What is health equity and why is it being censored?

On Nutrition

I didn’t think that I would be writing about ultraprocessed food again this soon, but a kerfuffle at the National Institutes of Health over a recently published study nudged my hand. The study in question was a randomized controlled trial — the research gold standard — exploring whether ultraprocessed foods are addictive. Because the study’s conclusions didn’t fit the pre-decided narrative of current political appointees, the lead NIH researcher, Kevin Hall, wasn’t allowed to speak to The New York Times about the study. So, he quit, and he didn’t go quietly.

I’ve long followed Hall’s work, often citing his study that put the nail in the coffin of the “3,500-calorie rule” — the idea that if you cut and/or burn 500 calories per day, you’ll lose a pound a week. I also refer frequently to his study showing that contestants on “The Biggest Loser” experienced a slower metabolism even as they regained the weight.

I appreciated Hall’s willingness to question ideas that “common wisdom” says are true by putting them to the test of rigorous research studies. And the idea that ultraprocessed foods are addictive — and designed to be addictive — has certainly become “common wisdom” over the past decade.

But what does this have to do with health equity? Well, Hall was also told he needed to remove his name from a yet-to-be-published review article of ultraprocessed food research that he co-authored with some university researchers. Why? Because the paper included language about “health equity” and the fact that many people in this country don’t have access to healthful food.

Health equity is about helping everyone have the opportunity to live a healthy life by providing what they need based on their unique situation, whether that’s access to fresh produce, access to parks or access to telehealth. It also recognizes the social factors that support health — economic stability, affordable housing, quality education, safe neighborhoods with clean air and water, built environments that accommodate people of differing physical abilities, and positive social and community interactions.

What disturbed me deeply about Hall’s experience wasn’t just the censorship — although, as someone who’s been a journalist for more than half my life, that alone is deeply disturbing — but what omissions of words like “health equity” and “diversity, equity and inclusion” are signaling.

The more benign answer is that federal leadership can’t handle the fact that this country isn’t perfect. That we have inequities that affect health. That some people don’t have enough to eat. That experiencing the worst inequities contributes not just to chronic stress, but to chronic disease. But removing the words “health equity” from websites and documents and muzzling government employees doesn’t make the problem disappear. Words are powerful, but they’re not that powerful.

The more malignant answer is that federal leadership doesn’t want better health for all Americans. It only cares if certain Americans have access to food and health care and safety and education and jobs. Either way, the attempt to censor discussion of health equity is whitewashing — unfortunate pun intended.

The mass firings of scientists — which has disproportionately targeted female, Black and Hispanic scientists — will certainly have a chilling effect on attempts to bring some equity to research on the health risks and health concerns in traditionally marginalized and overlooked groups. I recently wrote that rugged individualism isn’t an ideal “health solution.” We aren’t just individuals — we are families, we are communities, we are a country that’s strengthened by diversity. And we need to take care of each other.