Immigrant children’s health declines rapidly after arrival in Canada

The study would have benefited if the data and analysis included economic information to assess the influence of economic versus other factors.

But approaching an unhealthy Canadian norm, while reflecting integration, is not a positive development:

A healthy, happy future, free from poverty: This is the aspiration of many new immigrants and refugees to Canada and the United States. Leaving harsh conditions and food scarcity behind, they embrace the safety and relative affluence that North America offers.

Few would have imagined that migration would damage their family’s well-being and lead to rapid health decline.

Yet research studies over the past 15 years have found that immigrants arrive in better health than Canadians — with a lower incidence of chronic diseases such as heart disease, cancer and diabetes — but suffer a decline in their health as their time in Canada increases.

This decline applies to young children too. As a professor and a postdoctoral fellow in the School of Public Health and College of Pharmacy and Nutrition at the University of Saskatchewan, we recently conducted the first comprehensive research project in Canada examining the health of immigrant and refugee children after their arrival in the country.

This study, published in Applied Physiology, Nutrition and Metabolism, found several health concerns and nutritional deficiencies in many of these children.

Higher blood pressure, unhealthy cholesterol

Our study of 300 immigrant and refugee children in Saskatoon and Regina, Saskatchewan, found that these newcomer children often embrace a Western diet and sedentary lifestyle. Some parents are unaware of the dangers of overeating and the calories attached to the Western diet.

Overall, newcomer children were found to have borderline or elevated blood pressure— substantially higher than that of Canadian children.

Thirty-six per cent of the children in our study also had an inadequate intake of zinc, which is essential for growth and development.

Fifty-two per cent had unhealthy cholesterol levels, whereas just 35 per cent of Canadian children had similar levels. It is worth mentioning that increased stress is a known risk factor for high cholesterol.

Other research has found that some groups, such as South Asian immigrants — particularly women — are at a higher risk of developing high blood pressure the longer they reside in Canada.

Non-European newcomers also experience significant deterioration in how they rate their own health, and increase in body mass index (BMI) over time, compared to people who were born in Canada.

Poverty and dead-end jobs

Why this decline in health? Canada offers relatively abundant food, accessible health care and a standard of living that is one of the highest in the world, so the findings may appear counter-intuitive.

The answer lies both in the situations that immigrants and refugees have left behind, and the conditions they find when they get here.

Some immigrants find their pre-immigration dreams confounded by circumstance. They live in relative poverty, working dead-end jobs that fail to exploit their experience and potential. Some came to Canada as highly qualified professionals, optimistic about their prospects in a new country, but are unable to find meaningful, rewarding employment. Some who dreamed of a middle-class lifestyle struggle at the bottom of the economic pile due to language and educational barriers.

A diet of cheap, readily available junk food doesn’t help.

For many immigrant families, the stress of adjusting to life in Canada may contribute to deteriorating health. Many lose their social support network through migration. It can also be challenging to access culturally appropriate health care.

Living in survival mode

We spoke with numerous immigrants and health-care providers about newcomer health, diet and lifestyles. Many newcomers spoke of their aspirations to attain a good standard of living in Canada and the daily struggles they experienced to achieve this.

Some had become disillusioned with life in Canada because of their difficulties achieving the lifestyle they had expected, or aspired toward.

One refugee was so disheartened by the difficulties he encountered in getting a good job and providing for his family that he wanted to be sent back.

“Refugees and immigrants are in survival mode, because doctors, engineers and professors are pushing shopping carts,” said one service provider, commenting on the rising number of food insecure immigrants.

Research has shown that health disparities among ethnic groups can be reduced when individuals are able to achieve their desired level of socio-economic attainment. As such, living on a low income for extended periods can contribute to physical and mental health problems and a turn towards unhealthy affordable food.

On a low income, a hamburger and fries may cost less than a salad, but will fill a rumbling stomach.

An abundance of food

Refugee children who have known hunger can also find it hard to control their appetite.

“A lot of people change the way they eat. That’s why they gain so much weight. There is an abundance of food here,” said a health-care provider in Regina.

“Sometimes children coming from a refugee camp with very little to eat come here and eat too much,” added an immigrant service provider.

Another factor is that in some cultures, plump children are considered healthy. One family told us that eating meat, once a luxury to be enjoyed once or twice a month, was now considered both desirable and essential.

Thirteen per cent of Canadian children aged three to 19 years are obese, compared to 10 per cent of newcomer children who have been in Canada for five years or less.

Understanding these newcomers’ rapid routes to obesity and deteriorating health is important if we are to prevent chronic disease in adulthood, including Type 2 diabetes and hypertension.

