Should the Government Single Out African-Americans for Low-Sodium Diets?

Osagie K. Obasogie, Slate, April 18, 2011

{snip} On Jan. 31, the departments of Agriculture and Health and Human Services released the newest version of the official Dietary Guidelines for Americans, billed as “the federal government’s evidence-based nutritional guidance to promote health, reduce the risk of chronic disease, and reduce the prevalence of overweight and obesity through improved nutrition and physical activity.”

{snip} But one particular piece of advice has been making headlines: the government’s strong warning that Americans need to reduce their salt consumption. In a separate report published last April, the Institute of Medicine noted that cutting the amount of salt in our diets could prevent more than 100,000 deaths each year.

{snip} [The Dietary Guidelines] also recommend reducing salt intake to 1,500 mg for people who are 51 and older or have hypertension, diabetes, or chronic kidney disease. And they set the same, more stringent goal for anyone–anyone at all–who happens to be African-American.

{snip} But should the same rules apply to all black people? If these guidelines are evidence-based, what’s the evidence that race–in and of itself, regardless of age, ailment, or other considerations–is a risk factor of the same consequence as, say, diabetes? Are discredited biological explanations for racial disparities in health hiding in these new nutrition guidelines?

This isn’t the first time the government has made race-specific recommendations regarding salt intake; similar advice was put forth in the last version of the guidelines in 2005. However, these race-specific recommendations take on a new meaning within the emerging political climate of America’s “war on salt.” What’s striking is that with regard to minority health, the new federal guidelines shift this conversation away from widespread public health initiatives–such as New York City’s efforts to reduce salt in packaged and restaurant food by 25 percent over five years–and toward the idea that some races are biologically predisposed to certain diseases.

This stems from a decades-long debate over the disproportionately high rates of hypertension among blacks. Some studies have shown that blacks have greater “salt sensitivity” than whites, meaning that similar amounts of salt ingested by each group lead to greater increases in blood pressure among blacks. {snip}

Yet what seems like a bland statement of fact leads all too easily to the idea that blacks’ higher rates of sodium-related chronic diseases like hypertension stem from inherent biological differences rather than social, economic, or environmental pressures. Without a doubt, African-Americans have higher rates of hypertension than U.S. whites; research shows that the age-adjusted prevalence in blacks is 41.8 percent, versus 29.8 percent for whites. However, epidemiologist Richard Cooper has placed this and other racial disparities in an international context, showing that U.S. whites have a higher prevalence of hypertension than Nigerians, while U.S. blacks have a lower prevalence than Germans and Finns.

Moreover, there are no widely accepted biological explanations linking social categories of race to salt sensitivity and hypertension, despite common assumptions that a yet-to-be-found gene will answer all our questions. {snip} At the same time, the National Poverty Center estimates that over 25 percent of blacks are poor compared with 9.4 percent of whites. If poverty leads to hypertension–perhaps mediated by chronic stress–then there’s at least one alternate explanation for the racial disparity.

But the subtle ways that social factors might impact health are lost when federal guidelines lump in race with other risk factors that have well-defined physiological mechanisms. While made with the best intentions, the government’s dietary recommendations strongly imply that blacks suffer from higher rates of salt-related chronic diseases because they are genetically different–and perhaps less resilient–while obscuring these health outcomes’ social determinants.

Why should this matter? Regardless of any implication that blacks’ worse health outcomes are linked to their own inherent deficiencies, isn’t the simple purpose of federal nutrition guidelines to identify which groups should take extra precautions? Isn’t this about health, not racial politics?

The truth is that they aren’t mutually exclusive. Racial politics shape our understanding of health disparities more than we realize. For example, biological explanations of blacks’ heightened salt sensitivity have led to theories like the “slavery hypothesis.” According to this idea, endorsed by serious researchers as well as media luminaries like Oprah Winfrey, the ability to retain salt was advantageous for anyone enduring the grueling slave trade; surviving Africans who populated and reproduced in the New World are thought to have conferred this presumed, yet unproven, genetic trait–now, ostensibly, a disadvantage when salt is abundant–to their descendants.

While debunked theories such as this acknowledge that past wrongs perpetrated against blacks are relevant to understanding current health disparities, such a solitary focus on history does not fully engage with how modern injustices–from urban blacks’ lack of access to healthy food to the environmental contaminants in their communities–also impact health. Indeed, these injustices “get under the skin” to produce the very disparities that are thought to be a simple part of who blacks are.

When the federal government endorses guidelines implying that innate, physiological differences are at the root of racial disparities in health, it ultimately disserves the very communities whose health it is trying to promote. America has a long history of using biological explanations to justify racial subordination. We run the risk of recreating similar types of injustices when we frame persisting health inequalities in biological terms instead of acknowledging other possible causes.

The federal government’s misstep with its nutrition guidelines is not a reason for colorblind medicine. Reducing racial disparities in health necessarily begins with taking race seriously as a marker of social and economic differences that affect health. But we don’t need to use race as a crude proxy for some unknown genetic factor that mysteriously produces drastic health disparities all by itself. It is past time that we take the social determinants of health seriously as a matter of public policy. By implying that blacks’ higher rates of salt-related chronic disease stem from inherent biological differences, the new guidelines only rub more salt in the wound.

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  • Anonymous

    Oh for crying out loud — “lack of access to healthy food”!? The author writes as if corporate America is purposely not selling fruit and veg in “da hood”, in order to make blacks unhealthy. Yeah, right. I could go to any town or suburb in America and buy a piece of fruit or a vegetable.

    Have you ever seen a black eating something that wasn’t processed? I sure haven’t. This clearly is because of their preference for junk, not “racism”.

