Closing the culture gap between client and provider by Constance Brown-Riggs

There’s no question that COVID-19 exacerbated the existing racial disparities in food insecurity. According to Feeding America in 2019, food insecurity among Black and white individuals was 19.3 percent and 9.6 percent, respectively. For 2021, projections for Black individuals are 21 percent compared to 11 percent of white individuals.

The cultures of Black people seeking help with dietary issues and most dietitians providing it affects the quality of and compliance with that advice. Constance Brown-Riggs devotes her attention to helping to narrow that gap. April is National Minority Health Month. I will highlight issues around this topic during the month. It is my pleasure to introduce my readers to Constance Brown-Riggs with her ideas on closing the gap between minority clients and dietary advisors. RS 

Moreover, Blacks bear a disproportionate burden from chronic diseases such as obesity, diabetes, and hypertension. Blacks are 1.3 times more likely to have obesity compared to whites; 60 percent more likely than whites to be diagnosed with diabetes, and Blacks are 40 percent more likely to have high blood pressure and 30 percent more likely to die from heart disease than whites.

These individuals need factual information—in a way they can receive it, in order to navigate food insecurity and chronic disease. Black people cope with illness and food insecurity within a particular cultural context. Their approach to diet and exercise, their eating habits, their relationships with caregivers, even their spirituality and behavior patterns are unique—and all of that has an impact on how they approach their life circumstances and manage their health.

Registered dietitian nutritionist (RDN) and diabetes care and education specialist (DCES) play a vital role in supporting these individuals toward good nutrition and better health. Yet while the most successful intervention programs often include practitioners who culturally identify with the population being served, according to 2020 demographic information from the Academy of Nutrition and Dietetics (the Academy), 71 percent of RDNs are white—and only 2.4 percent are black with another 9.8 percent identifying themselves as belonging to a minority ethnic group.

You can find the same lack of diversity among DCES. According to information from the Association of Diabetes Care and Education Specialists (ADCES), 85 percent of DCES members are white, and only 15 percent identify themselves as belonging to a minority ethnic group.

Black family filling their plates around a kitchen island
Sharing Healthy Food Traditions. Photo by August de Richelieu from Pexels 

This is not to say these health care professionals cannot work effectively with clients of ethnicities other than their own. But because the majority of the food-insecure population and those with chronic disease include people of color, cultural competence, cultural humility, and a fundamental understanding of a client’s circumstances are critical to effective counseling.

This begins with exploring your own views, values, and practices as well as prejudices. To be clear, developing this awareness can be emotionally exhausting work. It involves digging deep and addressing biases and beliefs we may not want to admit to. (And we all have them)

Studies show that most health care providers have an implicit bias in terms of positive attitudes toward whites and negative attitudes toward people of color. This bias is particularly worrisome given the previously mentioned RDN and DCES demographics.

Implicit bias—also known as implicit social cognition—refers to attitudes or stereotypes that affect our understanding, actions, and day-to-day decisions in an unconscious manner. Implicit bias is activated involuntarily and without innate awareness or intentional control. It’s different from the thoughts we might hide for political correctness or explicit bias to which we fully admit. Think of implicit bias as the thoughts you never knew you had. Early life experiences, the media, and news programming contribute to our feelings and attitudes about other people based on characteristics such as race, ethnicity, age, and appearance.

As a diabetes nutrition expert who is passionate about finding ways to shorten the culture gap, I’m often called upon to talk about cultural competence. Here are six tips I frequently share with providers to shorten the cultural distance.

    • Learn about the communities you are serving. What are their histories? What brought them to this current geographical and social location? Approximately 44 million Black people are living in the United States. Some have been in the United States for many generations; others are more recent immigrants from Africa, the Caribbean, or other parts of the world. What and how they eat may differ significantly—at least until immigrants become acculturated.
    • Be inquisitive and identify cultural barriers.In a thought-provoking 2018 Huffington Post article titled ‘White People Food’ Is Creating An Unattainable Picture Of Health, author Kristen Aiken observed that some of the healthful foods RDNs promote are often perceived as “white people’s food” in communities of color, and healthy eating must be addressed in the context of cultural barriers. Unfortunately, some uninformed practitioners make nutrition recommendations unattainable for many Blacks who can neither afford nor identify with them. Nutrition professionals and DCES should treat each person as an individual and be inquisitive. Ask about their traditional foods? How and where they get their food (Whole Foods or the dollar store) and how they include those foods on the plate. Ask what healthy eating means to them.
    • Don’t pass judgment on current practices. Build on current practices by accentuating the positive aspects of the food currently eaten. Many experts blame “soul food” for putting the “die” in diet. But there’s so much more to soul food than dishes that are deep-fried and laden with salt, sugar, and calories. Foods like collard greens, cabbage, sweet potatoes, cornbread, and Hoppin’ John (black-eyed peas and rice) are high in fiber, vitamins, and minerals and, depending on how they are cooked, low in fat. These same healthy foods show up on the plates of emigrants from the Caribbean and Africa. For example, Jollof rice and black-eyed peas on an African plate and rice and peas (kidney beans) on a Caribbean plate.
    • Try to use educational materials that depict the ethnicity and foods of the clients you are working with. Look beyond MyPlate.gov. Explore sites such as Oldways Preservative Trust, where you’ll find the African Heritage Diet Pyramid based on the healthy food traditions of people with African roots. The African Heritage Diet Pyramid naturally mirrors evidenced-based recommendations such as the USDA 2020 Dietary Guidelines while fully embracing African-based foodways.
    • Inquire about your client’s beliefs in the role of religion on health outcomes. Black Americans tend to be a community of believers in God—and this spiritual foundation that sets the tone for their lives has an impact on how they feel about physical afflictions, healing, and the relationship between faith and medicine.
    • Make a strong effort to see the world through other people’s eyes. Recognize that what you think of as a health myth someone else may consider a fact. Understanding the perspective of Black people, both culturally and as individuals, can close the cultural gap and lead to more successful outcomes.

Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, is the author of several books including, Living Well With Diabetes 14 Day Devotional: A Faith-Based Approach to Diabetes Self-Management and the Diabetes Guide to Enjoying Foods of the World, which received a Gold Hermes Award in the 2019 competition for books. Learn more about her work at www.eatingsoulfully.com and follow her on Instagram: @your.diabetes.nutrition.expert, Facebook: @livingwellwithdiabetes, Twitter: @eatingsoulfully

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