15 Is Nutrition the Antidote to the Hypertension Epidemic in South Los Angeles?

Lule Deshields, Chrystal Kumar, Sabrina Montgomery, Nicolas Bautista, Mubarak Sanni, Kevin Artiga, Chidi Ezeofor, Martin Vazquez, Ferdinand Anokwuru, Alan Nguyen

About the Community

South Los Angeles, particularly Service Planning Area 6 (SPA 6), is a vibrant and culturally rich region predominantly inhabited by Black and Latinx communities. This area, home to approximately 1.2 million residents, is characterized by a unique blend of cultural heritage, resilience, and community spirit. However, it faces significant public health challenges, particularly concerning hypertension. Black adults have a higher prevalence of hypertension, with approximately 56% affected, due to factors such as genetic predisposition, obesity, diabetes, and socioeconomic stress (Thomas, 2018). Adults with hypertension are also more likely to experience severe complications like stroke, heart disease, and kidney failure due to the complications of associated microvascular and macrovascular disorders (Long & Dagogo-Jack, 2011). Although less prevalent in Latinx adults, with about 25% affected, hypertension remains a significant concern due to acculturation stress, dietary habits, and higher diabetes rates, leading to lower blood pressure control and increased end-organ damage (County of Los Angeles Department of Public Health, 2023).

SPA 6 faces higher hypertension rates than the national average due to socioeconomic disparities, limited healthcare access, and a higher rate of uninsured individuals (Harding, 2017). These health disparities largely stem from socioeconomic factors such as poverty, limited access to healthcare, food deserts, and a lack of educational resources. This underscores a dire need for culturally relevant public health interventions to address the pressing health concerns in these communities.

The cultural ties and historical contexts of the residents play a critical role in shaping dietary habits and health behaviors. Traditional dietary practices rooted in Black and Latinx heritage often include high-sodium foods or dishes lacking in essential nutrients (Airhihenbuwa, C. O., 2010 & Elfassy, 2019). These cultural preferences can create barriers to dietary changes, complicating efforts to manage health conditions such as hypertension (Satia, 2010). The need for culturally sensitive approaches to nutrition education and community-based interventions is paramount. These approaches must honor the unique traditions and experiences of the community while fostering awareness of healthier food options and lifestyle choices.

How Our Work with the Community Began

Our journey into this community began with a growing recognition of the health disparities impacting Black and Latinx populations in South Los Angeles. All members of our team know someone who has been impacted by hypertension. It is a condition that we have seen that can impact someone’s quality of life significantly when not managed correctly. This inspired us to learn more about the different holistic approaches to medicine that can help manage such a prevalent condition like hypertension. We settled on nutrition because we were interested in getting a better understanding of the cultural implications that nutrition holds in the African American and Latinx communities. Further, we wanted to also understand the nutrition-related challenges faced within SPA 6.

We did this through reviewing literature and conducting interviews with local healthcare providers, community organizations, and residents. Throughout the project, we listened to the voices of community members through interviews and focus groups that allowed us to gather rich qualitative data, illuminating their experiences, cultural perspectives, and willingness to adopt dietary changes. In talking to community-based organizations like Food Access LA and It’s Bigger Than Us, who both aim to provide resources and support to low-income communities, we sought to engage directly with residents to identify their unique needs and barriers related to hypertension management and dietary choices.

Moreover, our commitment to culturally sensitive health interventions was enhanced by understanding the historical and socioeconomic contexts that influence dietary habits. By establishing relationships with leaders and organizations within the community, we were able to assess existing resources, gaps in support, and opportunities for impactful interventions.

Project Description

The project was designed as a multifaceted initiative aimed at understanding hypertension management through culturally relevant nutrition education and resource mobilization in South Los Angeles. Our primary goals included:

• increasing access to healthy foods,
• improving health literacy, and
• fostering community engagement.

We did this through a systematic review and interviews with patients, community organizers, and physicians.

Components of the Project

By engaging with the South Los Angeles community and recognizing the multi-factorial influences on health outcomes, our project sought to create sustainable, positive impacts on dietary practices and overall health in SPA 6.

