From Chronic to Crisis: How Malnutrition Makes Covid-19 Lethal

July 13, 2020

As citizens protest racial inequalities across the country, Black and Latino Americans have died of Covid-19 at two to three times the rate of white Americans. In the nation’s capital, the gap is more extreme: Black residents are dying at six times the rate of white Washingtonians. Exposure to the virus through high-risk jobs, and underlying health conditions exacerbated by lack of access to nutritious foods, are among the main causes of this disparity. Improving access to healthy food for people of color—indeed, all American people—should be a primary concern as Americans examine ways to rectify centuries-old inequalities.

Nutrition and Covid-19

The Centers for Disease Control and Prevention (CDC) found that 33 percent of people hospitalized for Covid-19 are African American, who comprise only 13 percent of the U.S. population. The CDC also reports that nearly 90 percent of people hospitalized for Covid-19 have one or more underlying medical conditions, including obesity, type 2 diabetes, and heart disease. Studies show that high rates of obesity and diabetes, which are disproportionately present in communities of color, may explain why Black and Hispanic Americans are dying from Covid-19 at rates higher than their proportion of the population.

Chronic health diseases like obesity, type 2 diabetes, and heart disease are, for the most part, preventable or well managed by a healthy diet. Research shows that consuming fresh fruits and vegetables, in combination with a low-saturated-fat, high-fiber diet, has a rapid anti-inflammatory effect. Such diets prevent micronutrient deficiency and are potentially lifesaving in the face of Covid-19, which elicits an overwhelming inflammatory response in the body. However, barriers have long existed that hinder access to fresh and unprocessed food by communities of color.

Nutrition in Low-Income Communities

Diet-related diseases are the number one cause of poor health in the United States, and diet-related diseases—such as obesity, type 2 diabetes, and hypertension—are more likely to exist in communities of color. Nationwide, the rate of obesity is 38 percent among non-Hispanic, Black adults; 32 percent among Hispanic adults; and 27 percent among white adults. In 2018, the U.S. Department of Agriculture found that the prevalence of food insecurity was also highest among Hispanic and Black households. It is worth noting that malnutrition has not taken root in these communities simply because of individual and behavioral choices. Obesity and food insecurity often go hand in hand, as obesity is not usually the result of eating too many calories but of eating calories from unhealthy foods—particularly from highly processed items that are high in sugars and saturated fats. These foods are often cheapest and most readily available in low-income communities, which is a symptom of an inequitable food system.

Today, in the neighborhoods east of the Anacostia River in Washington, D.C, which are majority-Black, there are only three full-service grocery stores for nearly 150,000 community members. In contrast, just across the river in D.C.’s Waterfront neighborhood, where nearly 50 percent of the community is white, there are 12 full-service grocery stores for just over 75,000 residents. Unfortunately, and unsurprisingly, residents east of the Anacostia also have the highest obesity and type 2 diabetes rates in the city. Businesses like grocery stores operate on narrow profit margins, so they may avoid opening in low-income communities, further limiting access to nutritious food. Just two years ahead of the pandemic, residents east of the Anacostia had to petition for food services to deliver in their area.

Poor nutrition among communities of color is not a twenty-first century phenomenon, but the result of centuries of imbalances in economic, political, and social power, which trap communities of color in cycles of poverty and poor health.

Disparities in access to healthy food in the United States present a protracted problem. This is largely a product of historical “redlining”—denial of services by federal, state, or local governments, or the private sector, to communities of color—resulting in disinvestment in transportation, education, health care, and other services, like grocery stores. Poor nutrition among communities of color is not a twenty-first century phenomenon, but the result of centuries of imbalances in economic, political, and social power, which trap communities of color in cycles of poverty and poor health.

Work-Related Risks

From the migrant workers harvesting ripe tomatoes in Florida, to the assembly line personnel in meat processing plants, to the delivery drivers ensuring groceries or take-out dinners arrive on time, people of color in the United States are more likely to work in jobs that put them at risk of exposure to the coronavirus—often in jobs in the food industry. At 11.4 million, workers in the food and agriculture industry make up 20 percent of essential workers nationwide, second only to health care workers. Before the pandemic, over 30 million U.S. workers were employed across six “essential” industries: food and agriculture, public transit, delivery services, health care, and social services. People of color make up the majority of essential workers in these fields, often working without medical benefits.

In the United States, meatpacking plants are making headlines as outbreak after outbreak showcase dire working conditions. Working in a meat processing plant is already dangerous work, and the pandemic is making it even more deadly. Some use this to exemplify a supply chain crisis, but it is drowning out something far more important—27,000 meatpacking workers have fallen ill to Covid-19, and 86 of them have perished due to the virus. Approximately three-quarters of workers in the meatpacking industry are Latino or Black, and, according to the CDC, 87 percent of infected workers are from “racial or ethnic minorities.” Although there should be immediate action to curb the conditions that fuel such high numbers, policies immunizing employers from liability took precedent over the lives of those that contribute to our national food security.

People have to work. Food has to be put on the table. Bills have to be paid. Those who can work from home are able to avoid the deadliest risks. However, 43 percent of Black and Latino workers are employed in positions that cannot be done remotely. To support themselves and their families, frontline workers must leave their homes, work in crowded places, and often utilize public transportation to make ends meet. Doing so puts them and their household at heightened risk of contracting Covid-19.

Moving Forward

Despite a heavily polarized political landscape, two previous secretaries of agriculture —one Republican and one Democrat—recently agreed that expanding supplemental nutrition programs may be one of the most successful ways to improve access to nutritious foods during the coronavirus pandemic. Though these programs are important components to increasing access, they do not fix the systemic barriers to an equitable food system. Investments in food security, particularly for people of color, can reduce morbidity and mortality from Covid-19 and help redress pervasive race-based inequalities throughout our country.

The food system has not suddenly broken—as it never worked for all Americans in the first place. There is no “silver bullet” solution to improving access to nutritious foods; tackling food system inequities means addressing the issues that limit food access, including business investment, transportation, and jobs. Today, there is a unique window of opportunity to encourage cross-sectoral reforms of food systems. To promote equity in food systems in the United States—and to lead by example on a global scale—access to safe, healthy, and affordable diets should be a bipartisan priority.

This commentary from the CSIS Global Food Security Program, is the first in a series that explores policy-based solutions to inequities in food systems in the United States. It is made possible by the Bill & Melinda Gates Foundation.

Eilish Zembilci is program coordinator and research assistant for the Global Food Security Program at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Caitlin Welsh is director of the CSIS Global Food Security Program.

Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).