How My Summer as an Ice Cream Scooper and Health Educator Taught Me About Health Disparities
SAMANTHA GARCÍA, MS
Rising MS1
Drizzle of chocolate sauce to coat the dish, a sprinkle of hand-crushed topping, a generous scoop of homemade organic ice cream, a ladle full of rich Valrhona Chocolate hot fudge, and repeat. Add a spoonful of whipped cream, some more chocolate sauce, then topping, and the sundae is now completed. I cleaned up my area while admiring the hot fudge sundae I created and then headed over to the register to give the customer my monstrous creation. “Here you go, enjoy!” I say as I handed over a sundae that could easily feed three grown adults to a little girl with a Barbie doll tucked underneath her arm.
After my shift at Sweet Rose Creamery, an ice cream shop tucked away in the affluent city of Brentwood, California, I found myself at St. John’s Well Child and Family Center, a federally qualified health center in South Los Angeles, where I worked as a program coordinator. At St. John’s, I managed and served as the lead health educator for “Kids N Fitness,” a family-centered nutrition education program. As participants of Kids N Fitness, children and their parents engaged in hands-on activities covering the five food groups, how to make healthy choices when dining out, and how to read a food label. In addition to educating families about these topics, I discussed the importance of physical activity and exercise with the pediatric patients that participated. These responsibilities were completely different from the tasks I performed at Sweet Rose. In Brentwood, I was whipping up sweets, but at Kids N Fitness, I was educating children who were struggling with obesity and diabetes in an area of Southern California that faced a number of health disparities.
That summer, I wondered what a child who orders a massive dessert at Sweet Rose would eat at home, especially since few of the children I ever served gave me an impression that they were “unhealthy” or “overweight.” My observations over the summer made me realize that some of the prevailing assumptions brought to the obesity debate are faulty. Often people associate obese and unhealthy children eating lavish desserts or being undereducated about food choices. However, the children at Kids N Fitness were being educated, yet were struggling with their weight, while the kids at Sweet Rose were eating lavish desserts and appeared to have a healthy weight. What was going on that made this deeply ingrained idea wrong?
Perhaps a source of variability was found in the contrasting environments and landscapes between these two Los Angeles neighborhoods. Just outside the window of Sweet Rose, past the decorative flowers that neatly aligned the window’s perimeter, I saw luxury cars with engines that purred and paint that glistened. Sometimes I served up ice cream for people I saw in movies or on the television. The surrounding neighborhood is composed of parks and country clubs; kids often stopped in for a scoop after soccer or tennis practice. In contrast, as I got off the freeway and drove through the community surrounding St. John’s, I noticed abandoned train tracks, street food vendors, and various fast food chains—all with “EBT Accepted Here” signs. There were no luxury cars, country clubs, or celebrities.
The difference in my two work environments is one that arises as a result of the socioeconomic circumstances of these communities. Between Brentwood and South Los Angeles, I worked in one of the richest and poorest neighborhoods of Los Angeles, continuously exposed to the contrasting social fabrics of Angelinos. I often reflected about how unfair it was that from one ZIP code to the next the health status of Angelinos could have such a stark difference. I wondered why such differences existed in the first place in a city like Los Angeles. As Roshan Bastani, director of UCLA’s Kaiser Permanente Center for Health Equity, described, “We associate this type of disparity with third world countries…we don’t realize the same thing is happening in our own backyard.” In a public forum discussion, Bastani and other professionals involved in public health and policy discuss health disparities that mirror what I witnessed that summer. Bastani goes on to point out how those who live in wealthier areas of Los Angeles are more likely to have easier access to commodities like organic vegetables and means for engaging in regular exercise (Biscelgio, 2015). This idea reminded me of the little girl and other child customers from Sweet Rose Creamery. Although these customers consumed large amounts of sweets these children were perhaps supplementing their diets with organic foods and had better access to recreational facilities or organized sports for exercise. Sadly, this was not the case for the families and patients at St. John’s. As I fostered relationships with them I gained insight into their lives and the multifactorial challenges they faced toward achieving a healthy lifestyle. Poverty, immigration status, language barriers, and difficulty balancing work and home responsibilities were some of these hurdles. I came to realize that patients confronted a majority of these constraints before they even entered the clinic; these issues existed in the places where they lived, ate, and worked.
Los Angeles public health data captures this phenomenon. The Los Angeles County 2017 “Key Indicators of Health Report” underscores how Angelinos’ health status varies drastically by highlighting disparities that exist within the county. In the report, the South Los Angeles community, referred to as Service Planning Area (SPA) 6, fares far worse than other areas of the county in regards to physical and social determinants of health related to nutrition and physical activity. For instance, in the neighborhood surrounding Sweet Rose Creamery, SPA 5, 97.4% of adults believe their neighborhood is safe from crime, while only 40.3% of adults in SPA 6 hold this belief (LACDPH, 2017). Without secure neighborhoods, residents are less likely to use parks, playgrounds, or other areas for play and exercise. Unfortunately, similar health disparities extend far beyond the population of Los Angeles and exist in other urban and rural communities throughout the United States.
Although it has been five years since my busy summer as an ice cream scooper and health educator, the insights I gained remain with me. After that summer, I became more motivated to learn about health disparities and how to address social concerns to promote healthier communities. I spent three years at St. John’s Well Child and Family Center where I became more cognizant of the challenges that patients face toward living a healthy life. My experience working in an underserved community also taught me that, like the sundaes at Sweet Rose Creamery, health is complex with layers of variables all intertwined. In a few months, I will enter medical school and aim to build on the lessons learned from my summer job at Sweet Rose and my time at St. John’s. I look forward to cultivating the clinical knowledge and skills needed to meet the complex needs of underserved communities and to exploring both the social and biological determinants of health.
Citations
Bisceglio, Paul. "Who Can Afford Organic Kale on the Minimum Wage?" Zocalo Public Square. 15 July 2015. Web. 11 Sept. 2015.
Los Angeles County Department of Public Health (LACDPH), Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; January 2017.
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