Understanding the intersection of cultural practices and dietary habits is key to developing interventions that resonate with the Latinx and Black populations. Ultimately, the findings from this research could inform policy recommendations to improve food environments and support long-term health improvements in South Los Angeles. By focusing on this high-risk population, we can help reduce preventable deaths and improve long-term health outcomes, ultimately contributing to health equity in marginalized communities.

Outcomes

Culturally relevant and community-engaged initiatives in South Los Angeles are vital for effective dietary changes. The resources currently available to patients differ considerably based on economic factors, geographic location, cultural relevance, and healthcare infrastructure. Economically, many South Los Angeles residents rely on supplemental food programs like EBT (Electronic Benefit Transfer) also known as CalFresh in California. These programs provide supplemental income to individuals and families that are at or below the 200% federal poverty line. With California making budget cuts, programs that benefit those who use supplemental food programs are on the brink of being closed. In our interview with Summer Walker, the manager of Food Access LA, she stated that:

“[Budget cuts] are going to affect not only just our markets, but it’s going to affect all low-income, mid-income communities throughout Los Angeles because they heavily rely on these extra incentives to feed their families. And while EBT and Cal Fresh are never going to be going away at our markets, having this extra subsidy is something that could potentially go away. And right now, we’re trying to get the word out about that. So, people aren’t impacted.”

Programs like the market match (where families with EBT are given extra vouchers to purchase strictly fresh fruit and vegetables) available in farmers’ markets, are essential for low-income families, contrasting sharply with more affluent neighborhoods where residents have better access to fresh produce without needing subsidies. Geographically, the presence of food deserts and food swamps in South Los Angeles restricts access to healthy food options. In areas defined as food deserts and food swamps, grocery stores offering affordable fresh produce are scarce and there is an overabundance of unhealthy fast-food options, contributing to poor health outcomes. In comparison, other neighborhoods with numerous supermarkets provide a stark contrast, highlighting the geographical disparities in food access.

Organizations like Food Access LA prioritize cultural relevance in their programs, ensuring that the food provided meets the community’s cultural preferences. For example, along with offering Farmer’s Markets to low-income communities they also implement Teaching kitchens that teach community members how to make their favorite cultural meals healthier while also incorporating fruits and vegetables sold at the market. In contrast, other regions might not emphasize cultural relevance, leading to less effective interventions. Globally, some health systems integrate cultural practices better than others, showing varying success in addressing food insecurity. The healthcare infrastructure in South Los Angeles includes initiatives to address food insecurity through community health programs. However, resource allocation can be uneven. Comparatively, some countries have robust public health frameworks that systematically address food insecurity through national policies, while others face challenges similar to those in South Los Angeles. Brazil for example in 2003 launched their Fome Zero (Zero Hunger) program to systematically addressed food insecurity. Through policies like Bolsa Família, a conditional cash transfer program, and the National School Feeding Program (PNAE), which provided nutritious meals to students while supporting local farmers (FAO, 2014). These initiatives significantly reduced hunger, leading to Brazil’s removal from the UN’s Hunger Map in 2014 (FAO, 2014).

One of the most impactful aspects of our research project was understanding the deep-rooted historical context of food insecurity and its connection to systemic oppression within the Black community. In our conversation with a community leader at It’s Bigger Than Us, we discussed the legacy of slavery. They stated:

This is a simulated reading of the paragraph below. Click [Play] to begin, and [Pause] to stop at any time.

1. African American Male 50+

“Cultural norms are different for folks, of what we’ve been raised to eat regularly within our diet. You know, for me, it’s gumbo and chitlins and fried chicken and all of these different things, and for, Black African Americans, it stems back to slavery where, you know, you’re, the slave owners or masters would give the leftovers to folks on, you know, at the end of the week and it would, it would have to make something out of nothing. And eventually, that tradition just kept going.”

Enslaved people were forced to eat discarded food, and this unfortunate practice continues to influence dietary habits and health outcomes today (Roussel, 2021). This historical context highlights the complexity of food insecurity, revealing that it is not just an issue of access but also cultural and psychological significance. Learning about the critical role of culturally relevant food interventions was eye-opening. The success of programs incorporating cultural sensitivity underscores the importance of meeting communities where they are and respecting their heritage and preferences. This approach is crucial not only for creating sustainable and effective health interventions at a community level but also for establishing trust-building clinical interactions between health care teams and patients from such communities.

