“Over the years since I left home, I have kept thinking about the people I grew up with and about our way of life. I realize how much the bond that held us had to do with food.”

- Edna Lewis, Chef, historian, and author

I spent many summers wandering around the tiny patch of grass in the backyard of my grandmother’s Brooklyn brownstone. Somehow, she grew overflowing bushels of fruits and vegetables ‒ berries, various greens, bok choy, and a host of delicious foods that we would harvest year-round and incorporate into daily meals and holiday gatherings.

We took for granted this tiny swath of paradise and how it enhanced our bodies and minds. The fresh produce that she grew year after year kept money in our pockets and spared our bodies from some of the detrimental impacts of the fast-food restaurants slowly encroaching on the retail spaces in our neighborhood.

The History of Food in the African Diaspora

Food of the African diaspora – specifically, the documentation and the infusion of African American cuisine into popular culture ‒ reflects the resilience, creativity, and necessity of the components and origins of our food choices.

As enslaved people, we utilized the foods at our disposal. Discarded parts of livestock and root vegetables packed heavy with proteins, fat, and carbohydrates helped us endure the daily and lifelong physical toll of being forced to till the soil, withstand the brutal heat of the Southern climate, and overcome waves of disease with lack of rest, recovery, and aid.

Thankfully, we retained some of the foods and practices of our African ancestry. In our Gullah communities, which still fight for land rights and survival along southeastern coastal lands, and through our Southern heritage practices, African American food culture continues to thrive.

Our history also emphasizes food utilization for civil and human rights. The Black Panther school meal program, sit-ins at Woolworth’s lunch counters, the ubiquitous repasts, reunions, and BBQs united the community and provided aid during times of trauma and victory. Such practices saturate our holiday seasons and daily bread as families nationwide gather to share mac and cheese, greens, smoked meats, desserts, stews, gumbos, and cornbread.

Health Disparities Within the African American Community

As technology, food processing, and ease of food availability have evolved, our health, globally, has suffered. We lead increasingly sedentary lifestyles and rely more heavily on readily accessible goods like fast food and junk food.

Obesity, diabetes, coronary artery disease, cancer, and early mortality are disproportionately higher in the African American community. According to the Center for American Progress, “African Americans have the highest mortality rate for all cancers combined compared with any other racial or ethnic group; 80% of African American women are overweight or obese compared to 64.8% of non-Hispanic white women.” African Americans are also 30% more likely to die from heart disease and 40% more likely to have high blood pressure ‒ and are less likely to have their blood pressure under control.

Why do these statistics exist? The reason is multifactorial. Food deserts. Poverty. Systemic racism. Redlining, a form of systemic oppression, continues to restrict people of color from living in neighborhoods that readily provide access to fresh meat and produce. Additionally, the prohibitive expense of healthy food alternatives, predatory infusion of fast-food chains, and lack of regulation on food, alcohol, and tobacco advertisements deliberately situated in minority communities largely contribute.

Combating Health Crises While Maintaining Our Heritage

What can we do to combat this surge in health crises while maintaining our cultural heritage and vibrant culinary tradition? As a health care professional, I realize that financial, cultural, and geographic awareness regarding patients is of utmost importance. Understanding availability, accessibility, and affordability for your patients and broaching these sensitive conversations should be the standard of culturally competent care.

I consider the following as it relates to my approach to creating health with my patients:

• What transportation or delivery services are available?
• Do they have food gardens, food pantries, or affordable food options nearby?
• If they are affluent and often dine out, what adjustments ‒ like home cooking, meal prep, or food preparation modifications such as grilling versus frying ‒ can be recommended to improve their health outcomes?
• Would taking cooking classes or learning at-home urban farming techniques help reverse the tide of detrimental food-consumption practices?

Food has been and will continue to be a central core of spiritual renewal, healing, and survival in our lives, and as health care advocates, we must honor this tradition when discussing lifestyle modification to address health concerns with Black and Brown patients.

As a society, we have an emotional bond to meat ‒ and much of this stems from advertisers, caregivers, and institutions who have taught us that meat is essential for sustenance. But meat consumption is problematic. Plant-based meals, if prepared properly, can provide just as much – if not more – nutritional value, though historical and cultural lack of health education has limited this option for minority communities. A great way to introduce plant-based options is to slowly incorporate alternatives or graduated reductions in meat consumption over time.

Where Do We Go from Here?

This past holiday season, I practiced what I preach. Instead of grabbing the smoked meats to add to our family’s collard green recipe, I opted for liquid smoke and dried seasonings such as onion powder, garlic powder, and smoked paprika to add a smoky flavor that would make my grandmother proud. Trust me, I was suspicious at first ‒ but I loved the taste and texture without the necessity for smoked meat.

As a plastic and reconstructive surgeon, there are instances when a patient must lose weight to qualify for insurance coverage for a procedure. Often, I refer patients to a nutritionist to help with food choices and weight-loss programs focusing on improving the relationship with food and dietary habits rather than going for a quick fix. It’s in these cases that having the option to refer my patients to a holistic Health Coach could change their lives and those of future generations.