by Melissa Connor, MA, RDN
The intersection of nutrition and social determinants of health, including racism and socioeconomic status, shapes our well-being in profound ways. In recent years, there’s been a growing recognition of how racism and socioeconomic status impact nutrition care access and overall health outcomes. At Culina Health, we’re deeply committed to addressing these interconnected issues because we understand their critical importance to our patients’ lives.
Understanding terms like racism and socioeconomic status can be like navigating the latest nutrition trends — complex and sometimes overwhelming. We’re here to provide more clarity on how racism and socioeconomic status intersect with nutrition, so we can work together as providers, patients, parents, colleagues, friends and allies to bring more awareness to the root causes of health inequalities and work towards creating equitable access to culturally-affirming nutrition care for all.
How Race and Culture Affect Nutrition and Health Care
Racism refers to prejudice or bias towards individuals or groups of individuals based on their ethnicity or the color of their skin. Racism is presented on different levels– systemic or institutionalized, personal and internal. It’s important to note that many “race-associated” differences in health outcomes are in fact due to the effects of racism, and not skin color or ethnic background. It’s well-established in social and biological sciences that race is actually a social construct, and not a biological attribute.
Socioeconomic status is mostly determined by your income, which is also influenced by education level and occupation. However, racism can affect the ability to establish a certain socioeconomic status despite attaining higher education and a prestigious occupation.
Public health data consistently shows that there are substantial gaps in wealth, economic status, and health care access between people of color and their white counterparts, even when adjusted for education and job status, because of the consequences of systemic and generational racism. This often leads to a different picture of debt to income ratio.
For instance, recent studies have revealed that Black households in the United States hold just 13% of the wealth that white households do, and Hispanic households hold only 10%. These disparities persist across various socioeconomic indicators, including income levels, homeownership rates, and access to financial resources.
Furthermore, generational and structural racism perpetuate these inequalities, creating barriers to economic advancement for marginalized communities. For example, discriminatory lending practices and housing policies have historically limited opportunities for minority populations to build wealth through homeownership. As a result, many African American households face higher levels of debt relative to their income, exacerbating financial instability and hindering access to resources like nutritious food and quality health care.
These disparities have profound implications for food security and health outcomes. Research consistently shows that individuals experiencing economic hardship are more likely to suffer from chronic health conditions such as obesity, hypertension, and diabetes. The health disparities are stark: according to recent statistics, Black Americans are nearly twice as likely as white Americans to have diabetes, while Hispanic Americans are 1.7 times more likely.
Therefore, understanding the impact of racism and socioeconomic status on nutrition-related health disparities is essential for addressing the root causes of these inequities and advancing health equity for all populations.
Systemic Racism and Health Disparity
Take the example of the contrasting life stories of two women of the same age and geographic location, but with different skin color. Elsa, a white individual, and Tiana, a BIPOC individual, highlight the significant impact of systemic racism on socioeconomic status and access to resources. Despite similar backgrounds and education, Elsa’s family’s financial security afforded her opportunities such as education without debt, financial literacy, and access to resources like a personal trainer and travel. She enjoys a comfortable life in Spain with her family, including access to fresh foods.
In contrast, Tiana faced financial struggles due to her family’s lack of wealth and financial literacy. She had to take out student loans despite receiving a scholarship and settled for lower pay due to fear and desperation. Her husband, also facing racial discrimination at work, eventually left, leaving her as a single mother working multiple jobs to make ends meet.
These real life stories exemplify how systemic racism can perpetuate disparities in opportunities, wealth, and quality of life for BIPOC individuals despite similar backgrounds and efforts.
Racism and socioeconomic status weave together to create a web that disproportionately traps minority groups in communities that cannot support strong social determinants of health. This is a public health issue. We’ll look at each strand of that weave and some of the processes Culina Health has in place to begin to untangle it.
The Role of Racism in Nutrition Care and Food Access
Communities that are majority brown and black people have limited access to fresh and whole foods. Food deserts or food apartheid– no fresh food stores within walking distance of the majority of homes as a result of racist zoning codes; food swamps– only convenience stores or fast foods restaurants available; food mirage– fresh foods stores that are too expensive for the general population in the area to afford, are all barriers to healthy food access that BIPOC communities face. This lack of access to fresh foods has long been linked to increased risk of chronic diseases, early mortality, maternal health, and mental health disorders.