  • sbuffalonative

    Blacks won’t stand for being singled out even if it was for their benefit.

    “If poverty leads to hypertension—perhaps mediated by chronic stress—then there’s at least one alternate explanation for the racial disparity.”

    My blood pressure rises every day when I go to work and come home.

    You see, there are now black men in my neighborhood who do nothing but stand around all day in empty store fronts drinking beer.

    My stress and blood pressure levels rise every time I think about having to work while these black folk hang out all day drinking beer while I’m at work.

    When I was waiting for the bus after work, I saw one of these guys leave the social services building downtown.

    I wonder what kind of benefits he gets and for what. Is there a beer voucher?

  • Anonymous

    Where in the Constitution does it call for the Federal government to be concerned about salt intake? How about dismantling the nanny state, and let people be what they will?

  • Anonymous

    Wasn’t there a commercial on TV many years ago that had a black guy standing by his kitchen table saying, something like, “because of our greater efficiency, doctors recommend we reduce our intake of salt, and that’s important when I eat my wheaties”? Something like that. Too bad for them, more didn’t listen.

  • Middle American

    I agree with number 2 above.

    You can’t even try and help blacks without it getting thrown back in your face. Who cares why blacks are more sensitive to sodium. The evidence is clear. But no, politics says we must ignore the evidence.

    That’s like saying, hey, we should spend millions to screen every person of Irish descent for sickle cell anemia. Even though the evidence says it’s a waste of resources.

    Fine, eat more salt. Don’t listen to whitey.

  • Anonymous

    Would it be racist to limit food stamps to only fresh fruits and vegetables?

  • Anonymous

    An encompassing issue is that Americans just “can’t git it” when

    it comes to focusing upon the range of individual differences among members even of a large nuclear family unit, let along for the larger references of race and , then, of overlapping differences between two races, between males and females of the same race, etc. etc. For example, average daily requirements for vitamins, minerals, etc., by blurring needed distinctions, get to be little more than scatter gun “guesstimates”. The London school of differential psychology (Galton, Spearman, Burt, McDougall, Eysenck, Jensen, Brand, Rushton, Lynn…and others ) has been an antidote to this American delusphere. However, the London school on an American campus is more a matter of covert awareness than of overt, career-friendly acknowledgment. Thus,increasingly, in America, much of what is directly relevant comes to us, if at all, across the pillow, across the cocktail lounge table, etc., and in publications like AR. Campus USA 2011: Hide and seek for grownups.

  • Anonymous

    1. It’s not our problem. Our problem is getting away from these people’s other unfortunate social ‘vulnerabilities’ like 7X the violent crime and 8X the property crime of whites. Not helping them out in spite of ‘stated preferences’ for non racial medicine put forth by a black LAW PROFESSOR. Whose social mediation instincts are about creating conflicts so that he can resolve them for a profit rather than through any personal expertise in medicine.

    http://goo.gl/1YQAj

    2. Slate’s Ethnic Author also doesn’t care to mention other ‘racial indicators’ like lowered overall lifespan, lower immune response, lower IQ and rapid sexualization. All of which could easily be related to the fact that ‘due to environment’ (disease ridden Africa for several millennia more than we had to endure it) _the genes_ of blacks have adopted a rapid developmental condition which makes everything work twice as hard to achieve a sexually mature level necessary to sustain a population through Muller’s Ratchet and other genetic asssortation mechanisms which fight hard against the adaptive nature of multiple, hostile, diseases.

    We have proven, over and over, that slower is better. Some of our most brilliant children _do not learn to read_ until 4-5, almost a year AFTER their peers. Why? Because teaching the brain to learn, adaptively, from the environment is more important to eventual intellectual performance than rote imprinting. Is this genetic? Yes, the HAR-F1 gene sets the _epigenetic_ factors on brain development, early in childhood.

    3. There is real harm in modern processed foods. Soda Pop is now so saturated with chemically active caffeination that it literally sucks MORE than the hydration of the liquid you drink from your body’s own tissues, requiring you to drink 1.5 times as much to replace what you just drank. And yet we have moved from 12 oz cans of the stuff to 16 oz bottles and our schools now have pop machines for everyone rather than just the staff.

    I am quite willing to believe that blacks, eating cheaper, non prepared, foods from a very early age, develop a severe _behavioral_ vulnerability as chemical or psychological (‘comfort food’) habituation to things they really should not eat. Anymore than we should.

    Which brings me back to #1. _Not_. _Our_. _Problem_.

  • Anonymous

    To Poster #6,

    You are on to something there. If “poverty leads to hypertension” and a disproportionate number of blacks are on food stamps, requiring purchases to be strictly fresh fruit, vegetables, whole grains, lean meat, and such would go a long way to improve their health.

    Of course, I don’t see this happening anytime soon. Or ever.

  • Anonymous

    Since I have retired from my government job with horrible black women:

    (1) I have lost 20 pounds, from a chubby 140 to a slim 120. This is unusual for a 67 year old. It is doubly unusual because I did not consciously diet.

    (3) My blood pressure has gone from the 130s to from 95 to 110 depending on time of day. I have a lot of Dr apts so my blood pressure is taken about 6 or 7 times a month.The highest it has been for 3 years was 112.

    (3) I have totally stopped drinking alcohol. When I worked with blacks I drank a lot to forget the horrors of abuse to which I was subjected every day by the blacks. Like the weight loss, I never consciously decided to stop drinking alchohol.

    Obviously I got the job in 1966 before Whites were banned by our judiciary and federal government from government work.

    Associating with blacks leads to all sorts of problems from child abuse to rape and murder to high blood pressure, insanity and other mental and physical problems caused by this disfunctional group abusing each other and everyone else they come in contact with.