Corey Dion Lewis (00:00.502)
Hello everybody. Thank you for listening to the Healthy Project podcast. I am your host, Corey DeYoung Lewis. I have another wonderful guest in the building, experienced public health nutrition and health disparities researcher with an emphasis on development, management, and implementation of culturally appropriate nutrition and healthy food access interventions, which I think is dope. I have Dr. Allison Brown with me here today. Dr. Brown, thank you so much. I really appreciate your time.

Alison Brown (00:30.265)
My pleasure and thank you for the invitation, Corey.

Corey Dion Lewis (00:33.346)
Yeah, absolutely. So before we get into our discussion today, can you tell the people a little bit more about yourself, what you do, and what gets you up in the morning?

Alison Brown (00:43.933)
Yeah, that's a great question. So I'm a program director at the NIH's National Heart, Lung, and Blood Institute. And my role is a program officer, so I help support researchers that do work around the space of nutrition and health disparities, but also obesity prevention. My training is in nutrition and health disparities. I graduated from Tuft School of Nutrition in Boston. And what keeps me going? And

And up at night is really trying to look at strategies to address the health disparities that plague our nation. So just thinking about the diet related diseases like cardiovascular disease, obesity, high blood pressure, that really motivates me for the day to day work that I do, just trying to address those diseases that we see that are prevalent in the communities.

Corey Dion Lewis (01:29.478)
Yeah, and especially within communities of color. And one thing that we all know, when we think about cultural competency, you hear cultural competency everywhere, right? Like that's, it shouldn't be uncommon, but can you talk to us why cultural competency is important when we're talking about nutrition?

Alison Brown (01:53.681)
Yeah, that's a great question. So cultural competency, it's defined as the ability to understand and respect the values and attitudes as well as the beliefs of other people's cultures that differ from you. But I do have to have a little pushback. I prefer the term culture humility because the term competency, it gives this false impression and notion that you can become fully confident in another person's culture.

Corey Dion Lewis (02:10.709)
Mmm.

Alison Brown (02:17.977)
It also suggests that there's a categorical knowledge of a person that you could attain of a certain group of people. And that often perpetuates biases and different stereotypes that you have about certain groups. So back to the term cultural humility, even that word humility, it comes, you come to people of different backgrounds with this kind of ongoing self-expiration and self-reflection. You don't put people in the box and you really understand and have a better understanding of the complexity.

of a person's experience. And it really acknowledges from the practitioner and researcher's perspective that you can never really fully become competent in another person or patient's experiences. So we often hear about cultural competency, as you mentioned. I personally prefer cultural humility, but see the value overall to really understanding another person's cultural background, but particular to nutrition.

Culture provides the rules and behavioral norms of a certain group. And it also includes food. For example, one's culture can impact what they think of as a meal, what components make up a meal, what foods are combined or go together, what foods are segregated or spaced out throughout the day. Even the timing of meals is culturally informed. So just like aspects of culture, like language

religion and other cultural norms. A food and a diet that someone consumes, it's learned and passed down generation from generation, and it starts even in childhood, and when children are educated or socialized into their own cultural background. So, food and diet is definitely cultural. I come from a bicultural background. My mom is African-American. My dad is from the Twin Island of Trinidad and Tobago. So, growing up, you know, I

I had soul food from my mom's African American upbringing, but I also consumed foods from Trinidad. And because of Trinidad's background and colonial history, they had indentured servants from India, they had Chinese migrant workers as well. So there's a lot of cultural influences there on the food. So I grew up consuming curry and salted prunes and fruits that you often don't see in traditionally African American.

Alison Brown (04:37.166)
So again, cultural background certainly impacts the foods that you consume.

Corey Dion Lewis (04:42.634)
Yeah, you brought up a great point to Dr. Brown and something that, you know, with the patients that I work with, I'm seeing more and more of, especially with my kind of the older population, when we're talking about behaviors around their food, a lot of those cultural behaviors are so hard to break away from because of it's a part of their culture. And I feel like sometimes

The people that I serve may feel like we're telling them they can't have their culture anymore by telling them they may come to me with hypertension or diabetes and saying to change your diet or whatever may say, you're telling me to change my culture. And that's not necessarily what we're trying to say, but that's how it comes off.

