Communities fight obesity by addressing racism, poverty
Communities have identified structural racism as a foundational cause of poverty and obesity and are partnering with advocacy groups, nonprofits and residents to build wealth in low-income neighborhoods and increase access to healthful food and opportunities for physical activity that can promote better health outcomes.
More than half of adults in every state are overweight or obese, and childhood obesity rates also are increasing, with poverty and institutional racism major factors that inhibit progress in reducing the problems, said John Auerbach, CEO of Trust for America’s Health. Auerbach was at a forum to highlight the group’s 2019 State of Obesity report and to discuss local solutions to prevent future generations from becoming overweight or obese.
“In 2012 no state had an obesity rate over 35%, but by 2018, nine states did,” Auerbach said. “In 2016, which was the most recently available data for children, 18.5% of children between the ages 2 and 19 had obesity.”
The report’s recommendations include increased obesity prevention funding, especially at the CDC, which currently spends 31 cents per person per year on prevention programs, and a focus on evidence-based solutions, comprehensive policy approaches and system change.
“If we do nothing differently, if our society doesn’t take any immediate action, there are projections to show that by 2050 the majority of today’s children will have obesity by age 35,” said Dr. Ruth Petersen, director of the CDC’s Division of Nutrition, Physical Activity and Obesity.
One of the CDC’s three main funding streams for programs to address obesity is the Racial and Ethnic Approaches to Community Health, or REACH, which provides money to state and local health departments, tribes, universities and community organizations.
The Health Improvement Partnership-Cuyahoga in Ohio, a network of community organizations and residents, began in 2009 to address issues affecting health and long-standing inequities. Coordinated by the Cuyahoga County Board of Health, it has received multiple rounds of REACH funding from the CDC, including $792,000 in 2018.
“Locally we are not unlike many of the communities across the country,” said registered dietitian Martha Halko, deputy director of Prevention and Wellness for the county. “Our data show we too have escalating rates of obesity and other chronic diseases, which are disproportionately affecting people of color and those living in poverty in our communities.”
Eliminating structural racism, or racial bias that has become an established part of society through policies and practices, is one of HIP-Cuyahoga’s priorities, along with healthy eating and active living, linking clinical and public health, and chronic disease management.
Halko said historical practices such as redlining shaped the inequalities that still drive poverty and obesity.
“There were housing policies supported by FHA and carried out by banks that limited loans to people of color in the 1930s, leading to intentional racial separation and limiting access to wealth-creating opportunities such as homeownership,” Halko said.
Those neighborhoods continue to have high rates of poverty and obesity, lower life expectancy and poor health outcomes. Halko said African-Americans in Cleveland are three times as likely to live in poverty as whites, who have median incomes 2.1 times higher than blacks. Life expectancy can vary by more than 20 years between poorer urban core neighborhoods and first-ring suburbs, and outer suburbs.
“We really believe that where people live should not dictate their ability to access and eat healthy foods,” Halko said. “Yet in the city of Cleveland, 1 in 3 residents live in a food desert.”
One of HIP-Cuyahoga’s success stories is the Good Food Here initiative to help neighborhood grocery stores stock and sell healthful foods. So far the program has increased access to healthful foods for more than 177,000 residents.
In national statistics, Cleveland residents rank low for physical activity. Shared building use agreements have led to greater opportunities for physical activity for more than 139,000 residents, with programs offering yoga and Zumba.
Interest in bicycling is increasing in communities of color, so HIP-Cuyahoga also is working with partners to get protected bike lanes, Halko said.
“As a partnership we are committed to continuing to work on addressing the systemic and structural issues like racism, poverty and trust that continue to shape conditions and limit opportunities in our communities of color, and really, in turn, impact their health and well-being,” Halko said.
Detroit also is affected by structural racism, along with hardships created by suburbanization, said Food Lab Detroit Executive Director Devita Davison. Economic decline was associated with a decrease in population from 2 million in the 1960s to around 700,000 currently, and in 2007 the city lost its last regional grocery store. About 30,000 people do not have access to a full-line grocery store, and 40% of households are food insecure.
An effort to create a community co-op grocery store was unsuccessful, and gentrification of inner-city neighborhoods attracted retailers such as a high-end leather goods store, Starbucks and Whole Foods, which many residents could not afford.
Davison said it became clear that trying to get larger grocery chains and restaurants to open in these neighborhoods, as an answer to food deserts, was not a viable way to encourage more healthful eating. Community stakeholders needed to come together and solve these problems without relying on government programs or funding aimed at incentivizing businesses that may not meet local needs.
“In the city of Detroit we resist the notion that government can solve all of our problems, especially when they are not listening to us,” Davison said. “So we take a community-based approach, and we believe in the power of the people.”
The nonprofit Food Lab has a goal of building wealth in low-income communities by advising and training residents and raising funds for local efforts to open businesses that sell fresh, healthful foods and provide living wages.
It works with Keep Growing Detroit, a nonprofit that helps farmers and gardeners in the city use vacant spaces. There are now more than 1,500 gardens and farms in the city, and around harvest time more than 25,000 residents are engaged in farming and gardening.
Food Lab helps entrepreneurs find buildings and funding to open business and restaurants. Two African-American women took a closed ice cream shop and reopened it as Detroit Vegan Soul.
“We’re talking about healthy, fresh retail that’s locally owned, that’s a sit-down restaurant, owned by people who are from Detroit, that are making culturally appropriate soul food,” Davison said.
Food lab also supported community members who took a vacant liquor store and turned it into a diner and production facility for farmers to process and package their produce. People who are not ready to open a restaurant can use shared kitchen space to prepare foods for catering.
This is “how we begin to change the conversation around food and we begin to improve health and obesity,” Davison said.