The elephant in the room

The last day of February is Friday and before the month is over, I want to address some things.

We are almost at the end of February, which means we are closing out on Black History Month and Heart Month. There has also been a ton happening within our government that is rooted in doom and gloom since many important programs, such as National Parks funding, healthcare cuts, federal aid, and much more, are on the chopping block.

With Medicaid, Supplemental Nutrition Assistance Program (SNAP), school lunch, housing assistance, and much more having the possibility of being gone, we are heading into a very “you’re on your own” message from the government. It’s giving “pull yourself up by your bootstraps.” It’s also, unfortunately, giving eugenics. Many folks who have chronic medical conditions, disabilities, people who are pregnant, and low-income families with children rely on these programs. So what’s going to happen to everyone? I also want to make it clear that WE ALL will be affected (unless you are a billionaire wealthy), so it’s not just a matter of having empathy for others. I mean, yes, you should, but we are all going to feel this in some form or another. And if you are a billionaire, congrats, I guess.

This is the picture that comes to mind when I think of the billionaires today. Image from https://www.cbr.com/scrooge-mcduck-net-worth-explained/

So, I think it’s time for another reminder of how we can’t just eat or exercise our way to health. Eating all the kale isn’t going to make our health better if we can’t access food, shelter, healthcare, clean water, and I could go on and on. It’s disappointing that many people can’t see this.

As dietitians and other health professionals, my colleagues and I are constantly thinking of various ways to discuss heart health and provide resources. However, I can’t help but notice that most of the focus is on health behaviors in terms of nutrition and exercise, with the implication that if people put in effort, they could improve their health with a simple snap of their fingers. Don’t get me wrong, talking about nutrition is indeed important, and we can always find ways to discuss this, but I do get frustrated when important pieces of the puzzle are often left out of the conversation. We cannot talk about health as if we all have equal and equitable access to it because we don’t. We also can’t discuss health with the implication that we all have the same experiences within society because we don’t. And this isn’t new information or something that hasn’t been discussed before. It has been confirmed that our zip codes determine our health more than our genetics. Wait what??? Yes.

Up to 60% of health is determined by zip code rather than genetic code. Please read that again—60%. There is poverty, of course, but there are other factors we don’t often think about, including unsafe living conditions, such as noise, light and air pollution, overcrowding, and safe and affordable housing, among other variables, which are associated with chronic diseases and illnesses, such as cancer, diabetes, and cardiovascular and pulmonary ailments. It’s safe to say that where we live (zip code) affects how we live. It impacts whether we have access to food options, places to exercise safely, and convenient health services when needed. Our zip code is also connected to the availability of jobs, unemployment rates, education, and training opportunities, and yes, these factors shape and determine our health and longevity.

This also happens to be a topic that I often discuss because it is near and dear to my heart. I’m a dietitian who works in public health, but I am also a Black woman who sees the disparities among certain populations firsthand. I wrote about this last year for Well+Good in an article, “Heart Health Is About Far More Than What You Eat—Especially If You’re a Black Woman in America.” I remember wanting to write about this topic last year, and various publications passed on it mostly due to timing and being short-staffed, so imagine my enthusiasm when Well+Good was on board with the piece this time around. I notice there are many misconceptions and stereotypes of how Black people take care of their health that I believe are important to discuss. The food eaten is labeled “unhealthy” (Soul, Caribbean, and Southern cuisine), is in need of fixing, and needs to be healthified, is what we’re told. I’ve discussed cultural foods already (feel free to click and read the FREE Substack newsletter) and how to have more humility when discussing them, but again, making people feel as though they have complete control over their health is incorrect.

“When I read that Black women suffer from the highest rates of stroke, I don't wonder what these women are eating, or whether they should be exercising more. I think about the constant state of stress that many are in due to the systemic barriers they are faced with daily.”

As I mentioned earlier, different zip codes will have different outcomes on health for a number of reasons. The cities with the widest gaps in life expectancy, NYU researchers found, were those that were most segregated by race and ethnicity, with predominantly minority neighborhoods often facing obstacles. “Neighborhoods with large black populations tend to have lower life expectancies than communities that are majority white, Hispanic, or Asian. Such racial differences reflect the places in which different races live, not the individual characteristics of people themselves.” I remember hearing Tony Hillery, a food activist and the founder of Harlem Grown, speak at my school when I was studying nutrition. He said something that made my ears perk up, mostly because it was true. He stated that the school system in New York City is the most segregated in the country, and guess what? It’s true. This sounds shocking because when we think of diversity and inclusivity, NYC is probably one of the first cities that comes to mind. However, this isn’t quite true, especially with schools. Our zip codes matter and affect our health, and literacy and education are a part of this. Access to certain schools depends on zip code, and yes, NYC is indeed segregated when looking at statistics.

As a NYC kid, I remember growing up and attending school outside my zip code because my parents, like all parents, wanted what was best for their child. My mother somehow convinced the principal in another school district to let me attend public elementary school there. I was too young, so I have no idea how this conversation went, but the principal let me attend, even though he really shouldn’t have. This is more than 30 years ago, and he has since passed, so I feel like disclosing this now isn’t going to get anyone in trouble. Fingers crossed.

Needless to say, I am constantly discussing systemic health barriers for a reason. We cannot discuss health, only focusing on food and exercise. There are so many unique factors and experiences that shape our individual realities. The CDC has declared racism as a public health threat. Most of us acknowledge that racism still occurs in society, but what does that have to do with public health?

Racism can impact health through, for example, reduced access to employment, housing, and education. Decreased healthy behaviors, such as sleep and exercise, and/or increased engagement in unhealthy behaviors, such as alcohol consumption. And also physical injury as a result of racially-motivated violence. A 2015 review confirmed that racism is consistently associated with increased mental health conditions like depression, anxiety, and psychological stress. Constant exposure to stressful situations can cause long-term health risks, including digestive issues, muscle tension and pain, heart diseases, heart attacks, high blood pressure, stroke, sleep problems, and more. Chronic stress also suppresses the body's immune system, making it harder to recover from illnesses.

I talk about this subject constantly because there will always be the implication that we as individuals are responsible for our outcomes 100% of the time. We all make choices and are free to change certain things about our individual lives. However, we all have unique circumstances and experiences that should be acknowledged. We cannot continue to turn a blind eye to all of the numerous factors that influence health. We cannot just tell someone as health professionals to change their food intake to healthier foods without first finding out about their current lifestyle. We as humans cannot continue to look at someone and say that they need to make better choices without understanding their current choices. So no, we cannot all eat our way to better health. But what we can do is understand the systemic structures that are at play and acknowledge them.

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I also have a book out now called Live Nourished: Make Peace with Food, Banish Body Shame, and Reclaim Joy.