Alison Brown (05:29.053)
Yeah, no, that's an excellent point. I would add that there are cultural assets and benefits that you should elevate in a particular person's background and not to vilify a certain group's cultural traditions. So thinking about the culture of West Africans or Hispanics, you think of rice, we often think of that with diabetes that is often vilified. But if you space out the...

Corey Dion Lewis (05:36.472)
Mmm.

Alison Brown (05:55.757)
rice that you consume, you know, it's about the quantities that you consume. And then even mild adaptations, mixing brown rice with white rice. You know, there are a lot more affordable brown rice options on the market now. And just trying to meet the patient and client where you are, I think, is critical. And again, there are a lot of cultural assets and benefits and different cultural backgrounds that you need to explore. And again, talking with the patient or client and saying, what do you currently eat?

and asking them, what fruit and vegetables do you like? They often think of their traditional foods and they may consider their traditional foods to be unhealthy, but again, I think there are healthy options in every cultural background. And research actually shows that in some immigrant groups, that the foods from their traditional background is actually healthier than the more Western diet. And thinking of Western diet, I'm thinking of...

Corey Dion Lewis (06:47.063)
Mmm.

Alison Brown (06:49.037)
you know, sugar sweetened beverages, going to fast food restaurants, you know, the American and Americanized way of fast food culture, that's actually more unhealthy than the more traditional foods that people often consume of different cultural backgrounds. And I say this in the context of the US, which is very, very diverse, very culturally diverse, and increasingly so by 2050 is predicted that America will become a majority minority country.

So with that comes cultural diversity and why it makes this conversation so important. And another concept that I want to talk about is known as acculturation. And that process is when an immigrant might migrate here to the United States and they can either adhere to their cultural diet and background or adopt the host country's cultural diet and background. And again, in certain immigrant groups, certain Hispanic and Latino populations.

It's shown that if you adhere to your cultural and traditional diet, that you're actually more likely to have healthier outcomes and diet-related health outcomes than those who acculturate to the more Western style of diet. So again, there are cultural assets in every ethnic group's background, and it's a matter of practitioners and those who work in the diet and nutrition space to meet clients where they are and try to find those healthier alternatives in their cultural diet and backgrounds.

Corey Dion Lewis (08:14.622)
Yeah, no, I love that. And that kind of leads to my next question, Dr. Brown, is food insecurity. And can you discuss the impact of culture on food insecurity, especially in terms of access to traditional foods or the affordability of culturally appropriate foods?

Alison Brown (08:34.697)
Yeah, so that's a great question, Corey. And during the COVID-19 pandemic, food insecurity became first and foremost in people's minds. So first, I want to start off with the basic definition based on the US Department of Agriculture's definition of food insecurity. And it's defined as the limited or uncertain availability of nutritionally adequate and safe foods or having limited or uncertain ability to acquire acceptable foods in a socially acceptable way.

So with this definition, there is some interpretation of the term acceptable because if someone is migrating here from another country, certain foods may not be culturally acceptable for them. So it's important in the emergency food system, such as in food banks, that they are actually, increasingly so, trying to find more culturally relevant foods that are offered in their food banks. And this can be challenging at times, given the donations.

that come in are often limited, but there are efforts across the country where food banks are creating partnerships with communities that they serve to better understand the cultural background as well as explore culturally appropriate foods for the clients that they serve. And they also might collect, have this bilateral communication with their clients to really better improve their services and better meet their clients' needs. But I also...

want to add on to that in terms of a new definition and a new concept that's increasingly popular. And it's the concept known as nutrition security. And this is somewhat similar to food insecurity, but it's defined as having consistent and equitable access to healthy, safe, affordable food that's essential to operable health and well-being. So it has this element of really trying to support better quality foods. And then it's also a matter of

access, not just the affordability, but also the access at the community level. So, when thinking of someone's neighborhood and where they live, making sure that they have access to that culturally appropriate foods. And in some cases, cultural foods may not be available. And that's where someone of a diverse background might, again, more so adapt this Western approach to eating, you know, more fast foods, more sugar-sweetened beverages, foods that are often higher in sodium.