To understand the impact of policy on food disparities, we interviewed a lawyer who was executive director of the Office of Civil rights in the U.S Department of Health and Human Services. They mentioned that in South Los Angeles, they saw many community members with chronic diseases such as hypertension and diabetes, who did not have access to healthier foods since the community was a food desert.  To combat this disparity, they founded the South Los Angeles Community kitchen, which helped teach cooking skills to the community members. The community Kitchen was an effective way to integrate nutritional education along with cultural foods of the community members.  They emphasized the importance of such initiatives by stating,

“I got to participate in these programs that honored and recognized community-based nutritional efforts, cultural sensitivity, and how to make healthy eating fun and accessible.”

They demonstrated the effectiveness of implementing policies and programs that benefit the community.

Patient Interviews

Four patients were also interviewed to better understand their journey in receiving healthcare in South Los Angeles and explore their needs.

The first patient we interviewed was an African American woman in her late 50’s with controlled hypertension who is an Inglewood native, currently employed living with one of her two daughters.  She noted that a potential barrier for people within the African American community to eating healthy could be found in the traditional food dishes.

A key article by Swierad et al. (2017) echoes this sentiment when they stated:

“Most African Americans realize that some aspects of their traditional cuisine are unhealthy, ethnic food is comforting and allows for connectedness, expression of one’s cultural identity, and the connection to African American culture.”  (Swierad, 2017)

While our first patient noted this as a potential barrier, it is essential to all to highlight that she personally did not experience the lack of unhealthy options when eating what she considered her traditional cuisine. This patient noted that she was able to change her diet on her own time with the motivation of her children. With this motivation, she has effectively lowered her blood pressure. This was a critical phenomenon to note because it presented an opportunity to learn more about effective ways to motivate patients to create long-lasting diet changes.

In their important study, Lynch EB et al. (year) aimed to build a connection between spiritual and health values to encourage healthy lifestyle changes (Lynch, 2023). Using community health workers, the church-based intervention showed potential for behavior change in African American communities. Learning more about different multi-factorial techniques that address the complexities of this community can lead to policy recommendations that are more effective in casting a wider net of change.  Despite reporting a healthy diet, Patient 1’s experiences revealed a potential healthcare system gap. When asked:

“Have you ever received advice or recommendations from health care providers about dietary changes to manage or prevent hypertension?” She said, “No.”

This patient had to independently seek out information regarding how to eat healthier to improve her blood pressure without guidance from her provider. This also leaves organizations open to creating nutrition interventions tailored to patients’ motivations.

Patient two was an African American male. Patient 2’s interview offered a compelling glimpse into the intersection of cultural influences, dietary habits, and potential gaps in healthcare experiences in managing hypertension. He emphasized that preparing meals rooted in soul food traditions reflects the significance of cultural heritage in shaping dietary choices. His incorporation of vegetables, greens, and grilled meats showcases a blend of traditional flavors and health-conscious cooking practices.  From a health provider perspective of addressing the healthcare system, Horowitz et al. state:

“Our goal is to promote healthy diets that are consistent with people’s cultures so that they willingly adopt and maintain these diets over time.” (Horowitz, 2004).

Horowitz et al. noted that:

“These diets were often considered expensive, an unwelcome departure from traditional and preferred diets, socially isolating, and not effective enough to obviate the need for medications.” (Horowitz, 2004)

The third patient we interviewed was a 73-year-old Mexican male from the Martin Luther King Outpatient Center who had lived in South Los Angeles since childhood. Currently, he is on dialysis due to his chronic kidney disease and was diagnosed with hypertension in 1998. When asked about his medical care and barriers, he said:

“Only linguistic. Only the language, I don’t understand the doctor sometimes because it is in English and understanding what the doctor is saying.”

This shows that he not only suffered from the language barrier but also health literacy, and compelling evidence that should implore doctors to ensure patient’s understand their health care and plans of action. This could have led to a disconnect between the physician and the patient. This miscommunication could have led to a decline in patient-centered comprehensive treatment and care. According to the California’s Physician Shortage White Paper:

“By 2050, Latinos are estimated to represent 44.5% of the state’s population. While the Latino population continues to grow, the supply of Latino physicians has not caught up.” (Vargas Bustamante, 2020)

This finding underscored the importance that we, as future physicians, must be mindful of the patient population we serve and find ways to communicate with patients in their native language, ensuring cultural competency is the norm in medical practice. With medical schools like Charles R. Drew University of Medicine and Science College of Medicine whose is qualified as a Hispanic serving institution, they are combating this Latinx physician shortage with a medical student class of nearly 25% students who identify as Latinx.

