By: Mike Johnson Jr

Date Created: Aug. 27, 2016, 8:04 p.m.


In this study we examine inequalities in health based on diabetes prevalence, obesity prevalence, and food insecurity of the counties of the United States, as all are markers for health inequality (with diabetes and obesity on one end, and food insecurity on the other). We note that the most vulnerable populations to health problems due to lack of access to quality food are low-income communities, minority populations, as well as some immigrant populations.  

Diabetes and Obesity Prevalence

Diabetes and obesity are becoming increasingly prevalent among low-income communities, some immigrant populations, and communties of color. Factors related to lifestyle like diet and exercise do not fully explain the universality of what Candib calls a syndemic, "a complex and widespread phenomenon in population health produced by multiple reinforcing conditions," from which which more complex factors (genetic, physiological, psychological, familial, social, economic, and political) coalesce to create and exacerbate these conditions.[1]

Diabetes Prevalence in the United States

Looking at our Diabetes Prevalence Visualization we see a trend of high prevalence in the geographic Black Belt region. While there are insights that can be drawn from other places, the Black Belt will be our focus for this study.

Obesity Prevalence in the United States

As evidenced by our obesity and diabetes visualizations, obesity and diabetes are syndemic in the United States, with high proportions in the Black Belt. The factors for both obesity and diabetes come down to the following[2]:

  1. Fetal and Maternal Explanations - low calorie intake of a mother during pregnancy causing a hoarding of calories during childhood as a response, sometimes called the thrifty phenotype
  2. The thrifty genotype - biological, evolutionary differences in how different ethnic groups store calories during food scarcity (to withstand starvation throughout human history), and the vulnerability of certain groups to obesity and diabetes due to these differences
  3. The nutritional transition - "The change from a pattern of low calories and low fat in resource-poor settings to higher calories and high fat"[2]
  4. The health impact of urbanization and immigration - people who live closer to the city tend to have diets higher in fats and sugars than people who do not
  5. Social attributions and cultural perceptions of increased weight - Some minority groups are more likely to perceive one's own and others' overweight status as acceptable, desirable, or sexually attractive.

In general, many factors relating to the quality and intake of food (as well as ethnically based genetic factors and cultural factors) coalesce continuously in low-income and minority communities, and particularly the Black Belt, to create less than average health conditions.

Understanding Food Insecurity

On the other end of the spectrum is food insecurity. Food Insecurity is defined by the USDA as "a household-level economic and social condition of limited or uncertain access to adequate food." 

Food Insecurity (lack of access to quality food) in the United States

Both food insecurity and health problems due to low quality foods are endemic in the Black Belt. More than one in three (34%) of African American children live in households that lack access to quality food, compared to one in seven (15%) Caucasian children[3]. In fact, one in four (26%) of all African American households are food insecure, compared with one in ten (11%) Caucasian households and one in seven (14%) overall.[3] (Health inequality is a problem in all communities, but here at Code Black we are focusing mainly on the African American community for historic and proportional reasons. Though, we do note the health inequality in low-income Caucasian communities as well (not to mention immigrant and Native populations, and other minority communities)).

The Black Belt

Black Belt (geographical region) of the United States

A Call to Action

Without intervention at the community level by clinicians, healthcare professionals, and other passionate individuals, economic and social conditions might hinder or inhibit the ability of a citizen to change one's diet and exercise. Informing folks can be the first step to more equal health and food quality conditions. And fortunately, action at the federal level and community work involving health interventions are already in motion. Though more work needs to be done in this area. How can you help? You might educate yourself further at the references and data sources below, or share this post. Both are recommended and appreciated.


Data sources:,,