INTERVIEW | PART 1 Tackling Structural Racism in Healthcare with Dietitian Esosa Osagiede, MPH, RDN

This week, we interviewed Esosa Osagiede, Registered Dietitian, on structural racism in healthcare and her experiences as a Black woman in health care. As a health promotion specialist for HealthSmart, Esosa utilizes her education and life experiences to educate those in her community.  As a Black woman, she wants to use her voice to teach nutrition through a Black lens; emphasizing the connection between ancestry, heritage, food, and the health of Black people.

How long have you been a Dietitian and a Nutritionist?

I’ve been a dietitian for seven months, but I’ve been in the nutrition and dietetics field for about seven years. I also have a master’s in Public Health emphasis on underserved communities.

What’s the difference between Dietitian and nutritionist

Dietitian: Is a nutritionist, regulated by a license and schooling. They are qualified to diagnose eating or food-focused disorders, design diet treatments, and other nutritional ailments. 

Nutritionist: Someone who calls themselves a nutritionist is not a dietitian. The nutritionist profession is less protected under the law. Nutritionists that do not intend to use the titles of “dietitian” or “registered dietitian” are often free from government regulation.

Why did you become a dietitian?

I heard about nutrition and dietetics from my mom. She’s a Registered Nurse, and she told me about dietitians in her hospital who provide medical nutrition therapy for patients. Even before then, I’ve always enjoyed learning about the science of food, reading cookbooks, and books on how specific nutrients work for the body. That’s why I pursued a BS in nutrition emphasis on dietetics. At first, it was difficult, but what made me stay was because of the lack of representation in the field and having people in my family who have a chronic illness who could have benefited from nutrition interventions.

“We (Black people) make up most of the statistics, especially when discussing health disparities, but we aren’t there to represent or speak up about the issue. “

Being the only Black person in my classes, I noticed there weren’t people who could speak or identify with me or the statistics. I believe we need Dietitians of color to bring a perspective that’s different from the majority.

Today, we’re talking about structural racism in healthcare, can explain structural racism, and give an example of what that looks like in health care.

Structural racism is a system in which public policies, institutional practices, cultural representations, and other regular norms perpetuate racial group inequalities. In terms of healthcare, historically, healthcare systems and hospitals have engaged in systematic segregation and discrimination based on race and ethnicity, leading adverse health outcomes for Black patients. 

For example, a study in New York compared the maternal morbidity of Black women and White women. It showed Black mothers were 12x more likely to suffer a pregnancy-related to death than White mothers. The study said, place the Black mothers in a predominantly white area, deaths would decrease by 47-50%.  If you look closely, you find out that placement care is the issue; hospitals in predominantly Black and Brown communities have older equipment, less funding, management, and less oversight. Discrimination based on race, coupled with the deadly misconception that Black people “don’t feel pain,” severely affects their ability to seek proper care. 

Do you feel like how medicine’s taught has affected how medical professionals treat people of color, specifically Black people in healthcare?  

Yes, I  think it’s essential for medical professionals to realize and confront that issue; it plays a part in how they treat Black patients. In my experience, even though I’m a Black woman with two degrees and advocate for myself,  it’s difficult to get doctors to believe my pain. They repeatedly ask questions and don’t consider how much pain I’m in or understand my words. 

In Black and Brown communities, we often take the doctor’s word and go with it. I know my body, and when I’m in pain, I wish professionals would see or listen to that. Maybe if I walk in with my Dietitian badge, I’ll get a little respect, but it shouldn’t be like that.

Can you talk more about Black pain and trauma? The medical assumption on Black pain and mistreatment.

 That stems from slavery; history has taught us about how much the Black body has endured. There’s this assumption that Black people don’t feel pain or have a higher tolerance for pain because previously, their bodies were used for medical experiments. There are past examples like James Marion Sims, the “Father of Modern Day Gynecology,” who conducted forced reproductive experiments, i.e., vesicovaginal fistula on enslaved Black women, without anesthesia or proper care. The assumption is that if “they” could endure those procedures, they must have a higher pain tolerance. In medical schools, there is research on lower pain tolerance. It’s one thing I wish medical schools would address; race and misconceptions of the Black body.

Is there is a lack of trust between medical professionals and people of color, specifically Black people? 

Yes, Black people are always skeptical for sure. We want to do everything we can before we go to the doctor. That’s rooted in historical experiences with medical professionals. If you factor in a lack of access to healthcare, transportation, or having to pay out of pocket, would you want to see a professional just for them not to believe you?

Can you describe some issues you found in your profession, research, or work in racial disparities in healthcare?

There’s an overabundance of food deserts in underserved areas that are predominantly Black and Hispanic. These communities have fewer supermarkets and more small grocery stores than their white counterparts. Filled with junk-food options, these smaller establishments rarely offer healthy whole-grain foods, dairy products, or fresh fruits and veggies that a supermarket would provide. That might be more of a public health disparity rather than a healthcare disparity.

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 Addressing Structural Racism in the Dietetic and Nutritionist Profession

Read the second part of interview here

Follow Esosa for culturally attuned health and wellness lifestyle information. @melanin_poppinrdn

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