more healthful choices at the first neighborhood's stores, the second neighborhood still had access to a lot of the same foods being offered, but those foods weren't being purchased.
The biggest influence on the disparities in this example was actually education, not access.
What we can do as nutrition professionals to improve is tailor our education to fit the needs of different groups of people.
It's impossible to pinpoint a single reason for nutrition disparities, as the people who comprise “minority people” in the US cover countless ethnicities and cultures. It isn't right, even, to apply the same intervention practices to people of the same ethnicity but from different countries. One study saw better diet-related behaviors and health outcomes in men of Cuban-American descent when compared with men of Mexican-American descent (1).
One form of successful intervention was the concept of peer education. I strongly believe that customizing education to be culturally relevant and to have an awareness of other factors, like access, is important when reaching out.
Peer education is promising because it includes individuals from an area and engages them with others from their same community. The peer teachers are given a training, usually over a weekend, and share what they've learned. Who understands the needs of a specific neighborhood and group of people better than someone who has grown up or lived there for a very long time?
When looking at this in practice, a study performed in a hispanic community asked older women, who were seen as abuela (grandmother) figures in their community, to teach nutrition to young mothers (4). Six months later, the young women who responded to a follow-up survey reported that they maintained a more nutritious diet after the education (4). Positive outcomes were seen in how type II diabetes was being managed and in breastfeeding amongst those who were included in the study (4).
On an individual level, we all have differences in our lives: where we grew up, how we were raised, the level of our education, and where we live now. There is no denying that in the US, there is an underlying system which pushes minority people into lower income areas and creates disparities in education and health. But we can change that. We can start with education. I am raising awareness of this issue by writing about it here. Embrace your own family's cultural heritage by cooking food from it. Make healthy amendments to family recipes.
If you are interested in getting more involved in food justice and serving in your local community, try reaching out to food banks, community gardens, and leaders in the food and nutrition industry in your area.
Some places to help you start:
WIC
Sources
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