Could Collective Action Influence Racial Health Outcomes?

The murder of George Floyd by police in Minneapolis, MN in May has sparked a resurgence of discussions regarding the numerous impacts of systemic racism in America. These discussions have, appropriately, focused on police brutality. Yet, American racism permeates almost every facet of life, and has acted to oppress people of color for centuries in so many different ways. The health and healthcare of Black and indigenous people in this country are no different, and the racist underpinnings of these systems have silently increased disease prevalence and decreased the lifespans of BIPOC (Black, Indigenous, and People of Color) for generations. 

Diabetes is one of the most prevalent diseases in the country, with nearly 11% of the U.S. population suffering from it. The CDC reports that, while 7.6% of non-Hispanic whites in the United States develop diabetes, 13.2% of non-Hispanic Blacks and 15.6% of Native Americans have been diagnosed with this disease. This means that Native people are more than twice as likely to develop diabetes than white people, and African Americans aren’t far behind. The American Diabetes Association has developed a number of guidelines for diabetes prevention and maintenance, yet systematic reviews have found minority populations are less likely to be able to achieve these goals, and see worse health outcomes as a result(2). Among many other factors, neighborhood statistics play a large role in determining the prevalence of diabetes in a population. A 2011 study found that African American individuals in a Deep South town noted a lack of healthy food options as a major issue in their area(3). Food scarcity is reported with about 20% of diabetic individuals, and research has shown African Americans have about half the access to chain supermarkets compared to white people. These interlinking factors are no accident, and they represent an example of the numerous ways racist policies and investment strategies have harmed minority populations in this country, either intentionally or unintentionally. 

Unfortunately, the story of diabetes doesn’t end with diagnosis. An all-too-common result of diabetes’ progression is Peripheral Artery Disease followed by limb amputation. While about 130,000 diabetics undergo amputations every year, Black patients are nearly three times more likely to have their limbs amputated4. While amputations are often seen as an appropriate way to treat the negative vascular outcomes of diabetes, they are a critical step in an individual’s life and life expectancy. Not only do amputations prevent people from continuing to participate in the workforce in the same capacity, but the cessation of physical activity following the surgery adds to a person’s already deteriorating health condition. Research has shown that 5-year mortality rates in diabetes patients with amputations to their lower extremities range from 52% up to 80%(5). At least half of all of these patients are likely to be dead within five years of their surgery, and Black patients are far more likely to be forced into an extreme measure like amputation compared to white patients. 

In addition to long-standing inequities, the current SARS-CoV2 pandemic has proven to be a powerful magnifying glass on the many flaws in American society. Soon after SARS-CoV2 began spreading through this country, it became clear that predominantly African American communities were being hit much harder than white communities. As of April, African American residents of St. Louis, MO were more than 4x as likely per capita to contract the virus compared to their white neighbors. Similarly, at that point in time, every single person who died from COVID-19 in St. Louis county was Black(6). Navajo Nation, the largest reservation in the country, has been suffering the highest per capita infection rate in the country for months now. In mid June, Navajo Nation had 3,806 cases per 100,000 residents(7). Compare that to New York City, one of the global centers of the pandemic, which had a per 100,000 case rate of about 2,700(8). 

By June, Dr. Anthony Fauci noted before a Congressional panel that racist structures were undoubtedly contributing to this state of affairs. Importantly, Dr. Fauci included that the economic opportunities, or lack thereof, available to people of color in this country put them at greater risk of contracting the virus(9). Studies conducted by the Center for American Progress show that African American and non-white Hispanic populations are more likely to work in service industry jobs, as a direct result of Jim Crow segregation and unequal distribution of New Deal programs, among other policies(10). These jobs are more likely to be deemed “essential,” requiring workers to engage with more people than in jobs that allow for remote work. Further, individuals in these positions are compensated less overall and less consistently, meaning they have less bargaining power for jobs that might protect their workers more.

Given the recurring role of food and job security in American inequality, the work of Chef José Andres is notable. His project, World Central Kitchen, aims to simultaneously address both issues.  The pandemic has caused a national spike in reliance on food banks, with Feeding America estimating 1 in 6 Americans are facing hunger as a result of the pandemic(11). World Central Kitchen has served as a necessary supplement to established food banks, serving nearly 21 million meals as of the end of July. In order to buoy the crippled restaurant industry as well, WCK partners with restaurants to make the meals that will be donated. This allows some restaurants to keep their employees on payroll longer, a boost in an industry where the unemployment rate has floated between 24% and 35% since March(12). This double-edged approach to crisis response is also an excellent example of how programs could support food-insecure people moving forward, especially considering the link between disease epidemics like diabetes and food insecurity. 