Alison Brown (10:53.197)
added sugar and really do contribute to the diet related diseases that we see in the country. And I also want to share a little story about some qualitative research that I did when I lived in Boston. And this was among black immigrant groups in Boston. And this gets to the point around culturally adapting or adapting recipes based on what's available in the communities where people live. And in this particular focus group that I held, there was an Ethiopian woman who was sharing her story.

and the bread in Ethiopia that's typically consumed is known as injera bread. And it's made from this grain called Teff. And because Teff in the Boston community where she lived was very expensive, she adapted how she actually made and prepared the Teff and did like a 50 breakdown of using wheat, half wheat, and then half Teff in order to adapt based on the economic constraints that she was experiencing. So that actually brings me to another.

Corey Dion Lewis (11:44.643)
Ah, no.

Alison Brown (11:50.925)
point that I want to elevate that's important and aligns with the concept of food insecurity because of the issue of affordability of foods. And it's this concept known as social determinants of health. And to kind of push that a little bit forward, social determinants of diet and dietary behavior. So culture is one piece of it, but also the social factors that impact people's lives very directly also impact if they can access healthy, affordable food, right?

of the NIH, we have a definition of it. And it really looks at the conditions in which where people are born, where they grow, where they learn, work, play, and age, and these wider structural factors that really shape the conditions of people's daily lives. And these structural factors include the social and economic as well as the legal forces and systems as well as policies that determine the opportunities of

Corey Dion Lewis (12:45.57)
Mmm.

Alison Brown (12:48.197)
access to high quality jobs, access to healthy, affordable foods, education at the community level. So all of these factors in the end of the day impact if someone can afford healthy food. So say it, going back to that story of the woman from Ethiopia, depending on her socioeconomic status, she could have potentially afforded the grain teff to make the recipe how she normally made it if she was living in Ethiopia.

certainly impact and drive how people eat. And if they even have time to prepare healthy foods in their home, time is a huge resource that we often undervalue, you know, in terms of how much time it takes to prepare healthy foods. And the cost of eating healthy outside of the home is also another important consideration. So again, those social factors, the impact diet is something that I also wanted to elevate in the conversation.

Corey Dion Lewis (13:47.466)
Yes, no, that's real. And to go with your point around those social drivers, something that I'm noticing too, and I'd love to see if you know of any research or had any ideas on this, are those how food apartheids or food deserts affect somebody's ability to get culturally appropriate foods. And I'm sure those kind of tie into those social determinants of health. But is there anything that you're

someone may not be able to have even to get to somewhere where they can get the foods that they need for their health.

Alison Brown (14:26.097)
Yeah, that's an excellent point. And the historical practice of redlining, you know, even though that was outlawed in the 1960s, we still see these invisible boundaries, you know, that really result in racial ethnic segregation across the country. And it leads to differences in allocation of resources, including access to healthy affordable foods where someone has to drive.

or take public transportation to get healthy foods in their communities. That is if they can afford a car, if they can afford a car insurance, afford to get that, take that train or that bus to get healthy, affordable foods. But again, these are all assumptions that someone can, again, afford and have those resources to drive to get the foods that we know based on research that contribute to better cardiovascular outcomes, better health outcomes.

But again, unfortunately in certain communities, that's a little bit harder and there are much more barriers to accessing foods that are culturally appropriate and affordable in their proximity. So I think it's an excellent point in, you know, food apartheid or racial ethnic segregation, food swamps, food deserts, these are all terms, you know, that really hit the nail on the head for issues of the historical legacy of redlining in this country.

Corey Dion Lewis (15:45.33)
Absolutely. I want to talk to you a little bit about some of the kind of the food programs that you hear about. You know, food is medicine, produce prescription programs, things like that. Are there things that these types of programs to help patients improve their health? Are there things that we can improve on to make them more culturally appropriate for those people that

We're serving

Alison Brown (16:16.553)
Yeah, and I'm glad that you bring that up because food is medicine is definitely of interest to the country, to NIH. After the 2020, 2022 White House Conference on Hunger, Nutrition and Health, there's been a growing interest in this food is medicine movement, you know, through produce prescription programs, like you mentioned, medically tailored meals as well. And they're growing conversations around, you know, making sure those foods that are in these programs.

