Minakshi Raj, University of Illinois at Urbana-Champaign
Food is a powerful part of community and medicine. It has the potential to build connections, elicit nostalgia, spark joy, mark celebration and promote healing.
It also plays a role in determining whether the health care system is inclusive and equitable.
I study the challenges that older adults and their family caregivers face in the U.S. health care system, especially for those from racial or ethnic minority communities. Health disparities, such as unequal access to care based on race and ethnicity, affect many communities in the U.S.
Sociocultural characteristics such as language, skin color, religious beliefs and immigrant status can present access barriers to high-quality health care. I’ve found that food can also be a source of alienation and exclusion in the U.S. health care system. To many patients, it is a salient reminder that the system was not built for them.
Current food standards at health facilities
Current regulations around food in health care environments such as hospitals and long-term care facilities emphasize occupational and food safety. Dietary quality standards are based on clinical need, and specialized foods cater to patients who have difficulty chewing or swallowing, for instance. Health care facilities and the organizations providing menu recommendations to them consistently advertise an alignment with taste preferences, allergy-related needs and nutritional quality.
Although some facilities offer kosher and halal options, culturally inclusive options are often neglected. For instance, some facility menus prominently feature sandwiches and salads that only reflect American cuisine. Without culturally inclusive menus, patients might be given foods that don’t align with their cultural or religious preferences. As one family caregiver I interviewed for my ongoing study of older Asian immigrants from multiple ethnic communities described, “My mother-in-law would get to the nursing home and my father-in-law hadn’t eaten all day until 5 o’clock. He likes to eat roti and curry for lunch and dinner, but they would just give him a sandwich.”
Another participant had to help her mother come to terms with a new diet in an assisted living facility. “So she’s in this new place and one day they served kielbasa and sauerkraut, and she’s looking at it like, ‘What’s that?’ and I was like ‘Oh, sausage, you’re not going to like that, and [sauerkraut] … you’re not going to like that either.’”
Subsequently, these patients may lack important nutrients to manage their health conditions and maintain their weight. Undernourishment can cause negative physical and mental health effects, including frailty, or an increased vulnerability to adverse health conditions and diseases, and depression. Functional decline due to undernourishment can also lead to an increased risk of falls, hospitalization and death.
The caregivers I interviewed believed that the health care system wouldn’t be able to accommodate their relatives’ needs and felt resigned that it would not change. As one caregiver said, “I would say that the hospitals need a lot more work. My mom is quite religious and also has diet restrictions. When she went to the hospital, all those days, most of the time she was not eating at all.”
Improving patient health and well-being
Offering culturally inclusive foods in health care facilities has the potential to support mental well-being and even promote joy among older adults. It can foster a sense of belonging and community in a place where it can be difficult to form relationships. It could also help patients and their families understand the types of treatment-aligned meals they can prepare and eat at home.
Culturally inclusive food may also be critical to helping patients feel they are respected and being treated with dignity. This is especially the case when they may be adjusting to language differences or unfamiliar healing traditions. It could build their trust in their clinicians and the health care system by demonstrating commitment to supporting diverse patients.
Supporting caregivers and the local community
A health care system that offers inclusive foods supports more than just patients.
Family caregivers have myriad responsibilities, including helping their relatives with transportation and dressing themselves. The caregivers in my study often must also prepare and transport food to ensure that their relatives are eating. One participant estimated that “it was about an extra half an hour to an hour every day to prepare the food and then bring it in … going straight from my workplace to the hospital.”
The local community could also benefit. Health care organizations could work with local vendors that supply ingredients from different ethnic traditions, economically supporting the community. Health care facilities could also employ chefs and dietitians from diverse backgrounds to ensure meal quality.
Finally, the U.S. health care workforce is becoming increasingly diverse and multicultural. But health care workers from racial and ethnic minority communities still grapple with hiding their cultural identities to belong in the workplace. Having access to traditional foods may help health care workers feel more included in their workplace, or at least alleviate some of the burden to “fit in” by beginning to build an organization that welcomes diversity.
Emerging approaches to cultural inclusion
Implementing culturally inclusive meals across the country’s health care system requires a concerted and long-term effort. In a health care environment where every penny is pinched, it might be hard for facilities to come up with multiple choices at mealtime. It requires revisiting regulations around dietary quality in health care facilities and ensuring cultural sensitivity among care providers and staff. It also requires facilities to have the human resources, funding, knowledge and support to ensure these efforts can be sustained.
Some health care facilities have already dedicated considerable effort to provide culturally inclusive meals to patients and residents. Holy Name Medical Center in Teaneck, New Jersey offers a bowl of rice to its its Asian American patients instead of a sandwich, and warm instead of cold water to drink per cultural preference. Rather than depending solely on individual workers to modify their practices, they emphasize a system-level commitment to inclusion and educate clinicians and other health care workers on different aspects of Asian cultures.
Similarly, one of the assisted- and independent-living facilities owned by Bria Health Services near Chicago has a special unit catering to the dietary, language and cultural preferences of South Asian adults. It’s not clear that segregated units are necessarily the ideal answer – ideally anyone at any facility would be served culturally appropriate and appetizing food. But it’s a starting point.
Achieving a strong and inclusive health care system requires ensuring it is built for everyone. And food is one fundamental way to do it.
This work was developed in collaboration with Merin Oleschuk, Emma Willoughby and Sudha Raj.
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Minakshi Raj, Assistant Professor of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
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