In asking this patient about his diet growing up, we were also able to learn more about his culture. He described his typical breakfast: “Mexican tortillas and beans, and eggs.” This diet is typically seen in Latinx households because they are staple foods that have been ingrained since childhood. Then, when asked how culture can influence food choices, he said:

“It can be bad because there are not many vegetables since childhood.” Eventually, he reflected, “Mexican meals lead to diseases like diabetes and hypertension due to not eating vegetables.”

The powerful self-realization that traditionally Mexican foods might not be the most nutritious is an important first step in breaking cultural food norms, though the road ahead will be difficult and challenging.

According to the Hypertension in Hispanics/Latinos: Epidemiology and Considerations for Management, they found:

“Culture is an important determinant of behavior and influences many of the lifestyle factors that contribute to the development and management of hypertension.” (Thomas, 2019)

Culture is extremely important for patient-centered care, and we must become more cognizant of having more culturally aware physicians. By addressing these medical issues earlier on since diagnosis and applying culturally sensitive care, we might be able to see a decline in hypertension in all populations. This means that the physicians and their team can go the extra mile and offer healthier meal substitutions to the traditional Latinx and African American cultural food.

Our fourth patient, an 83-year-old retired Salvadoran patient from MLK Outpatient Center who has lived in South Los Angeles for over 44 years, expressed significant challenges in managing his hypertension due to cultural dietary preferences and a lack of trust in healthcare professionals. He shared, “I want someone who understands that I can’t cut out certain foods,” highlighting the cultural importance of certain foods that he finds challenging to eliminate. The Hispanic Community Health Study/Study of Latinos reveals that hypertension is prevalent among Hispanics/Latinos, with lower rates of awareness, treatment, and control compared to non-Hispanic whites. The study states:

“These findings indicate a significant deficit in treatment and control of hypertension among Hispanics/Latinos residing in the United States, particularly those without health insurance.” (Sorlie, 2014)

This underscores the critical need for healthcare systems to develop culturally sensitive approaches that address these gaps in care. By understanding and integrating cultural dietary habits into hypertension management plans, healthcare providers can improve patient trust and adherence to dietary guidelines and health outcomes.

His reluctance to use translators and preference for his daughter’s assistance during medical visits point to a significant barrier in healthcare communication. “I don’t like it when a translator is in the room. I trust my daughter more than the doctors,” he says, illustrating a common issue of mistrust and cultural disconnect between patients and healthcare providers. Research on neighborhood social organizations in Los Angeles has shown that social and cultural factors significantly impact hypertension risk and management among racial and ethnic minorities. In their study on the impact of neighborhood social organization, Sharp & Carpiano state:

“Our findings reveal that neighborhood organizational participation is associated with a lower probability of being hypertensive. This suggests that living in neighborhoods where people are involved in informal and formal organizations and associations (e.g., neighborhood watch, civic groups, ethnic pride organizations) may protect residents against excessive exposure to area stressors that can elevate the risks of developing high blood pressure.” (Sharp, 2023)

This highlights the importance of integrating community-based strategies to enhance trust and communication between patients and healthcare providers. By fostering a sense of community and understanding, these interventions can reduce barriers to effective hypertension management and improve health outcomes for minority populations.

Moreover, dietary practices rooted in Salvadoran culture pose another challenge for this patient. “Vegetables are not the usual part of our diet,” he explains, which aligns with findings from the National Health and Nutrition Examination Survey (NHANES) that indicate lower intake of fruits and vegetables among Hispanic/Latino men compared to women.

“Poor dietary quality and practices among Latino adults may have a strong impact on younger generations within the family unit, given long-held beliefs, traditions, and sociocultural influences persistent in Latino culture.” (Overcash, 2021)

This statement emphasizes the inter-generational impact of dietary habits and the importance of addressing these practices in health interventions. Healthcare providers should consider community-based interventions and educational programs that respect and integrate cultural dietary habits. Additionally, increasing accessibility to culturally relevant health education and services could enhance healthcare literacy and improve hypertension management in Hispanic/Latino populations.