making sure that they're culturally appropriate. Now, produce prescription programs, those have a little bit more flexibility where the patient or the client have the flexibility to go into the grocery store and pick out the produce that they eat and their backgrounds. They're based on their cultural backgrounds. The medically tailored meals, that's where it's really gonna take innovation and partnerships with the cultural groups in a specific locality in order to really tailor.

those programs because it's one thing to offer the meals, but are these meals culturally appropriate? And I think that's what research is actually doing now. There's the partnership to the American Heart Association, the Rockefeller Foundation, as well as Instacart that is looking at pilot, implementing pilot programs across the country to test the acceptability, the feasibility of these food as medicine programs in order to address.

the diet-related disparities and issues with diet-related conditions across the country? So excellent question. It's at the forefront of research as we speak and really excited for the work to come in this space.

Corey Dion Lewis (17:52.594)
Yeah, I think it's great. And the produce prescription program is something that we utilize. But some of the challenges that I've heard has been maybe some of the grocery stores that are available don't have certain foods. It's only certain grocery stores that participate. So I know it's early. I know as things get progressively better and people start to learn more about it, those things will get better.

But that's just something that I'm currently kind of experiencing with the people that I serve, where they think it's great, but there are certain places that they can't go yet.

Alison Brown (18:33.309)
Yes, I think that's an excellent point and that's why these conversations are so important. You know, with those produce prescriptions, what grocers can be that can actually take those vouchers, you know, and making sure that it's expanded. There are a lot of international grocery stores, for example, and cultural enclaves across the country. So it's important to leverage those type of grocers. And but, you know, with any movement.

there's going to have to be kind of this slow start where the major grocers are the ones that are quick to uptake it. And then the smaller ones come on board later. Um, so that's unfortunately where we are, but again, this conversation and more to come is what's going to be critical to ensure that there's a diversity of produce options that are available for those that accept the produce vouchers, um, through produce prescription programs. So excellent point. Glad that we were having this conversation.

Corey Dion Lewis (19:28.138)
Yeah, absolutely. And that leads to my next question. You've been in the game for a minute. You've been on the front lines. You've been doing the research. You've been doing all of the things, Dr. Brown. And with that, we're seeing these crime diseases that are, I wouldn't say running havoc. That's a little dramatic. But they are a problem within our communities of color.

With the research that you do and the experience that you have, do you see, is there a light at the end of the tunnel? Are there changes that you're seeing with your experience?

Alison Brown (20:09.245)
Yeah, I think that's a great question. You know, we are at interesting times for our country, you know, and I know you were trying to not exaggerate in terms of where we are, but, and it's not just, it's more of an issue in communities of color, but it's an issue broadly for the nation in terms of the medical care costs that are to come, you know, as even our younger generation are experiencing type two diabetes at earlier ages.

Corey Dion Lewis (20:18.734)
I'm sorry.

Corey Dion Lewis (20:26.743)
Uh huh.

Alison Brown (20:38.861)
You know, I think what gives me hope are more grassroots efforts in parallel with federal efforts. You know, it has to be a two-way street. The solution is not going to come from the top. It's also going to come from the bottom up as well. So something that I'm excited about through my work here at NIH is called the Compass Program. It's the Community Partnerships to Advance Science for Society program. And it advocates and what's really innovative for it. It doesn't advocate. Sorry.

But what's innovative about it is that it supports community-based organizations that are doing the work on the ground to do the work of the research themselves in partnership with academic institutions. So, again, I think it's going to be a two-way street in terms of community-based organizations coming together, developing solutions, but also in partnership with researchers and partnership with those in the federal space. But, yeah.

I'm hopeful. And also there's youth programming that I think we really do have to get our younger generation more so involved in this space because the, you know, as trite as it might sound, the youth are our future, you know, and that's a given. So really engaging the younger generation is really gonna be critical in this space when it comes to diet-related diseases.

Corey Dion Lewis (21:59.122)
No, that is so true. And just my opinion, I think one of the challenges of this is the fact that we're becoming more of a society where fast food is convenient. And it's just easier when we have busy lives. It's just easier to go do something else or do something that may not be best for your health.

Alison Brown (22:19.332)
Yeah.