The health care system also disfavors these communities: they are often lacking in access to quality medical care or access to healthcare practitioners that understand and affirm their unique experience as BIPOC individuals. This is a problem rooted in racism within the healthcare education system that has long placed multiple barriers to entry for students of color. As a result, BIPOC patients are often met with implicit and explicit racial bias, which informs critical and often life-saving/harming decision-making around medical treatment plans. Furthermore, when the value of food is looked at through a racist lens, cultural and ethnic foods are often dismissed as “unhealthy” or seen as less than, further perpetuating health inequity.
Experiencing racial bias in healthcare leads to higher stress levels, which is a known risk factor for nutrition-related chronic disease, like heart disease and type 2 diabetes. Racial bias in healthcare also leads to poor treatment adherence, which further worsens health outcomes. Studies show that every 10% increase in Black provider representation equates to a nearly 21-day increase in life expectancy for Black people.
The Role of Socioeconomic Status in Nutrition Care Access
Socioeconomic status determines not only the access to, but the quality of nutrition care and nutritious foods a person has. Having a stable and reliable income from a job or a spouse, being able to afford health insurance coverage, and having the option to outsource grocery shopping or meal preparation can significantly influence the choices we make about food.
BIPOC communities disproportionately face nutrition-related barriers associated with inconsistent income. Working multiple jobs leads to high levels of chronic stress, known to perpetuate chronic diseases. It also leaves little to no time or energy for shopping for fresh foods, meal preparation or sitting down with the kids to teach mindful eating habits. The broken cycle then continues with children only learning to prepare low nutrient dense foods and eating out of anxiety, boredom or food insecurity, leading to increased risk of childhood obesity and chronic diseases.
With inadequate income there is the higher risk of being uninsured or underinsured which is a major barrier to accessing quality and health and nutrition care. Since the COVID-19 pandemic more companies, like Culina Health, have opened the door for more people to get nutrition care covered by insurance, insurance coverage, as it stands in our country, is a privilege. We won’t truly be able to break down these walls without providing access to preventative nutrition care from Registered Dietitians to underserved populations by government programs like Medicare and Medicaid.
Nutrition Interventions and Health Outcomes
The cycle of lack of access to quality nutrition leading to diet-related chronic disease is a vicious one that continues to disproportionately inflict BIPOC communities.
Culturally-affirming nutrition care approaches, like the Culina Health Method, meet people where they are, and provide a safe space for them to have autonomy over their dietary choices, promoting self efficacy and more long term engagement, ultimately leading to better health outcomes.
How Culina Health is Increasing Access to Nutrition Care
These systemic problems go beyond the reach of one dietitian-led nutrition care company. While we can’t stop racism with our nutrition care method or boost incomes, we can and are doing our part every day to practice and advocate for equitable and accessible nutrition care for everyone.
Culina Health’s mission is to provide increased access to not only quality nutrition care, but care that is culturally affirming from a diverse team of Registered Dietitians. We strive to remove the barriers of cost– through insurance coverage and advocating for increased coverage of Medical Nutrition Therapy through government funded healthcare; stigma– we train our RDs to be aware of explicit and implicit bias in their own practice and providing a safe space for them to discuss and process difficult subjects; and trust– by hiring a more diverse team of RDs so our patients feel represented, seen, and understood.
Our inclusive nutrition care method goes beyond removing the stigma of BIPOC bodies and cultural foods being “unhealthy” or “not as healthy” and includes the consideration of socioeconomic status, living environment, mental and emotional health and lifestyle.
Working With a Registered Dietitian at Culina Health
Our patients can come to us on their own or be referred by their physician. Their care plan is then tailored to meet their individual needs with education, goal setting, accountability, partnership and interdisciplinary communication–if they choose.
When a patient logs on to their first session, they can be assured a Culina Health registered dietitian comes into the space with a blank canvas and is ready to work with them to paint the picture that tells their individual health and nutrition story. Our dietitians are dedicated to learning who they are as an individual and are ready to partner with them to break through any barriers they have been facing.
Our BIPOC patients need and deserve our attention to the many unfair barriers that they face. If you are a healthcare provider, take a little extra time to consider those barriers when patients come into your office. Foster a safe environment for your patients and your staff by checking your own practices and teams for bias and discriminatory practices. Then partner with us as your nutrition care provider of choice, knowing your patients will come into a place where they will find health equity and improved health outcomes.