Of all the patient interviews, the interviews that stood out the most were with Patients 2 and 4. The interviews with the patients reveal a common theme: the need for culturally sensitive healthcare approaches addressing diverse dietary practices and health challenges in minority communities. Each patient’s story highlights barriers tied to cultural food traditions, health literacy, and communication gaps between patients and providers. For the interviewees, healthcare interventions must go beyond standard recommendations and consider the deep-rooted cultural, familial, and social influences that shape dietary choices and health behaviors. Community-based programs, family involvement, and improved access to culturally competent healthcare professionals are essential to creating sustainable health improvements. By addressing these needs, healthcare systems can better support patients in managing chronic conditions like hypertension, ensuring that dietary changes and healthcare advice resonate with their cultural values and everyday lives.

Patient 2’s ability to navigate meal preparation without significant barriers contrasts with the challenges highlighted by Horowitz et al. regarding the perceived difficulties in following clinician-recommended diets. This contrast underscores the importance of considering individual circumstances and cultural preferences when promoting dietary changes for hypertension management. Patient 3’s positive experiences with accessing healthcare and receiving advice on nutritional changes stand out in contrast to broader narratives of healthcare disparities within minority populations. His proactive stance towards lifestyle modifications and preventive care aligns with the recommendations highlighted in the research article, emphasizing the importance of tailored interventions that consider cultural nuances and individual motivations.

Patient 2’s comments on nutritional beliefs within his community highlight the shift towards healthier eating among younger generations and the complex interplay between cultural norms, health beliefs, and dietary choices. He noted:

“The older generation has hypertension because we’re eating a lot of foods that we grew up on and believed in, but as we get older, we see the younger people, and they’re changing how they eat.”

Understanding these factors is essential for addressing disparities in hypertension prevalence. Incorporating his perspectives into the broader discussion on nutrition and hypertension prevalence among minority populations in South Los Angeles provides a nuanced understanding of the multifaceted factors influencing dietary choices and health outcomes. While the patient’s experience offers valuable qualitative insights, further research involving diverse individuals is essential to capture the full spectrum of beliefs, practices, and challenges related to nutrition and hypertension management. By combining qualitative narratives like patient 3 with quantitative data on nutrition habits and healthcare utilization patterns, a more comprehensive approach can be developed to address hypertension disparities effectively in culturally diverse communities.

Patient 4’s story underscores several key themes relevant to hypertension management among Hispanic/Latino populations. A shared barrier to dietary change is the struggle with breaking entrenched habits and overcoming psychological barriers associated with dietary change. Whether it’s:

• the attachment to familiar comfort foods,
• the challenge of resisting cravings, or
• the fear of missing out on social experiences centered around food,

these factors represent significant hurdles. His experience illustrates the universal nature of this barrier in the journey toward improved nutrition. Furthermore, the need for healthcare providers who understand the patient’s language and culture is critical. This need for culturally competent healthcare providers who can effectively communicate and empathize with patients’ cultural backgrounds is paramount. Addressing these shared barriers through culturally sensitive interventions and community engagement can significantly enhance dietary compliance and overall health outcomes for our patients.

Collaborative Partners

In South Los Angeles, community-based organizations such as Food Access LA and It’s Bigger Than Us are pivotal in providing access to healthy foods, nutritional education, and support services. Food Access LA provides SPA 6 and other food-insecure areas in South Los Angeles with access to nutritious foods.

The program’s mission is entirely focused on access to healthy foods and the sustainability of those foods within families. This is shown through the platform that they give local farmers and businesses to sell at their markets, accepting EBT and implementing market match programs, which provide people using EBT more money to specifically buy fruits and vegetables, free nutritional teaching kitchen programming, and curbside pick-up at the markets. They also offer different incentives based on where their farmer’s markets are located. Their teaching kitchens and nutritional department work together to teach the community how to implement the foods they sell into their everyday lives. People who come to the farmers’ market learn more about the food system and the seasonality of food. They also notice a change in their palate preferences based on trying fresh, healthy foods in peak season.

