Disparity of Power

Disparate Health and Obesity: By Design, Not Chance

Impressive presentations at ObesityWeek exposed a thread that knits together obesity and COVID-19. But the thread we see is not inflammation – though inflammation is certainly important. Rather, it is disparate outcomes in health and obesity. These outcomes are not by chance. They are by design.

In fact, a careful design of social systems ensured consistently poor outcomes throughout American history for some persons while others thrived.

A Thread That Weaves Through Our History from Slavery

Slavery Informs the Approach to Healthcare for BlacksIn his compelling presidential plenary talk, Jamy Ard followed an unbroken thread of health disparities. It began with slavery. Slave owners protected their investment, but made sure not to spend on any extras – like health. Living conditions for slaves fostered diseases, but white physicians invented medical terms to ascribe this to race. Drapetomania, for example, was a supposed mental illness that caused slaves to run away from their masters.

Disparities continued through Reconstruction, when freed Blacks were isolated and left vulnerable to epidemics. The priority was to keep infectious diseases away from the white population. Smallpox was devastating to this population as a result. The thread continued through separate and unequal healthcare in the Jim Crow era. Employment-based health insurance came to Whites, while occupations that employed Blacks did not offer this benefit.

The thread is still unbroken today with Blacks and other disadvantaged persons dying at more than twice the rate of Whites from COVID-19. Ard explained:

COVID has shone a bright spotlight on a sore spot that we have not taken seriously. This pandemic has highlighted the life and death consequences of our inability to protect the most vulnerable in our society.

Disparate Outcomes: Health, Obesity, and COVID

Later that day, Fatima Cody Stanford explained how obesity is amplifying disparate outcomes in the COVID pandemic. When baseline health is compromised by a high prevalence of obesity and chronic diseases, the outcomes are destined to be poor. She spoke from personal experience:

I can tell you, talking to my parents who lost ten of their friends to this pandemic, my best friend who lost her father, and my mentee who is an internal medicine physician and has lost both parents, that this is indeed real.

Thus we have little patience with quiet bystanders, folks who tire easily with the subject of health disparities. A White physician recently told us, “We need to move on. Most people who get this will do just fine.”

If we are willing to live with such profound injustice, we can be sure. Ultimately, it will diminish us all.

For a deep dive into The Color of COVID, we recommend Stanford’s presentation, available here.  To understand the origins of health disparities in America, click here for Ard’s presentation.

Disparity of Power, photograph © Alisdare Hickson / flickr

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November 5, 2020

One Response to “Disparate Health and Obesity: By Design, Not Chance”

  1. November 05, 2020 at 2:54 pm, David Brown said:

    Disparities in health outcomes have a genetic component. For example, “Genetic variants in FADS cluster are determinants of long-chain PUFA levels in circulation, cells and tissues. These genetic variants have been studied in terms of ancestry, and the evidence is robust relative to ethnicity. Thus, 80% of African Americans and about 45% of European Americans carry two copies of the alleles associated with increased levels of arachidonic acid (AA). It is quite probable that gene PUFA interactions induced by the modern Western diet are differentially driving the risk of diseases of inflammation (obesity, diabetes, atherosclerosis and cancer) in diverse populations.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808858/

    One way to get too much arachidonic acid is to consume the industrial meat. “As Americans, our diets have among the highest protein consumption rates and we are experiencing increased rates of obesity across all age groups. Here we reveal that consumption of corn-fed animal proteins are more common among lower socioeconomic status populations, which places these populations at a potentially greater risk for increased health problems.” https://www.pnas.org/content/117/33/20044