Hunger impacts people everywhere, and organizations like Rolling Harvest and Philabundance are working in southeastern Pennsylvania and southwestern New Jersey to tackle food insecurity head-on. Rolling Harvest collaborates with farmers to streamline community access to fresh produce and protein sources. The organization also regularly hosts nutrition and cooking seminars to integrate increased access to nutritious food with increased education about food and nutritional choices. Similarly, Philabundance aims to decrease widespread food insecurity, primarily through a focus on low-income seniors and children. Philabundance also hosts the Philabundance Community Kitchen program, which trains low-to-no-income men and women in a culinary training program and assists them in finding food service positions. Students are guided through the 560 hour course by preparing meals to be delivered to those in need, or through the program’s catering service, PCKatering. 

In 2018, both organizations combined to collect and serve approximately 27 million pounds of food and produce, all with a focus on nutritional value and ease-of-access for those who need it most (13,14). Rolling Harvest and Philabundance rely on active volunteer corps and donations, so reach out if you’d like to help them in their mission. Earth Fed Muscle is also accepting donations for each organization throughout the month of August, via the checkout page on EarthFedMuscle.com. Food insecurity is a very fundamental, very solvable problem in our society, and improving the state of food access here serves to improve society as a whole.

These are only a few examples of the interconnected nature of racist systems in America. Non-white communities lack access to common sources of healthy food, and see much higher prevalence of preventable diseases like type II diabetes as a result. Further, these same communities lack opportunities for higher paying, more mobile jobs, creating a situation where the people in these communities have been hit hardest by both rates of infection and death rates in a pandemic. Considering that these outcomes represent the confluence of centuries of official and unofficial policy, awareness alone won’t change them. Projects like World Central Kitchen, Rolling Harvest, and Philabudance are producing positive impacts, but they can’t succeed alone. We need collective action: voicing our understanding of the universal danger of racism, demanding policies that create a more equitable society, and supporting the numerous communities that are impacted by the harmful norms of this country. Then we can begin to see a more just and equitable society. 

References

1. Jones, Camara Phyllis. “Toward the Science and Practice of Anti-Racism: Launching a National Campaign Against Racism.” Ethnicity & Disease, vol. 28, no. Supp 1, 8 Aug. 2018, p. 231, 10.18865/ed.28.s1.231. Accessed 14 Jan. 2020.
2. ‌Walker, Rebekah, et al. “Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes.” American Journal of Medical Science, vol. 351, no. 4, 1 Apr. 2017, pp. 366–373, www.ncbi.nlm.nih.gov/pmc/articles/PMC4834895/, https://dx.doi.org/10.1016%2Fj.amjms.2016.01.008. Accessed 6 Aug. 2020.
3. ‌Scott, AJ, and RF Wilson. “Social Determinants of Health among African Americans in a Rural Community in the Deep South: An Ecological Exploration.” Rural Remote Health, vol. 11, no. 1, 7 Feb. 2011.
4. ‌Goodney, Phillip, et al. Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease. Dartmouth Atlas of Health Care, 2014.
5. ‌Thorud, Jakob, and Joslin Siedel. “A Closer Look At Mortality After Lower Extremity Amputation.” Podiatry Today, vol. 31, no. 4, Apr. 2018, pp. 12–16.
6. ‌Kohler, Jeremy. “Virus Hitting Blacks Four Times as Hard as Whites, According to St. Louis County Data.” STLtoday.Com, 8 Apr. 2020, www.stltoday.com/lifestyles/health-med-fit/coronavirus/virus-hitting-blacks-four-times-as-hard-as-whites-according-to-st-louis-county-data/article_d87922e9-12a3-522f-a924-53a12aeda473.html. Accessed 6 Aug. 2020.
7. ‌Cheetham, Joshua. “The People Battling America’s Worst Coronavirus Outbreak.” BBC News, 16 June 2020, www.bbc.com/news/world-us-canada-52941984. Accessed 19 July 2020.
8. ‌Times, The New York. “New York Coronavirus Map and Case Count.” The New York Times, www.nytimes.com/interactive/2020/us/new-york-coronavirus-cases.html. Accessed 3 Aug. 2020.
9. ‌Wise, Justin. “Fauci: Institutional Racism Playing Role in Disproportionate Coronavirus Impact on Black Community.” TheHill, 23 June 2020, thehill.com/homenews/coronavirus-report/504167-fauciinstitutional-racism-is-playing-role-in-disproportionate. Accessed 6 Aug. 2020.
10. ‌Solomon, Danyelle, et al. “Systematic Inequality and Economic Opportunity.” Center for American Progress, 7 Aug. 2019.
11. ‌Morello, Paul. “4 Stats You Should Know about Food Banks and COVID-19 | Feeding America.” Www.Feedingamerica.Org, Feeding America, 21 July 2020, www.feedingamerica.org/hunger-blog/first-months-food-bank-response-covid-numbers. Accessed 6 Aug. 2020.
12. ‌“Industries at a Glance: Food Services and Drinking Places.” U.S. Bureau of Labor Statistics, 21 July 2020.
13. Philabundance. “Philabundance Annual Report.”
14. Rolling Harvest. 2018 Annual Impact Report. 1 May 2019.