Closing the Culture Gap

When it comes to hunger and food insecurity in the United States, minority populations seem to be the hardest hit. According to Feeding America, one in four African-American and Latino households (25.1 percent and 26.2 percent, respectively) is food insecure, compared to 11.4 percent of Caucasian households. Meanwhile, 32 percent of black children and nearly 35 percent of Latino children live in food-insecure households.

Registered dietitian nutritionists and other professionals play a vital role in supporting these families toward good nutrition and better health. The most successful nutrition intervention programs often include practitioners who culturally identify with the population being served, but according to 2013 demographic information from the Commission on Dietetic Registration, 87 percent of registered dietitians are white and 11 percent of RDs identify themselves as belonging to a minority ethnic group.

This is not to say dietitians cannot work effectively with clients of ethnicities other than their own. But because the majority of the food-insecure population includes people of color, cultural competence and a real understanding of a client’s circumstances are critical to effective counseling.

This begins with exploring your own views, values and practices. To be clear, developing this awareness can be emotionally exhausting. It involves digging deep and addressing biases and beliefs — even prejudices — we may not want to admit to, eventhough we all have them. The point is not to stir up guilt or shame, but to recognize that what is “normal” to you may look very different to someone else.

Whether you’re engaging in personal interactions or working within a system or agency context, cultural competence is a fundamental awareness of the language, thoughts, behaviors and institutions of ethnic, racial, religious or social groups. The Campinha-Bacote model of cultural competence in healthcare delivery includes using that awareness to provide culturally appropriate, respectful and relevant care and education. Such models emphasize the ability of professionals to ask questions, listen carefully, respond to what is said, speak simply and respectfully, and involve clients in their own treatment plans.

“The objective is to compassionately evoke a more critical consciousness among white folks who work in communities of color regarding how to serve marginalized or vulnerable communities,” says Caridad Souza, PhD, director of the Center of Women’s Studies and Gender Research at Colorado State University.

For example, food insecurity as defined by the U.S. Department of Agriculture doesn’t just mean a lack of food, but also “reduced quality, variety or desirability of diet” and “disrupted eating patterns.” People in food-insecure communities eat what they can, when they can, which manifests as cycles of binge eating and fasting that can lead to dangerously high and low blood sugar levels and serious health consequences.

Yet a practitioner without any context for this reality — who may not understand why obesity is higher among food-insecure women and children, or that food-insecure African-Americans and Latinos are disproportionately affected by type 2 diabetes — may assume a mother who feeds her family what is available in her neighborhood simply needs someone to explain that fast food is not the most healthful option.

As you investigate your own cultural perspectives, learn about the communities you are serving. “What are their histories? What political or economic situations brought them to this current geographical and social location? What are their ancestral foods and food systems and how can you support indigenous practices?” says Marian Isel Barragán, a California-based health coach and community chef who, with Souza, presented “Check Ya’Self: A Workshop for White Folk Working in Communities of Color” at the 2013 Just Food Conference in March.

Finally, to assist in achieving cultural competence, consider joining one of the Academy’s member interest groups representing the ethnic populations with whom you work. Among colleagues and peers, you can ask questions and gain insight into thoughts and nuances of a culture or ethnic group. Understanding the perspective of the food-insecure client, both culturally and as an individual, can lead to more successful outcomes.

Tips to Shorten the Cultural Distance

  • Don’t pass judgment, but build on people’s food and nutrition practices by accentuating the positive aspects of the food they eat.
  • Try to use educational materials that depict the ethnicity of the clients you are working with.
  • Inquire about your client’s beliefs in the role of religion on health outcomes. For example, many Latino and African-American perspectives are fatalistic, believing divine powers control destiny.
  • Whenever possible, use visual aids instead of written materials and handouts. Even small language barriers can affect outcomes.
  • 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.
Constance Brown Riggs
Constance Brown Riggs, MSEd, RD, CDE, CDN, is president and owner of CBR Nutrition Enterprises — a multi-pronged company that focuses on providing complete medical nutrition therapy to patients.