Zohran Mamdani’s overwhelming victory in the New York City mayoral race has become a symbol of hope in a city and country plagued by inequality. Such inequality takes many forms, not least of which are disparities in health outcomes that affect the most marginalized. Colon cancer, a disease rising at an alarming rate in young Americans, is a prime example. Black New Yorkers are 30% more likely to die from it than white New Yorkers. While the Black-white incidence gap has been closing, with the rise in young white Americans outpacing Black Americans, young Black people are still at a 6% higher risk for early-onset colon cancer and 60% more likely to be diagnosed at the deadliest anatomical site. Lifestyle plays an important role in the disparities, as the ability to eat well and move enough is not distributed equally.
As a researcher studying how genetic risk for colon cancer is modified by dietary fat and fiber, I am intimately familiar with how eating healthily shapes the likelihood of getting this devastating disease. But as a physician trainee devoted to understanding social and structural determinants of health, I find a crucial reality is often missing: who has access to healthy choices and why?
Thirteen percent of Americans live in “food deserts,” low-income areas with limited availability of grocery stores selling affordable and healthy foods, making it harder to make choices that reduce risk for diseases like colon cancer. In New York City, approximately 3 million people live in such neighborhoods, with Black and Brown communities of the Bronx, central and eastern Brooklyn, far eastern Queens, and Harlem particularly burdened.
But reducing the problem to just a dearth of grocery stores ignores the structural forces shaping access and choice. The term “food desert” has in fact been increasingly criticized for blaming the community for its lack rather than the larger drivers of that lack. Historical practices like redlining were responsible for decades of racialized residential segregation and the systemic disinvestment of key resources, like grocery stores, from Black and minority neighborhoods in New York City and beyond. Such policies have had lasting impacts: Not only are fast food and ultra-processed foods more readily accessible in food deserts (New York City bodegas, while critical to improving food access, are typically dominated by unhealthy foods like chips and soda), but companies like McDonald’s specifically target Black and Latino youth in advertising, and colon cancer rates among Latinos born in the U.S. vastly outpace those of their foreign-born counterparts.
The goal is clear: get minorities hooked on highly processed, nutrient-deficient foods from an early age and create customers for life. Thus, while we know the diets that reduce colon cancer risk — high in fiber and fresh produce; low in fat, ultra-processed foods, and red meat — the adoption of this knowledge directly clashes with racist and capitalist systems that impede access to the ideal diet.
Problems of access are poised to get worse as the Trump administration enacts policies designed to devastate low-income Americans, including cuts to SNAP, which almost 2 million New York City residents rely on to help purchase food. Rather than addressing the increased costs of healthy eating — in New York, healthy food costs 3.2 times more than unhealthy food — the administration is removing junk food from SNAP while also eliminating the SNAP-Ed nutritional education program that teaches low-income Americans how to make healthy and cost-effective choices. Meanwhile, tariffs and immigration raids have made healthy eating even more expensive, as wholesale vegetable costs skyrocketed in July by nearly 40%, the largest one-month increase in almost a century.
Adding to the problem, Medicaid cuts passed in the Republicans’ recent bill will make cancer screening and care less accessible to millions. NYC outreach initiatives like the Citywide Colorectal Cancer Control Coalition have helped bring colon cancer screening for Black New Yorkers to the highest rates of any race at 76%, compared to nationally where Black people still lag behind. Such gains were driven in part by expansions in Medicaid coverage that are now set to be reversed, putting health insurance and critical preventative care at risk for over 11 million Americans, disproportionately people of color. And exercise, another key factor in reducing cancer risk, will become all the more difficult in the face of Trump’s deployment of the National Guard to cities, including his threats to send troops to New York City in response to Mamdani’s win. Such actions not only fail to address public safety issues but also create unsafe environments for Black and Brown communities that have historically strained relationships with law enforcement.
Community leaders, medical professionals, and legislators must work together to address the widening gaps affecting our most marginalized. On the most basic level, they must educate residents on making healthier yet realistic choices — opt for leaner cuts of meat; try baking and grilling instead of frying; consider broccoli (frozen is often cheaper and still nutritious) and beans as fiber-rich sides; try home exercises using household items. This education can happen in schools, community centers, churches, and clinics. In Houston, for example, the local cancer center partnered with community sites to offer colon cancer workshops, including healthy cooking demonstrations and workout classes.
Perhaps most important, however, is improving systems to make healthier individual choices possible. Mamdani’s plan for city-run grocery stores selling food at wholesale prices to increase affordability is an important step. In the wake of SNAP cuts, food banks and mutual aid initiatives will be crucial stopgaps. New Yorkers can donate to and volunteer with organizations like Food Bank for NYC and Hunger Free NYC, which are helping curb food insecurity among low-income residents. They can also organize fundraisers among colleagues, friends, and family to support these efforts. The NYC Directory of Resources + Aid provides a helpful map of food distribution centers across the city and allows New Yorkers to add resources and sign up for canvassing to share food distribution information. With bodegas outnumbering supermarkets 13 to 1, initiatives like Shop Healthy NYC! have been critical for increasing healthy food access and reducing the advertisement of unhealthy food at these local establishments. Community members can partner with the initiative to “adopt a shop” and improve food options.
People’s lifestyles, and their consequent risks for diseases like colon cancer, are shaped by systemic factors that have made access to the “right” choices more difficult for many. Centering access, especially as this administration further strips Americans of the bare minimum, is critical for defending the health of our communities that need it most.
Tania Fabo, MSc, is an MD-PhD candidate in genetics at Stanford University, a Rhodes scholar, a Knight-Hennessy scholar whose PhD research focuses on the interaction between genetics and diet in colorectal cancer risk, as well as a Paul and Daisy Soros fellow, and a Public Voices fellow of The OpEd Project.