7

Reflections

In the workshop’s wrap-up session, three panelists reflected on the day’s discussions and added their perspectives as stakeholders. The three panelists were Don Bradley, professor in the Department of Community and Family Medicine, Duke University; Ruth Petersen, director of the Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC); and Marjorie Innocent, senior director of health programs at the National Association for the Advancement of Colored People (NAACP). Bill Dietz, chair of the Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, moderated the session.

STAKEHOLDER REFLECTIONS AND PERSPECTIVES

Bradley underscored that words matter, urging the use of person-first language and careful choice of terminology, such as “people of color” versus “minority” and “power” versus “empower.” People of color are not minor people, he said as an example, noting as well that “empower” implies giving something to someone as opposed to recognizing his or her self-efficacy. He also shared his preference for social “drivers” rather than “determinants” of health, remarking that these factors are not necessarily set in stone for those they affect. Bradley next reiterated the importance of assessing racial inequities with more granularity, given the variation among single races within the same broader racial/ethnic groups. He called for acknowledging racism and white privilege, reaffirming Chin’s appeal for fearless conversations

in that regard, and proposed a focus on “dose” in policy, systems, and environmental changes.

Petersen echoed the importance of a granular assessment of inequities, but cautioned that this perspective should not turn into a competition for the limited resources available to address health equity. She emphasized to participants that there is some degree of knowledge about what works, and urged them not to be constrained if the exact recipe for success is unclear. When evidence-based strategies are provided to communities, she elaborated, communities can apply their “secret sauce” as they tailor the strategies to their needs and values. Petersen added that, based on the results of community needs assessments completed by CDC grantees, there are many iterations of evidence-based strategies for physical activity and nutrition, depending on what matters to the communities involved. She shared an example of grantees in the Racial and Ethnic Approaches to Community Health (REACH) program, who wanted to address food insecurity via churches and faith-based organizations. Finally, Peterson urged trust in communities, stressing that they possess a skilled public health workforce and a contingent of community-based organizations that are ready to apply the evidence and tailor it to their priority populations on the ground.

Innocent applauded the workshop for capably taking on what she said was a challenging conversation. She explained that NAACP’s health efforts include both engaging in federal health policy advocacy and working with its affiliates to raise awareness about chronic disease prevention and treatment. In her view, the United States has not taken health seriously enough to ensure progressive rights to access to health care, and a social justice lens is imperative when addressing these challenges. Innocent encouraged stakeholders to be steadfast in redefining the way they think about health, address health, and incorporate health in all policies in order to work more collaboratively and holistically within their own spaces and when talking with elected officials and other policy makers about solutions. Until this type of unified, sustained approach is advanced, she insisted, the result will be siloed approaches that perpetuate the status quo.

Innocent recounted a recent experience from an NAACP civil rights advocacy training event as an example of the importance of engaging communities to identify their assets and barriers to civic engagement on health issues. A training participant from one of the organization’s affiliates expressed the view that in the midst of the nationwide pushback on basic civil rights such as voting, health-related initiatives are perceived as necessary yet inaccessible in the face of concerns about basic survival. Innocent urged mindfulness about the current social and political challenges, adding that civil rights and social justice advocates are always tired, but are particularly “weatherbeaten” today.

FINAL REMARKS

Following the panelists’ remarks, Bill Dietz reflected that most obesity prevention and control efforts have focused on individual behavior change. Engaging and empowering communities and building their capacity for change in obesity is also critical, he maintained, referencing two major multicenter obesity prevention efforts that used state-of-the-art behavior change strategies yet did not observe impact in the trajectory of participants’ obesity rates. Dietz showed an equity-oriented obesity prevention action framework (see Figure 7-1) to highlight that unless such behavioral interventions are joined with community-based interventions, disparities in the prevalence of obesity are likely to persist.

Dietz maintained that building trust is an integral component of empowering communities. In light of the bias and stigma that accompany obesity, he said, trust is even more difficult to achieve within a context of racism, colonization, and displacement. A promising approach is group model building, he suggested, in which the community is engaged in developing innovative solutions.

Dietz also commented on the growing literature associating ultraprocessed foods with increases in obesity rates, caloric intake, and mortality. Many African American and Hispanic populations depend on corner stores for their food supply, he observed, leading to their consumption of ultraprocessed foods because healthier options are more expensive and less available. He suggested that this circumstance reflects a conundrum in the U.S. agricultural production system, which subsidizes the development of ultraprocessed foods. Reflecting on Chin’s presentation, he agreed that a restructuring of the health care payment system is also warranted to address disparities in obesity.

Kumanyika returned to close the meeting, urging participants that something different should come out of the workshop and that all participants could contribute by thinking about what can be done differently. She remarked that the obesity community has repeatedly tried the same approaches because some of them are known to work, but they do not work alone. The next step for the obesity community, she suggested, might be to combine solutions that target individual behaviors with those that address social determinants and engage communities to change environments and policies (see Figure 7-1).