Introduction
One of the most common misconceptions is that any given person’s health status is mainly influenced by their genetic makeup; 91 percent of Americans believe that their genetic information has a large effect on managing their health. (3) It is commonly assumed that some people are genetically gifted, and others are genetically not. In fact, genetics only account for 10 to 15 percent of someone’s health status. (13) Additionally, many people agree that the second most significant determinant of someone’s health status is the quality of their health care. While health care does play a more minuscule role in health outcomes, these two misconceptions are not only incorrect but also extremely dangerous.
While Princeton, New Jersey, and Trenton, New Jersey are only twelve miles apart, the life expectancy gap between these two N.J. cities is fourteen years, with the average life expectancy being 87 years in Princeton, and 73 years in Trenton. (1) Whereas it is commonly thought that health outcomes are mainly influenced by genetics and the degree of access to a high-quality health care system, in fact, there are a number of social factors that are more important to determining health outcomes. (2) These factors are increasingly referred to as the Social Determinants of Health.
The Social Determinants of Health include economic stability, neighborhood and physical environment, education, food and nutrition, community and social context, and accessibility to a high-quality health care system, and are estimated to account for 80 to 90 percent of people’s health status.(13,14) The World Health Organization stated that “a combination of faulty social policies, economic arrangements, and politics are accountable for the inequities in daily life which engender avoidable inequities in health.” These six determinants are responsible for health inequities and the unjust, avoidable differences in health status seen within nations, states, and even counties. Arguably, health care has greatly impacted health outcomes when it comes to increasing life expectancy, however, MD Donald Berwick shares that the benefits of being on a cholesterol-lowering statin for twenty years are completely negated by living 43 feet further uptown in the journey from Midtown Manhattan to the Bronx (in life expectancy).
Other than life expectancies rates, Princeton and Trenton have significantly different rates of obesity and Type 2 Diabetes. In Princeton, 22% of men are obese, and 25% of men have type two diabetes. On the other hand, in Trenton, 48% of men are obese and 44% of men have type two diabetes. These disparities are assumed to be related to dietary patterns, however, the topic has not been thoroughly investigated or corroborated yet. This research will carefully investigate (1) what differences in food choice processes exist, and (2) how those differences affect diet in neighborhoods with different socioeconomic statuses, resulting in the current disparities in rates of obesity, and rates of Type 2 Diabetes.
The food choice process relates to how people select the food they eat. It comprises psychological and sociological aspects, economic issues and sensory aspects.(4) It is hypothesized that the different rates of obesity and Type 2 Diabetes seen in the two communities result from different food choice processes, which then lead to different diets.
​
​