On the other hand, It’s Bigger Than Us focuses on solution-based resources for all communities to thrive. In line with this mission, they specialize in creating community activities centered around addressing health inequities through food distributions, resource distributions, and school programs. They have significant staple events like their back-to-school or Christmas events, with a turnout of about 5,000 to 10,000 people. The actions behind everything they do is centered around helping individuals live a stronger, better, healthier life.

Conclusions

A significant barrier to improving outcomes in patients with hypertension is patient education that is culturally relevant and culturally competent. In an analysis conducted in the southeastern United States, young African American adults, 17-20 years old, were interviewed to determine their knowledge of hypertension prevention strategies (Savoca et al). Both males and females reported little to no formal education about hypertension. Thus, the authors of this study advocated for more relevant health education to be given throughout high school. Moreover, observational studies have shown that doctor-patient communication can have a strong impact on health outcomes (Auerbach 2012). The two healthcare providers we interviewed who practice in SPA 6 noted that while patients are aware of their health conditions, they are not always aware of the gravity of their predisposition to its potentially severe consequences. The providers we interviewed were culturally competent meaning they understood their patients’ respective cultures and thus were able to communicate their concerns to their patients in an effective manner.

For example, one provider was born and raised in Los Angeles and understands the specific struggles of living in an under-resourced community giving them a unique ability to emphasize with their patients and provide realistic recommendations to their patients. Furthermore, the nurse we interviewed noted that health literacy is a challenge that “cuts across all social classes,“ requiring integrated healthcare teams to provide proper health education to all individuals regardless of class, age, or ethnic background.

When assessing the importance of medication management, it was found that this was not a point of contention from the perspective of the healthcare providers we interviewed. For example, the physician we interviewed stated that access to clinics and medications is available, but more personnel are needed.

The healthcare providers also mentioned that exercising to ensure a patient’s heartbeat reaches 140 bpm for half an hour daily, five days a week, is crucial to managing hypertension. Most patients with labor-intensive jobs do not have their heart rate reach that threshold because their bodies adapt to their workload and thus decrease their demand for higher cardiac output. It is also crucial to note that the benefits of exercising extend beyond just losing weight, as it will, over time, systematically change how a person’s body functions metabolically. In all, the providers noted that working with a patient’s culture and approaching their condition on an individual level may lead to improved hypertension control. Although these points are pertinent, implementing feasible solutions to address all these needs is still in question.

The most striking challenge that continues to be at the root of addressing chronic diseases like hypertension is creating optimal policies aimed at patient outreach and support. Potential solutions to improve access and delivery of care for hypertension involve policy, health literacy, and increased access to healthier food options. Different neighborhoods have variances in public programs. For example, parks are less plentiful in some areas, and people work multiple jobs to make ends meet. Having more free resources to encourage improved physical health would ease some of the health issues this population is facing. To address this, one of the policy experts interviewed stated:

“I think there is a need to have people at the table, who are from those communities, who have a vested interest in supporting it as opposed to policymakers/academicians who have good intent but may not be at the ground level with the community-based advocates and faith-based leaders.”  

There is also a need to incentivize policy to fund public programs at parks, such as exercise programs and informational sessions. Increased access to healthier foods can be addressed by implementing farmers’ markets that are open after regular business hours to allow those who work during the day to still have access to better foods. Health literacy can also be improved by having dedicated consultations with patients and their families, where the health professional can help them select better foods from places they dine at, or teach them how to make healthier alternatives to foods they usually cook. This integrated approach has been shown to be effective by Himmelafarb et al. (2016), who found that nurses who expanded their hypertension care to include education, counseling, coordinating care, and performance measurement significantly improved outcomes. Overall, all the policy recommendations can be implemented at different levels of government and can have profound results in communities adversely affected by hypertension.

Lessons Learned

There were many lessons learned through the interviews conducted. Such as the heterogeneity within African American and Latinx food culture. The different patient experiences illustrated showed how diverse cultural backgrounds can influence dietary choices. These findings underscore the need for culturally sensitive approaches when developing nutrition interventions.

Some potential barriers noted for people within the African American community to eating healthy could be found in the traditional food dishes. An article found that:

“…although most African Americans realize that some aspects of their traditional cuisine are unhealthy, ethnic food is comforting and allows for connectedness, expression of one’s cultural identity, and the connection to African American culture (Swierad et al. 2017).” 

It is essential to note that physicians need to understand the reasoning why different group’s cultural identity influences what they are used to eating.

