We have a lot of choices to make about our diet. Add to that doing the right thing when it comes to preventing or treating a chronic disease, fighting a virus or losing weight, and suddenly our nutrition choices can seem almost overwhelming.

Well, I'm here to help. Welcome to the Nutrition Facts podcast. I'm your host, Dr. Michael Greger.

Does it ever seem to you that some of us maybe kept from living longer or healthier lives because of our skin color? In our first story, we look at health equity, and why black Americans are sicker and die younger than their white counterparts on average.

During the COVID-19 pandemic, the death rate for African Americans was as much as six times higher than white Americans.

The higher black pandemic deaths placed a harsh spotlight on their long-standing higher mortality and diminished longevity in general.

Unfortunately, diminished African American life expectancy predates the COVID-19 pandemic by decades. The black white death gap for women is about three years, and for men closer to five years.

The COVID-19 death disparities may have to do with limited access to healthy food and predominantly black communities, the housing density, the need to work or else, the inability to practice social distancing, but also the underlying burden of ill health increased COVID-19 mortality and complications occur more often in individuals with pre-existing conditions like hypertension, obesity, diabetes,

and cardiovascular disease comorbidities that are more prevalent in African Americans, more high blood pressure, more diabetes, more strokes, and more likely to die at early ages from all causes put together.

The question is why? Why do black Americans live sicker and die younger than their white counterparts?

Well, one big factor is socioeconomic status. In the United States, race is closely tied to class with African Americans about twice as likely to be living in poverty.

On average, education levels are lower as well, however, even among African Americans who socioeconomic status is comparable to that of whites, despite the higher education and more socioeconomic resources, health outcomes are still poorer.

Part of that has to do with lifestyle behaviors. For example, fewer than 5 percent of African American adults met physical activity guidelines.

Smoking rates are actually comparable, though African Americans tend to be exposed to more secondhand smoke and have lower quit rates.

This may be because they're more likely to use menthol cigarettes, which enhance the addictive potential of nicotine. Why menthols? Because tobacco companies target the marketing of mentholated products to African Americans. Black lives? Black loans.

Similarly, if you look at food messages on African American television shows, not only does black primetime contain a greater number of food commercials, African American audiences may be receiving nearly three times as many advertisements for low nutrient junk, such as candy and soda.

That may be one reason why African Americans tend to consume fewer fresh fruits and vegetables and are more likely to eat junkier foods. Of course, where are you going to get those fresh fruits and vegetables?

There are fewer supermarkets located in black neighborhoods compared with white neighborhoods, as in four times fewer supermarkets.

What black neighborhoods do excel in, though, is fast food.

Prudomely black neighborhoods have 60 percent more fast food restaurants per square mile compared to predominantly white neighborhoods.

Now, of course, dietary behaviors alone do not fully explain the significant differences in diet-related disease patterns between racial groups.

There are differences in employment, poverty, and home ownership, and healthcare access, all of which can affect outcomes.

But while there are certainly many social and economic factors such as racism and income inequality that contribute to health disparities, there is good evidence that simply eating a more plant-based diet could help eliminate disparities in cardiovascular disease and diabetes.

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