Our results indicate that racism is positively associated with a less healthy community food environment. Experiences of racial discrimination, which encompass the expression of interpersonal and institutional racism, were positively associated with food insecurity and, when evaluating this association stratified by household area, we observed a positive association only for households in areas with a poorer food environment (this association remained statistically significant even after adjusting for potential confounders). This result demonstrates that the food environment can be a modifier of the effect of the association. Based on our literature review, this is the first study to evaluate how the food environment can modify the effect of the association between racism and food insecurity.
Previous studies have demonstrated a consistent association between a greater presence of Black people in the neighborhood and a poorer community food environment,(13, 14, 17, 18, 19, 20, 21, 22) in line with the results obtained in the present study. A scoping review conducted in 2023, including only studies carried out in the United States, concluded that 30% of the included studies associated one or more indicator of structural racism, such as gentrification and racial residential segregation, with geographic access to food retailers, while 70% of studies documented disparities in access to food retailers according to the neighborhood racial/ethnic composition.(34) Likewise, in Brazil, studies based on secondary data conducted in the Southeast,(35) Northeast,(21) and South(13) regions documented that a greater presence of Black people in the neighborhood was associated with the presence of food deserts, that is, regions characterized by limited availability and access to healthy and fresh food. In Porto Alegre (South region), areas with a higher percentage of Black and Indigenous people are twice as likely to be classified as a food desert.(13)
The literature has characterized the poor availability of healthy food options in areas with a greater proportion of Black residents as a manifestation of structural racism.(13, 23) By using race/skin color as a variable to describe the household areas with a greater or lesser percentage of Black residents, we were able to identify an important part of the action of structural racism, which occurs through spatial segregation by providing residents with poor access to food products, services, and options in different areas or keeping access narrowed to ecologically degraded areas. In this study, structural racism operated through Black people’s difficulty in having access to healthy foods, resulting in a higher prevalence of food insecurity.(9)
Our findings regarding the association between racial discrimination and food insecurity corroborate those of international studies. In 2019, Phojanakong et al. performed a cross-sectional study in the United States showing that household food insecurity in mothers who reported experiences of discrimination was twice that in mothers without such experiences.(36) Our study demonstrated that each 1-point increase in the discrimination score was associated with a 7% increase in the likelihood of food insecurity. In line with this finding, Burke et al., in a cross-sectional study of Black people living in South Carolina, United States, found that each 1-point increase in the self-perceived racial discrimination scale was associated with a 5% increase in the odds of being food insecure.(37)
In Brazil, to our knowledge, there are no studies relating measures of experiences of racial discrimination to food insecurity. However, nationally representative data have previously demonstrated a higher prevalence of food insecurity among Black individuals, which indicates, as stated earlier, its relationship with structural racism.(38, 39, 40, 41, 42, 43) In our study, although prevalence rates were also higher among Brown and Black people, the result was not statistically significant. Black people in Brazil have lower wages, about 30% lower than those of White people, occupy only 29.5% of management positions, have higher poverty rates, reaching 34.5% for Black people and 38.4% for Brown people, and experience more physical, psychological, and sexual violence.(36, 44) The whole scenario, consisting of different indicators of institutional and structural racism, increases the vulnerability of the Black population to food insecurity in a country already widely affected by it.(9)
Considering the multiple causes of food insecurity, the community food environment was shown to be an important factor in the relationship with racism, since the association between food insecurity and racial discrimination was only present among residents of areas with a poorer food environment. Physical access to food retailers that primarily sell healthy and culturally appropriate foods is essential to ensure food security.(45) However, people experiencing racism may have difficulty accessing these food stores, a factor that contributes to increased food insecurity. Racial residential segregation in the city of Porto Alegre, a product of institutional and structural racism, has hampered urban mobility, access to retailers and services, and the availability of better employment and housing opportunities for Black people for decades.(46)
There are 2 main ways of measuring the consequences of racism in the health field, both of which were used in this study to analyze food insecurity. The first is through the association between race/skin color and the respective study outcome, considered a measure of structural racism, as it is not possible to identify the specific mechanisms and interventions for the outcome. These studies define race as a proxy for racism, identifying specific groups or populations that experience certain forms of oppression and discrimination and, as a result, also experience health inequalities. The second is based on psychometric questionnaires that measure experiences of discrimination, considered a more direct way of assessing racial discrimination in its multiple expressions and dimensions (interpersonal, internalized, or institutional racism).(27, 47, 48) Direct assessment of discrimination using psychometric instruments is a growing trend in research. Their use is supported by the need to understand the stressful experiences related to discrimination and their association with negative health outcomes. This allows for the investigation and construction of more detailed mechanisms on how discrimination operates in the study population.(47) In the present study, only the variable ‘experiences of racial discrimination’ was associated with food insecurity, unlike the variable ‘race/skin color’. This finding suggests that instruments that measure racial discrimination should be incorporated into future studies investigating the health of the Black population.(49) Conversely, it also suggests that other instruments and indicators are needed to understand the role of structural racism.
Finally, the findings revealed a high prevalence of food insecurity across the entire study population. The results are in line with reports in Brazil and worldwide. In Brazil, food insecurity increased from 20.6% in 2017 to 32.8% in 2022, while globally its prevalence increased from 21.7% in 2015 to 29.6% in 2022.(50) This demonstrates the growing importance of monitoring and understanding the factors associated with food insecurity to implement public food and nutrition policies focused on the most vulnerable populations.
Limitations and strengths of the study
This study has limitations and strengths. Strengths include (1) the use of 2 variables to measure and analyze the effects of the multiple dimensions of racism (interpersonal, institutional, and structural) on the study outcome, (2) the use of validated questionnaires for the study population to measure the outcome and exposures, and (3) the assessment of the community food environment through an audit of all food retailers, with this measure being more robust than assessment using secondary data, which only evaluates the presence of retailers. Limitations include (1) the enrollment of a study population that is not representative of the general population, but the explanatory mechanisms of associations may be used to help understand similar contexts in low- and middle-income countries, (2) the use of the variable ‘race/skin color’ as a proxy for structural racism, which hinders the development of detailed mechanisms about its effects and the most appropriate interventions, and (3) the use of the short version of the EBIA, which did not allow us to classify individuals according to different levels of food insecurity.