We also saw the intersection of cultural influences, dietary habits, and healthcare experiences in managing hypertension. The article “How do Urban African Americans and Latinos View the Influence of Diet on Hypertension” by Horowitz et al. states:

“Our goal is to promote healthy diets that are consistent with people’s cultures so that they willingly adopt and maintain these diets over time.” (Horowitz, 2004)

The emphasis on preparing meals rooted in soul food traditions reflects the significance of cultural heritage in shaping dietary choices. Incorporation of vegetables, greens, and grilled meats showcases a blend of traditional flavors and health-conscious cooking practices. Some patients might report no barriers, it is possible that some patients, including him, may not fully recognize or be aware of the challenges they face. For example, limited health literacy might prevent patients from fully understanding medical advice. Additionally, subtle cultural or socioeconomic factors could influence dietary choices and access to healthcare, even if they aren’t explicitly identified as barriers. Like many others may encounter difficulties related to these factors without realizing their impact on his health outcomes.

Another barrier that we saw is not only the language barrier but also health literacy. This could lead to a disconnect between the physician and the patient. This miscommunication could lead to a decline in patient-centered comprehensive treatment and care. According to the California’s Physician Shortage White Paper:

“By 2050, Latinos are estimated to represent 44.5% of the state’s population. While the Latino population continues to grow, the supply of Latino physicians has not caught up.” (Vargas Bustamante, 2020)

This is alarming because we need future physicians to reflect the patient population and speak their native language so that they can go the extra mile and offer comprehensive and culturally aware treatment and care. Charles R. Drew University of Medicine and Science College of Medicine is combating this Latinx physician shortage because currently, nearly 25% of the class size of 60 students identify as Latinx medical students. We are hopeful that future cohorts will surpass this percentage in aid to help combat the Latinx physician shortage not only in California but also in the United States.

Another important key theme relevant to hypertension management among Hispanic/Latino populations is a shared barrier to dietary change which is a struggle with breaking entrenched habits and overcoming psychological barriers associated with dietary change. Whether it is the attachment to familiar comfort foods, the challenge of resisting cravings, or the fear of missing out on social experiences centered around food, these factors represent significant hurdles. These experiences illustrate the universal nature of this barrier in the journey toward improved nutrition. Furthermore, the need for healthcare providers who understand the patient’s language and culture is critical. This need for culturally competent healthcare providers who can effectively communicate and empathize with patients’ cultural backgrounds is paramount. Addressing these shared barriers through culturally sensitive interventions and community engagement can significantly enhance dietary compliance and overall health outcomes for our patients.

Looking Forward

To tailor to the Black and Latinx populations of South Los Angeles, future efforts could focus on designing community-driven interventions tailored to this community.  Working together with health care providers, community organizations, and public health officials, we hope to establish programs that educate community members on nutritional information and provide access to affordable and healthy foods. To achieve this, one focus is on the creation of partnerships with farmers’ markets to increase the availability of fresh produce. Another focus will be on ensuring dietary recommendations are respectful of cultural food traditions and bringing people together around food this will hopefully build healthy familial traditions.

More importantly, this research project can serve as a foundation for policy advocacy:

• pushing for structural changes that address food deserts,
• improve public health infrastructure, and
• incentivize healthier food options in low-income areas.

The ultimate goal is to develop long-term solutions that can be applied not only in South Los Angeles, but also in similar marginalized communities across the country. Through collaboration and education, this research seeks to contribute to a future where hypertension is no longer disproportionately prevalent in marginalized communities.

Recommendations 

Our study concludes with several recommendations that could be implemented as solutions to the lack of optimal nutritional access and culturally-congruent guidance and influences for South Los Angeles residents, resulting in higher levels of hypertension prevalence in this population. By engaging with the literature, community partners, and community organizations we have come to understand that to improve access and delivery of care for food insecurity in the South Los Angeles community, there needs to be a multi-faceted approach, addressing local, regional, and national levels from various perspectives.

