Structural racism impacts African Americans’ ability to eat a healthy diet. What can we do as nutrition researchers and practitioners?

Take away

The Paper of the Month for November is from Nutrition Research Reviews (NRR) and is entitled 'Nutrition interventions addressing structural racism: a scoping review'  by Matthew D. Greene.

Nutrition researchers and public health practitioners have become increasingly focused on structural racism following protests against racial injustice in 2020 and the disparities in covid-19 mortality experienced by marginalized groups. Structural racism consists of overlapping systems of discrimination in society such as in policing, housing, and employment. These systems also affect marginalized groups’ ability to access healthful food. For example, African Americans are more likely to live in areas with higher densities of fast-food restaurants and may not have access to full-service grocery stores. Differences in financial resources may also impact their ability to pay for healthy food. Providing nutrition education alone can be insensitive in the face of these obstacles.

Our goal in conducting this review was to provide a list of all nutrition interventions which have been conducted in an attempt to address structural racism encountered by African Americans in their food environment. We included both nutrition education interventions that aimed to inform participants about structural barriers to healthful eating and also policy, systems, and environmental change interventions which made changes to communities to reduce barriers to healthy eating faced by African Americans.

We also compared our results to the Getting to Equity in Obesity Prevention Framework, which provides examples of 4 types of interventions that could address racial disparities in obesity rates: increasing healthy options, build on community capacity, reduce deterrents to healthful eating, and increasing social and economic resources.

All but 4 of the 30 interventions that met the inclusion criteria for this review fell into the increasing healthy options or building on community capacity categories, by providing additional sources of healthy food or nutrition education. Though these approaches may help address the barriers to healthy eating caused by structural racism, they target proximal causes of racial differences in obesity rates, not underlying financial differences which result in these disparities.

Sociologists refer to socioeconomic differences as a fundamental cause of health disparities because as new interventions and methods of prevention are created, people with more access to financial resources are better able to take advantage of those interventions and preventative measures. These fundamental causes have been proposed as one way in which structural racism results in racial differences in obesity rates.

Nutrition-focused policy, systems, and environmental or educational interventions may be able to play a role in addressing structural barriers to healthful eating experienced by African Americans, but more needs to be done to address the underlying fundamental cause, racial differences in socioeconomic resources. Future work should attempt to link interventions that increase the social and economic resources of marginalized groups to changes in their nutritional status and differences in obesity rates.

Matthew D. Greene