Alison Brown (22:28.873)
Yeah, no, certainly agree. And that's where a multi-sectoral approach is really going to be critical. It can't just be the government. I sit at NIH, that's my space, but community-based organizations, but also the food industry. For better or for worse, we need a moral awakening in this country. Are we making decisions based on the better interests of a company or the better interests of the nation?

and the survival of the people of the nation. And I'm in federal service, so I'm doing this because I love this country. I was born here and really want a better future for next generation. And I think we need to all have that mentality in whatever sector that we're in. Yes, I would just say it takes a multi-sectoral approach. And to your point about the fast food industry, it's here, it's here to stay and work.

work with the FDA and partnering with the food industry is really critical in this stage of our nation's history.

Corey Dion Lewis (23:36.062)
No, that's real. Dr. Brown, thank you so much for being on the podcast with me today. I really appreciated your time. For those that are listening or watching that want to learn more about you, connect with you or learn more about what's going on out here, where can they connect with you?

Alison Brown (23:56.393)
Yeah, so I'm on LinkedIn. I often respond to people's messages and appreciate you for reaching out. Also going on NHLBI's website. So we didn't talk much about the types of diets that are beneficial for your health, but I do want to put in a plug for the dietary approaches to stop hypertension. So that is an NHLBI funded study that showed that adhering to the DASH diet helps to lower your blood pressure.

And we have a ton of resources on the NHLBI's website. So I'd highly recommend going there, as well as finding additional resources on the Mediterranean diet. So have my personal plug, but also really want to highlight the resources on the NHLBI's website that can really help with behavior change and eating healthier foods for better health.

Corey Dion Lewis (24:43.69)
Yes. And can I just say real quick, I use, as a, as a clinical health coach, I can't prescribe diets, but based off the research, I can recommend plans. And the dash eating plan is something that I utilize for not only my hypertensive patients, but even my diet, my diabetics are people who are just trying to lose weight in general because of the fact that it is so well researched and it's, it is, in my humble opinion,

Alison Brown (24:52.429)
Mm-hmm.

Alison Brown (25:03.042)
Mm-hmm.

Alison Brown (25:08.722)
Exactly.

Corey Dion Lewis (25:13.194)
very easy to follow. So I love the Dash eating plan. Like, you'll sponsor me y'all, like come on. Yeah.

Alison Brown (25:15.199)
Yep.

Alison Brown (25:26.341)
So it's fine, and the DASH diet can be adapted for your cultural background, and that's what's the beauty of it. And you're right, it's the DASH eating plan. It can really be adapted because diets have that kind of negative connotation, right? Oh, people don't wanna say I'm on a diet, right? But eating plan is much more palatable. So yes, the DASH eating plan, it can be culturally adapted to your background. It emphasizes.

Corey Dion Lewis (25:30.858)
Yeah!

Corey Dion Lewis (25:41.134)
You're right.

Alison Brown (25:51.969)
which you know, Cory, fruit and vegetables, low fat dairy, lean meats. So whatever meat is in your background, make sure it's lean, cut off the fat. And also lower sodium foods and just being mindful and looking at the labels so that you have lower sodium option, less processed foods. Michael Pollan had the book, Eat Less, Mostly Plants, and Mostly like Fruits and Vegetables. So focusing on.

Corey Dion Lewis (25:54.535)
Yeah.

Corey Dion Lewis (26:18.798)
I'm honey.

Alison Brown (26:20.009)
eating real fruits and vegetables, time permitting, but also frozen and lower sodium canned goods can really help with promoting the DASH diet and adhering to the DASH eating plan.

Corey Dion Lewis (26:31.05)
Yeah, and I will say I've had success with many patients following that same logic you were talking about, not having to necessarily change their culture with foods that they're already eating, but just having some guardrails around it and change, maybe preparing them differently in some senses. And it's been a great way for people to improve their health.

Alison Brown (26:51.565)
Mm-hmm.

Alison Brown (26:57.333)
Yeah, indeed, indeed. I'm glad to hear that you use that with your patients and clients.

Corey Dion Lewis (27:01.214)
Yes, I do. I do. Again, Dr. Brown, thank you so much for being here. I really appreciated your time. And everybody, thank you for listening to the Healthy Project Podcast. I'll highlight you next time.

Alison Brown (27:15.746)
Thank you, Cora.