INTERVIEW | PART 2 Addressing Structural Racism in Healthcare with Dietitian Esosa Osagiede, MPH, RDN

 Addressing Structural Racism in the Dietetic and Nutritionist Profession

Are there examples of structural racism in your profession?

Yes, there are 2.6 black professionals in this field. To become a dietitian, you need:

• Bachelors of Science
• Minimum of 1200 hours of an unpaid internship (6 to 12 months)

The program requires an internship after graduation and cost between $4000-$8000, depending on your intern placement. The program is expensive, and without the assistance of financial aid, many people of color cannot afford it. I’ve heard stories of Black women who have been in this profession who couldn’t make it tough. It’s not just because of the tuition, but because of other restraints, it’s a competitive field. We go through schooling, but you experience a microaggression, othering, and systematic barriers. It’s already demanding mentally, but it’s almost impossible to pay for it. 

Is there something you’d like to implement into the program or curriculum?

I would make one mandatory class on race in undergraduate degrees. I would love to teach a course on racism because it’s a needed course.

I taught an undergraduate health course during my master’s that focused on health disparities and cultural awareness. It was great because many of my students wanted to serve in underserved communities. Many of my students were unaware of these issues, their implicit and explicit biases, or how to combat them. I think that’s why it’s essential, especially in healthcare, for professionals to learn about race, racism, and its impact on health. Educating ourselves on these issues allows us to treat our patients, especially Black patients, properly.

Let’s talk about Public Health, Nutrition, and the lack of representation in your program:  How did you feel about “being susceptible to everything” and learning about “race in health” with the lack of diversity or representation?

In undergrad, we focused more on statistics than on the individual or their communities. For example, you have a White Dietitian or medical professional seeing making an assumption and saying, “Maybe instead of eating fried chicken, let’s try chicken with salt and pepper.” Black people are not susceptible to certain chronic illnesses because of their skin color or because of their lifestyle choices. As professionals, we must take into account access and availability of food, and be culturally aware when working with people of color.

During my master’s, I explored Black People and culture within my curriculum. I took courses that allowed me to walk through interventions, steps, and procedures. I could combine my knowledge of nutrition and dietetics and create culturally competent interventions; focused on African Americans, nutrition, and HIV. Public Health programs do a great job of intersecting and implementing culturally relevant issues to their course work. It would be beneficial for healthcare professionals to take public health courses to become more culturally competent.

Do you feel like the lack of Black Dietitians has affected the way the profession cares for Black patients?

Yes,  structural racism is embedded in the nutritional and dietetic field. The assumption is that you change their diet, i.e., switching from carbs to only eating green; everything will be okay. Often, we don’t look at the individual’s community and accessibility. It does a disservice to people of color, especially Black patients when there are dietitians who don’t take their cultural background or issue seriously. Having more representation allows the patients to feel seen, comfortable enough to express their concerns. 

Before we move on, can you give us some advice on advocating for yourself in healthcare?

My mom used to say, “exaggerate your pain in the doctor’s office,” but then you’re met with doctors saying you’re faking. It’s a vicious cycle where you’re trying to get the provider to listen to you by exaggerating your pain, but they think your pain isn’t real.   Now, as an adult, I can advocate for myself and change my provider.

 If you’re not able to change providers:  I would say, do some research on your issues and concerns.  I don’t mean google, try to search for articles on X, Y, Z. For example, recurring yeast infections, take it to your doctor with questions and research.  Unfortunately, we have to be our “own” investigators for our health. It’s up to us to look, research, and seek help or advocacy from reputable sources. 

Is there a difference between the treatment of Black women as compared to non-Black women of color? 

I haven’t seen it firsthand because the population I work with is predominantly White. Historically, non-Black people of color have also suffered injustices, i.e., Hispanic and Native Americans who’ve traditionally had unequal treatment housing, job security, and healthcare.

Historically, Black people have faced mistreatment from the medical field, i.e., Tuskegee (syphilis) trials, disproportionate ranks of morbidity, mortality, and HIV rates in Black Americans. I want to add the practice of redlining, sectioning off specific neighborhoods from receiving adequate care, which has had a profound effect on Black people’s generational health. These experiences have negatively affected the way the Black community views medical institutions.

Do you feel comfortable talking about race or expressing your views on diversity and inclusion in your profession?

Yes, during my job interview, I used culturally competent wording and spoke about my research on the Black community, nutrition, and HIV. I facilitated a presentation on “sunlight and vitamin d,” where I talked about the discrepancies with vitamin d from the sunlight and skin tone. I test the waters by using language on cultural competence, and then after, I bring up race and safety.

How are you advocating for Black people and people of color?

 I started getting more vocal on social media and created content centered on Black women and nutrition. I want Black women to connect with their heritage, i.e., African, and African American roots, and food. That’s why I created melanin_poppinrdn. With this platform, I can reach Black women who need support or want to learn more about health, and express myself in my Blackness. The content deals with mental, physical, and emotional health issues and how it might stifle the individual’s health journey. Health and wellness have many dimensions, so I touch on these subjects because they all tie in to how you feel about your health and your body.

What is something you’d like the readers or medical professionals to understand structural racism and healthcare?

If you care about your patients or clients, you must do uncomfortable work that involves learning about the history of this country with Black Americans, unpacking the privilege you have, and discovering how you benefit from and contribute to structural racism. It’s uncomfortable to talk about privilege and racism, but we have to address it to move forward.

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

Interested in knowing more or have questions for Dietitian, Esosa Osagiede? Leave a comment below. Also, check out MediJob’s Diversity and Inclusion page for posts on Healthcare and Inclusion