Analysis By Mariah Campoy, PA-C, Doctor of Medical Science Candidate
Health equity is the principle that all individuals should have a fair and just opportunity to achieve their highest level of health, regardless of socioeconomic status, race, or geographic location.¹ Despite advancements in healthcare, obesity-related chronic diseases—such as diabetes, hypertension, and cardiovascular disease—continue to be one of the most pressing health equity issues in 2025. These conditions disproportionately affect low-income and minority populations due to systemic disparities in the social determinants of health (SDOH), including economic stability, food access, neighborhood environment, healthcare accessibility, and cultural influences.¹ Addressing these disparities requires a comprehensive approach that incorporates policy reform, healthcare system improvements, and community-based interventions.
The development of obesity-related chronic diseases is strongly linked to social and economic factors, which shape an individual’s ability to access health-promoting resources.¹ Economic stability plays a critical role in determining food security, healthcare access, and the ability to engage in physical activity.¹ The Unnatural Causes documentary highlights how historical oppression and forced dietary changes have led to disproportionately high rates of diabetes in Native American communities, particularly within the Pima and Tohono O’odham tribes. These groups, once reliant on nutrient-rich traditional diets, were displaced onto reservations and became dependent on government-provided processed foods, leading to increased obesity and chronic disease.² Additionally, food insecurity remains a major challenge for Native Americans and other groups that fall in the low-income and minority communities today. Studies show that food deserts—areas with limited access to grocery stores selling fresh produce—are disproportionately located in low-income, racially diverse neighborhoods, forcing residents to rely on fast food and convenience stores for sustenance.² Research by Barr emphasizes that while both race and socioeconomic status influence health, their combined effects worsen disparities in chronic disease prevalence.³ Additionally, low-income minority populations not only experience financial hardship but also face systemic discrimination within healthcare and economic structures, leading to worse health outcomes.³
Obesity disparities are further exacerbated by systemic barriers in healthcare, urban planning, and economic policy. Research highlights that obesity prevalence is influenced by built environments that limit access to physical activity and nutritious foods.⁴ Kumanyika emphasizes the need for targeted, equity-focused interventions that address not only individual behaviors but also the structural determinants of health.⁵ The Unnatural Causes: Place Matters documentary explores how neighborhood conditions can be a stronger predictor of health outcomes than genetic predisposition. Many low-income communities lack parks, sidewalks, and recreational spaces, reducing opportunities for physical activity. In these areas, fast-food establishments and liquor stores are often more accessible than grocery stores that offer fresh and nutritious foods.⁴ Research further indicates that communities with high levels of pollution, inadequate public transportation, and limited healthcare facilities also experience higher rates of obesity, diabetes, and cardiovascular disease.⁴ These disparities illustrate how systemic infrastructure and planning decisions contribute to health inequities, reinforcing patterns of chronic disease in marginalized populations.
The way health is defined and addressed within the healthcare system also plays a role in perpetuating disparities. Bill Walczak’s TED Talk argues for an expanded definition of health that includes social and structural determinants, rather than focusing solely on individual behaviors.⁶ He highlights the importance of integrating healthcare with social services, education, and urban planning to promote long-term health equity. A failure to address these broader influences results in reactive care models that treat disease rather than preventing it. Implementing community-based solutions that align with Walczak’s vision, such as neighborhood wellness programs and school-based health initiatives, can help bridge existing gaps and reduce chronic disease rates.