One effective solution is the establishment of community gardens and farmers’ markets. These initiatives provide fresh produce directly to residents, empowering them to participate in their own food production and access affordable, healthy options. A study found that by involving community members in the cultivation and distribution of fresh produce, these programs can create a sense of ownership and pride while simultaneously addressing food insecurity (Twiss, 2003). Additionally, community gardens and farmers’ markets foster community engagement and education about nutrition, promoting healthier eating habits in a culturally relevant manner. Strengthening partnerships between local farmers and community organizations can also enhance the availability of fresh, culturally relevant foods at lower costs (Reddy, 2004). Another solution is the deployment of teach-in kitchens equipped with nutritional counseling services.

These sessions can bridge the gap for residents who lack access to nutritional education and resources by offering personalized care and distributing healthy food options directly to underserved neighborhoods.

At the regional and national levels, advocating for stable funding of food subsidy programs like the market match program is crucial. Ensuring continuous support for low-income families can mitigate the adverse effects of economic instability. Another crucial strategy is expanding the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Enhancing these programs with increased funding, broader eligibility criteria, and incentives for purchasing fruits and vegetables can significantly improve access to healthy foods for low-income families. These enhancements can make a substantial difference in the dietary habits of families who rely on these programs for their nutritional needs, helping to reduce food insecurity and promote healthier eating patterns. Additionally, implementing regional public health campaigns to raise awareness about food insecurity and its health impacts can mobilize resources and support from broader communities and policymakers (Reddy, 2004).

Within the healthcare system, integrating nutritional services into primary care offerings is essential. Physicians should provide dietary counseling and information on access to healthy foods through on-site farmers’ markets or partnerships with food distribution programs. Investing in research to identify effective interventions and training healthcare providers on the importance of culturally relevant nutritional guidance can also improve patient outcomes.

How This Study Informs Community-Based Practice

The focus of this particular case study, which follows the social health theory, would classify it as a community psychology practice since it aims at reducing health inequities and improving the well-being of overburdened populations. However, Community Psychologists do not expect the community to be passive – it is about cooperating, understanding what leads certain communities to have social and health-related issues and what can be done about it to enrich the community at large.

This case study examines how such policies translate into practices, which are rooted in the community and society. It further demonstrates that such stressors lead to a higher prevalence of conditions like hypertension amongst Black and Latinx populations in South Los Angeles. Such policies do not exist in an ideological vacuum; the case shows how people live in an extrinsic context to which such policies are somehow relevant.

Food Access LA and It’s Bigger Than Us after all address the needs of the local community and meet the expectations of the Community Psychology model which suggests that the design of the intervention makes every effort to be appropriate for the characteristics of a particular group. Understanding food choices within communities should always consider cultural history as well as the effects of oppression and poverty experienced by those communities. This is crucial in addressing food preferences and in promoting better food consumption practices.

Working with communities, institutions and professionals to bring about change in addressable issues is one of the aspects that Community Psychology supports. As it has been shown in the case study, Food Access LA and other community-based organizations, health providers, and even policymakers were able to span hypertension through prevention of food insecurity. Working with such partners enables addressing the different dimensions of health by combining different skills and resources and involving the residents.

The case study includes multi-level interventions classifying them into three levels, which are local, regional, and national. Community Psychology promotes solving problems on different levels to achieve long term solutions. For instance, such measures as increasing the scale of urban agriculture, creating demand for food subsidy programs and protecting harmful practices within healthcare service integration depict this multifaceted approach. The integration of community-owned strategies with health policy as envisaged is a true reflection of community psychology’s prevention of the problem and its social causal factors.

Among many objectives of Community Psychology, a fundamental one is to help oppressed groups to speak for themselves. The case study endorses the empowerment of the people by promoting nutrition, making them active and responsible food consumers, and bringing together public health professionals and community representatives. Activities such as teaching kitchens and market match initiatives allow community members to take active steps in improving their health and are consistent with promoting self-efficacy and resilience amongst the community being the objectives of community psychologists.

The case reflects the principles of community psychology, for example, an illustration of the historical factors that contributed to the development of negative eating practices in the Black community. The story of food insecurity that has sought systemic racism and discrimination explains the ill-health of individuals as part of social structures, which is one of the principles of community psychology in addressing the root causes of social problems.

The role of the community in the case study is through interviews and involvement of local organizations in the research process, thus making the case a typical example of community engaged approach, a key methodology in community psychology. The community engaged approach focuses on engaging community partners in the knowledge-building processes to ensure that programs and strategies are based on the realities and requirements of the community.

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