Early in my time in Happy Valley, as a doctoral student in Penn State’s Health Policy and Administration program (We are!), I became curious about how—and how well—our health care systems respond to us. Maybe it was the stark cultural shift I experienced moving from Miami, FL, to central Pennsylvania.
Growing up in Miami, I was used to a rich mix of cultures, traditions, and ways of living. Central PA, by contrast, felt like a single, inherited culture—one shaped by Pennsylvania-Dutch traditions, where people were kind but largely uninvolved in each other’s lives. (I was there during the Sandusky scandal, so, yeah, secrecy was part of the monoculture.) There was a quiet “to each his own” sentiment that felt completely new to me.
But my first real cultural shock didn’t come from social norms—it came from the food.
The Salt Shaker Moment
I’m far from a foodie, but I do appreciate good food. Yet everything I ate in Central PA tasted like… nothing. Just textured water. Boiled food, apparently, was considered “cooked.” If it had been during the COVID era, I might have thought I’d lost my sense of taste.
Then one day, I went out to eat with a friend from the area. As soon as our food arrived, I picked up my fork. She picked up the salt shaker.
I was stunned. I had never in my life used a salt shaker at a restaurant. In my upbringing, salt and pepper shakers were decorative—little markers to distinguish a dining table from a nightstand. If someone actually used them, it was either a joke or an insult to the cook. But for my friend, this was completely normal. She wasn’t fixing bad food—she was salting to taste.
This moment stuck with me. I would later realize, these small cultural habits extend beyond the dinner table—they shape our health in profound ways.
The Link Between Culture and Heart Health
We know sodium intake is linked to several health outcomes, especially heart disease. So what happens when an entire region adds salt at every meal over a lifetime?
Looking at geographical trends in cardiovascular mortality, parts of Pennsylvania rank among the highest in the nation for deaths due to heart disease. Meanwhile, Miami-Dade County—where I grew up, and where salt-shaming is a real thing—ranks among the lowest in the country for mortality from major cardiovascular diseases.
Does this mean Central PA’s salt-to-taste habit is a direct cause of higher heart disease rates? Not necessarily. Heart health is shaped by more than just nutrition—genetics, exercise, access to care, and social determinants all play a role. In fact, Miami-Dade does poorly in other areas, ranking among the worst in the nation for cardiomyopathy and myocarditis-related deaths.
But here’s the takeaway: local health trends are deeply tied to local cultures. And that means health systems must do more than push generic heart health campaigns—they need to respond to the specific needs of the communities they serve.
What Health Systems Can Learn
February is Heart Health Month, and many health systems are engaging in broad awareness campaigns—#WearRedDay, educational flyers, and social media outreach. But the real question is: Are these efforts tailored to the communities they serve?
- If a community has high rates of hypertension, are health systems addressing sodium intake in culturally relevant ways?
- If genetics and obesity play a larger role in a region’s heart disease rates, are screenings and lifestyle interventions prioritized?
- Could a hospital-sponsored 5K or heart walk be more impactful than another awareness flyer?
All of these are good ideas for any hospital or health care system. But the better idea is to go with what will best serve your patients. The best approach isn’t just to educate—it’s to listen, analyze, and act on local data. Just like my salt-shaker moment taught me to recognize cultural habits that I’d never considered, health systems need to do the same with the populations they serve. Because at the end of the day, a pinch of salt might seem small—but over a lifetime, it can make all the difference.
Geoffrey Silvera, PhD MHA 