I believe in the power of nutritious food. I’m well versed in what scientific research says about the role of the food we eat in preventing chronic disease. I know how nutrition plays an integral role in treating or managing certain health conditions. I see, and experience, how eating food that nourishes the body while pleasing the taste buds can energize and delight us. But I also know that nutrition is not enough, because it doesn’t exist in a vacuum. The coronavirus pandemic and the recent protests against police brutality have illuminated that fact, starkly.
It came as no surprise to me that when the reality of the pandemic hit, many eyes turned to food as a salvation. Not just in the “cooking more to pass the time and avoid excessive takeout” sense (which I applaud), but in the “save me from this virus” sense. As I wrote back in March, while nutrition is ONE factor influencing the health of our immune systems, it is not the only factor. And we can’t give our immune systems a makeover with a snap of our fingers and some extra servings of vegetables and fermented foods.
As it turned out, what has been able to save Americans from COVID-19 is strict social distancing. In many cases, this meant having the privilege to have the type of job that allowed working from home. Often, this also meant being white.
that It’s not new news that people who are not white are disproportionately affected by COVID-19. By affected, I mean Black Americans are up to seven times more likely to die from coronavirus. Almost as disturbing as those numbers is what’s being communicated about the reasons why. Yes, people of color are more likely to have underlying health conditions such as high blood pressure and Type 2 diabetes, and statistically are more likely to be “obese” (although the relevance of that last part is hotly debated). But if that’s where the explanation stops, then we are turning a blind eye to what’s really going on. To understand that, we need to move further upstream, to the social determinants of health.
If you’ve never heard that term: Social determinants of health are the conditions in which we live, learn, work and play. These conditions, over time, lead to different levels of health risks, needs and outcomes. These conditions affect every single one of us, because they are like a web. If you have the privilege of a high level of education, you are more likely to have a high-earning job that offers health insurance. This allows you to afford good food, live in a safe neighborhood, get preventive health care and partake in relaxing leisure activities. So, socioeconomic status is a key determinant. But so is race.
The Centers for Disease Control and Prevention point out that Black Americans are more likely to live in densely populated areas because of institutional racism in the form of housing segregation. Black Americans are more likely to work in the service industry (read: essential workers) and not have paid sick leave. They are statistically less likely to have health insurance, which means less health care. And the first coronavirus testing centers were in predominantly white, higher-income areas.
If you are white, as I am, you likely have the privilege of not moving through life worrying that you will get killed while jogging or sleeping in your bedroom, or that someone will call the police because you asked them to leash their dog while standing next to a sign that says, “Dogs must be leashed at all times.” If you are white, it’s unlikely that you’ve ever been followed by a store security guard as you shop, had someone clutch their purse because you sat next to them on the bus, or had to fear for your life having been pulled over for failing to use your turn signal.
The benefits of education and income don’t erase the effects of systemic racism and oppression. You can be a Harvard-educated middle-age editor who enjoys birding. You can be a high-achieving college senior. You can be doing the things that society places high value on, yet still endure the toxic stress of racism your entire life.
I vividly remember learning in one of my graduate classes at the University of Washington nearly a decade ago that the reason that Black Americans have disproportionately high levels of high blood pressure has nothing to do with genetics, as was initially assumed. No, the cause is the cumulative toll of racism in its many forms, both overt and covert. And that was true regardless of education and income. All the good nutrition in the world can’t overcome that reality.
Deaths from heart disease declined dramatically between 1968 and 2014, but those rates of decline have been significantly slower among Black Americans in areas of the U.S. that had the highest concentration of slavery in 1860. Black women have significantly increased risk of the hypertensive disorder preeclampsia during pregnancy, which left untreated can kill both mother and baby. Disparities in maternal health outcomes between Black and white women may be due to “weathering,” early health deterioration due to social inequality.
I constantly remind my clients that nutrition is only one contributor to health. Regular (and hopefully enjoyable) physical activity, adequate sleep, social connection, the ability to manage stress in healthy ways, having something to look forward to when you get up in the morning — those are all vital, too. But that assumes that someone has the privileges of equality and access to health care, and many Americans do not.
If we want to be healthier as a country, we need to widen our lens instead of playing the “personal responsibility” card by focusing on diet and lifestyle. It’s not good enough to be “not racist” — we need to become “anti-racist” and oppose racism in all its forms, including its insidious presence in our institutions and systems. This is a huge challenge, but if we don’t become part of the solution, then we remain part of the problem.