Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Abstract

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity Tanya Agurs-Collins 1,* , Jennifer Alvidrez 2 , Sanae ElShourbagy Ferreira 3 , Mary Evans 4 , Kimberlea Gibbs 5 , Bramaramba Kowtha 2 , Charlotte Pratt 6 , Jill Reedy 1 , Marissa Shams-White 1 , Alison GM Brown 6 1 National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States; 2 Office of Disease Prevention, Bethesda, MD, United States; 3 National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States; 4 National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States; 5 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States; 6 National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States ABSTRACT Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food in dustry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations. Keywords: Nutrition Health Disparities Framework, social determinants of health, socioecological model, diet quality, health equity