Beyond environmental and economic factors, racial and ethnic disparities also shape health outcomes, even when controlling for socioeconomic status. The Hispanic Health Paradox offers an interesting perspective, demonstrating that despite lower average income levels, Hispanic populations in the U.S. often have better health outcomes than expected due to strong family and community support networks. In the BBC article it is mentioned that traditional diets consisting of fresh, home-cooked meals contribute to lower rates of cardiovascular disease among first-generation Hispanic immigrants.⁷ However, this advantage diminishes with subsequent generations as dietary habits shift toward processed foods commonly consumed in the American diet.⁷ Over time, obesity and diabetes rates rise among U.S.-born Hispanic individuals, underscoring the role of cultural and dietary changes in chronic disease prevalence.⁸
The Hispanic Health Paradox reminds us that obesity-related chronic diseases do not impact all populations equally. Systemic barriers make it significantly more challenging for certain groups to access quality healthcare, nutritious food, and preventive care. Native American communities experience some of the highest rates of diabetes, largely due to historical disruptions in traditional food systems and economic disenfranchisement.² Black and Hispanic populations also experience higher rates of obesity, hypertension, and diabetes, as food insecurity, environmental conditions, and healthcare disparities create significant obstacles to achieving optimal health.³ Low-income individuals in both urban and rural areas face distinct challenges—urban communities often contend with food deserts and poor housing conditions, while rural residents may struggle with geographic barriers to healthcare access.⁴ Children and adolescents are also increasingly vulnerable, particularly those in low-income and minority communities. The rise in childhood obesity has been linked to poor school meal programs, aggressive marketing of unhealthy foods, and reduced physical education requirements. Many students rely on free or reduced-price school meals, which frequently lack the nutritional quality necessary to prevent obesity and chronic diseases.³ These early health disadvantages create lifelong disparities, reinforcing the cycle of poor health outcomes in marginalized communities.
To address this growing public health crisis, multiple stakeholders must take part in reducing health disparities related to obesity and chronic disease. Federal agencies such as the Centers for Disease Control and Prevention (CDC), the United States Department of Agriculture (USDA), and the Department of Health and Human Services (HHS) play key roles in shaping policies related to food security, healthcare access, and public health initiatives. Expanding food assistance programs, improving urban planning, and increasing Medicaid coverage are essential steps in reducing disparities.9 Healthcare providers and insurers must also play a role in addressing these inequities by prioritizing preventive care, expanding Medicaid coverage, and incorporating culturally competent healthcare practices into their care models. Schools and community organizations have the potential to support health equity through improved nutrition programs, access to fitness facilities, and culturally tailored health education.⁴
Obesity-related chronic diseases remain one of the most pressing health equity issues in 2025, disproportionately affecting low-income and minority populations due to systemic disparities in social determinants of health. Economic stability, food security, neighborhood conditions, healthcare access, and cultural factors all contribute to these inequities. Addressing these challenges requires collaboration among government agencies, healthcare providers, policymakers, and community organizations. By implementing evidence-based policies and interventions, the healthcare system and broader society can take meaningful steps toward reducing health disparities and promoting equitable health outcomes for all.
References
- Prentice KR, Beitelshees M, Hill A, Jones CH. Defining health equity: A modern US perspective. iScience.2024;27(12):111326. doi:10.1016/j.isci.2024.111326.
- Unnatural Causes: Bad Sugar [Documentary]. California Newsreel. 2008.
- Barr DA. Health Disparities in the United States: Social Class, Race, Ethnicity, and Health. 3rd ed. Johns Hopkins University Press; 2019.
- Unnatural Causes: Place Matters [Documentary]. California Newsreel. 2008.
- Kumanyika SK. Advancing health equity efforts to reduce obesity: Changing the course. Annu Rev Nutr.2022;42:453-480. doi:10.1146/annurev-nutr-092021-050805.
- Walczak B. Unlearning & Expanding our Definition of Health. TED Talks. January 2020. https://www.ted.com/talks/bill_walczak_unlearning_expanding_our_definition_of_health_jan_2020. Accessed March 2025.
- Hispanic Health Paradox. BBC News. 2015. https://www.bbc.com/news/world-us-canada-32910129. Accessed March 2025.
- Thornton PL, Kumanyika SK, Gregg EW, et al. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci. 2020;1461(1):5-24. doi:10.1111/nyas.14270.
- Chen AM. Barriers to health equity in the United States of America: can they be overcome?. Int J Equity Health.2025;24:39. doi:10.1186/s12939-025-02401-w.
