health & discrimination

the important connection between health & discrimination that diet & wellness culture will never reveal

Diet and and wellness culture loves to put the onus of one’s health on the individual. You’ll often hear messages such as: all you have to do is make better choices. Choose healthier foods, choose to be more active. The ability to lose weight is all within your control – it just comes down to how you move and what you eat!

The problem is, an individual’s health and well-being is SO MUCH more nuanced than that. There is just so much more that goes into it than simply making better choices.

I wanted to pull and add to this past week’s newsletter on health & discrimination so that this information is accessible to everyone as I feel it’s important to understand.

Research has shown that good health rises in tandem with class & socioeconomic status.  Even in circumstances where everyone is on a level playing field with regards to having food, shelter, safety, sleep and the opportunity to exercise, we see disparity among classes. 

Regardless of whether we’re looking at income, formal education or job status – as societal inequality increases, so too does poor health.  Ignoring this as a health professional treating individuals, and focusing only on diet and exercise misses a huge and important piece of the puzzle.

There are many individuals who eat well yet are still impacted by diseases often blamed on “poor nutrition” (i.e. heart disease, diabetes, high blood pressure, etc.).  And of course, nutrition has some impact on our overall well-being and individual disease risk.  However, genes and lifestyle factors contribute to only a small part of the equation when looking at health differences among classes.  Conversely, structural, political and social determinants play a much larger role than are often given credit.

If you’re unfamiliar, social determinants of health refer to factors such as our physical environment, our access to medical care, our genetics and biology and social circumstance (which includes issues such as discrimination, stress, lack of job autonomy, living & work environment, and so on).  Most of which are largely out of our personal control.

When we focus only on food, body weight and exercise, we’re missing a major part of the health picture: structural and political issues that greatly impact health & wellbeing.  Self-care is important and valuable, but when it comes to tackling health disparities, issues of improved opportunity, education, environment and work circumstances have much more significant impact on overall wellbeing than diet & exercise.  It’s critical to consider the role one’s environment has on the reality of the choices they can make with regards to self-care and overall health.

When you make it all about choice, it neglects very really factors that play a role. Take access and safety for example. What if you don’t own a car and there’s no store within walking distance that sells fresh fruit and vegetables? Is the advice of “bump up your intake of whole foods like fruits & veggies” going to be truly useful when trying to improve your health? What if you can’t afford a gym membership and don’t feel safe going out to exercise? Will advice such as “just move your body more!” or “take a lunchtime walk!” really have any value or impact on your health? Likely not.

Living in a society with systemic racism means BIPOC (Black, Indigenous and People of Color) suffer injustice at every level of society. From wealth (inequality in the US has increased exponentially since the 1980s and continues to rise) to education (Black students are more likely than white students to be suspended for the same infractions), employment (Black individuals are 2x more likely than white individuals to be unemployed and applicants with ‘white sounding’ names are 50% more likely to be called back after interviews than those with ‘Black sounding’ names with similar resumes) to healthcare (from access to fair and quality healthcare to increased risk of certain conditions as a result of the stress of discrimination and injustice), housing (from the loans they are offered to the types and number of homes they’re shown), criminal justice (African Americans are incarcerated in state prisons at a rate that is 5.1 times the imprisonment of whites) and more.

There are a number of studies that have shown the critical role these injustices play in overall health & well-being, with one concluding “although reducing the prevalence of health risk behaviors in low-income populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged” (1).

Discrimination in any form is harmful to health.  Elevated rates of hypertension in Black communities span socioeconomic classes, unable to be pinned to genetic or lifestyle factors alone; only really making sense when the experiences of, exposure and response to racism is considered.  The experience of inequality and the degree of agency one has over one’s life and the opportunities presented, plays a significant role in overall health & longevity.

It’s critical for everyone, but especially healthcare professionals, to be aware of just how many other factors impact our health outside weight, diet and exercise. It’s about so much more, and it’s time to take the power away from the diet and wellness industry reducing our selves & wellbeing down to these things.

References:

• P.M. Lantz et al., “Socioeconomic Factors, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of US Adults,” Journal of the American Medical Association 279, no. 21 (1998): 1703-8.
• Bacon, Linda, and Lucy Aphramor. Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. BenBella Books, Inc., 2014.

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