The Washington PostDemocracy Dies in Darkness

Opinion My Southeast D.C. Zip code shouldn’t be my health destiny

Shoppers at a Giant food store in D.C.’s Ward 8 in 2019. The Giant is the only full-service grocery in the ward. (Michael S. Williamson/The Washington Post)

Lisa K. Fitzpatrick is founder and chief executive of Grapevine Health and a Health Innovators Fellow at the Aspen Institute.

In the United States today, where you live often determines how long you live. Our Zip codes are more reliable predictors of our health outcomes than our genetic codes.

The disproportionate impact of the novel coronavirus on underserved communities has shed light on this reality. In poor counties with high minority populations, the coronavirus death rate is more than nine times greater than predominantly White and wealthy areas. But even before the pandemic, these health disparities were well known. More than 40 percent of Black Americans suffer from hypertension, compared with 28 percent of Whites. Diabetes is 60 percent more common among Black Americans than White Americans. Almost 80 percent of Hispanic women are overweight or obese.

Poor nutrition is a primary driver of these conditions.

Moving to a disadvantaged neighborhood in Southeast D.C. helped me better appreciate this association. It also helped me understand how policymakers have made mistakes in addressing these disparities — and how, by fixing those mistakes, we can improve health outcomes for underserved Americans.

My own neighborhood is a food desert. Corner stores and carry-outs are more common than grocery stores and farmers markets. Health literacy is low, and some of my neighbors lack the proper kitchenware to even prepare a meal at home.

I’ve spoken to people in my community who have a strong interest in healthy eating, but they don’t know how to start. Some of them are food stamp recipients who receive food through government programs but don’t receive comprehensive nutrition resources to help them make better choices.

Living in an environment with scarce resources takes a serious toll on their health — and their experiences are hardly unique.

Culture, lifestyle and other social drivers of health play a role in Americans’ eating habits, of course, but so do government nutrition policies. For years, policymakers have attempted to make communities such as mine healthier. But most of their efforts have failed.

Consider soda taxes, which are levied in several U.S. cities. They’re supposed to reduce Americans’ consumption of sugary beverages, yet studies indicate that they have little impact on consumption rates and caloric intake.

Requiring restaurants to publicize nutrition information hasn’t worked either. As a study in Health Affairs concluded, posting calorie counts caused “no statistically significant changes over time in levels of calories or other nutrients purchased.”

Or consider the Dietary Guidelines for Americans, which the federal government updates and reissues every five years. The DGA is quite influential: It shapes school lunch programs, military rations, public nutrition programs and even educational curriculums.

The DGA supposedly offers “evidence-based nutrition information” to help Americans make healthy choices about food and beverages. But, in reality, the recommendations are based on incomplete science and ignore key populations. They’re entirely geared toward healthy Americans — even though 60 percent of U.S. adults have a chronic illness.

There’s also evidence that the DGA’s review process routinely ignores the latest scientific research. Consider how the guidelines recommend six servings of grains daily, despite the fact that rigorous clinical trials indicate that those with chronic diseases such as diabetes would benefit from limiting their consumption of carbohydrates. In many cases, low-carbohydrate diets have reversed Type 2 diabetes, reduced blood pressure, promoted weight loss and improved heart disease risk factors — yet the guidelines haven’t taken those findings into account.

Such gaps in the government’s recommendations harm minority and underserved Americans. These groups experience higher rates of diet-related chronic diseases and disproportionately rely on food assistance programs. It’s puzzling that the DGA doesn’t consider the health conditions of the communities where its recommendations have the most impact.

Amid the coronavirus pandemic, the consequences of these disappointing nutrition policies are now tragically obvious. Americans’ health has clearly worsened since the creation of the DGA. By distributing flawed nutritional guidance, the government now bears partial responsibility for the high rates of chronic diseases in underserved minority communities — who’ve also been hit hardest by the coronavirus.

I witness these inequities every day — and even experience them myself. Though I’m a medical doctor and have all the tools to make healthy choices, my health has suffered since my move. I’ve struggled to maintain a healthy weight, and my blood pressure is higher than it should be.

Fortunately, the scientific community has taken notice of the disparities that impact communities such as mine. Recently, the National Academies of Sciences, Engineering, and Medicine asserted the DGA needed to expand its methodological approaches to “include broader groups of people with a range of physiological needs, metabolic health, and chronic disease states.”

Now is the time for policymakers to heed such recommendations. Only by developing straightforward, reliable and science-based recommendations can we change course — and make sure that a person’s Zip code isn’t her destiny.

Read more:

Read a letter responding to this opinion piece: It’s socioeconomic factors that are making some Americans less healthy

Joy Sharon Yi: Riding the bus in a pandemic

Letter to the editor: Focus on food insecurity instead

Katherine Mangu-Ward: Five myths about healthy eating