Health and social service personnel should be sensitive to these risks when devising effective and culturally sensitive health screening programs.

Race or class irrelevant in intelligence of babies, groundbreaking Oxford study finds

The basics make the difference – medical care and nutrition:

Babies born in similar circumstances will thrive regardless of race or geography, Oxford-led research has found, quashing the idea that race or class determines intelligence.

In a scientific first, the team of researchers tracked the physical and intellectual development of babies around the world from the earliest days after conception to age two.

“At every single stage we’ve shown that healthy mothers have healthy babies and that healthy babies all grow at exactly the same rate,” said Professor Stephen Kennedy, the co-director of the Oxford Maternal and Perinatal Health Institute. “It doesn’t matter where you are living, it doesn’t matter what the colour of your skin is, it doesn’t matter what your race and ethnicity is, receiving decent medical care and nutrition is the key.”

The INTERGROWTH-21st Project, jointly led by Prof. Kennedy and Prof. Jose Villar at Oxford, involved nearly 60,000 mothers and babies worldwide, tracking growth in the womb, then followed more than 1,300 of the children, measuring physical growth and development.

The mothers – in locations as diverse as Brazil, India and Italy – were chosen because they were in good health and lived in similar environments. Their babies scored similarly on physical and intellectual development: in fact, researchers found more variation within racial groups than between them.

The study should help settle the ongoing debate genetics as a determination in intelligence which has been rumbling since the publication of Charles Murray’s The Bell Curve in the 1990s. The book argued that a “cognitive elite” was becoming separated from the general population.

“There’s still a substantial body of opinion out there in both the scientific and lay communities who… believe that intelligence is predominantly determined by genes and the environment that you’re living in and that your parents and grandparents were living in and their nutritional and health status are not relevant,” said Prof Kennedy. “Well, that’s clearly not the case.”

Anti-Immigration Laws Have Negative Health Effects on Undocumented Youth

Not too surprising:

Anti-immigration laws, coupled with the repeal of Deferred Action for Childhood Arrivals (DACA), have negative public health implications for undocumented Latino immigrant youth, according to results presented at the American Public Health Association 2018 Annual Meeting and Expo, held November 10 to 14 in San Diego, California.

These negative effects on public health stem from limited access to education and include higher percentages of tobacco and alcohol use, higher rates of stress-induced chronic disease, and a decrease in the use of health and human services.

The researchers conducted 5 focus groups in San Mateo County, with 3 objectives: to better understand undocumented immigrants’ feelings around the fear of deportation, to identify strategies that can lessen negative effects, and to develop recommendations to help support undocumented immigrants. The researchers also conducted interviews with 6 key informants and 8 healthcare providers.

The researchers found that participants noted signs of depression and anxiety in children and young adults. Particularly, participants expressed concern for older children who once qualified for DACA: these children now reported feelings of hopelessness and lower self-esteem.

The results of the study indicated that undocumented immigrant children sometimes refuse to continue seeking an education, fearing deportation and threats against the Latino community.

To mitigate the negative effects of the political climate on this community, participants expressed a need to increase awareness about health implications, offer practical support systems, and pass local policies that protect all residents, including undocumented immigrants.

“The research highlights the need to study the impact of DACA and immigration enforcement in relation to stress levels, including mental health and chronic disease,” lead study author Mayra Diaz, MPH, from the San Mateo County Health System, Belmont, California, said. “It will be critical to look into areas of outreach for access to public, health, and social services.”

Source: Anti-Immigration Laws Have Negative Health Effects on Undocumented Youth

Refugee and immigrant youth are more likely to end up in the emergency room during a mental health crisis than their Canadian-born peers, a new medical study shows

Not too surprising but nevertheless significant:

Refugee and immigrant youth are more likely to end up in the emergency room during a mental health crisis than their Canadian-born peers, a new medical study shows.

Newcomers did not seek early help from primary care doctors likely due to barriers in accessing and using outpatient mental health services, said researchers from the Institute for Clinical Evaluative Sciences (ICES) and the Hospital for Sick Children.

“Efforts are needed to reduce stigma and identify mental health problems early, before crises, among immigrant populations,” said the study published in the Canadian Medical Association Journal Tuesday.

Based on health and demographic data, researchers looked at emergency department visits for mental health issues by youth between the ages of 10 and 24 years in Ontario.

They identified a total of 118,851 young people who visited an ER with a mental health concern between 2010 and 2014, including 1.8 per cent or 2,194 refugees and 5.6 per cent or 6,680 non-refugee immigrants. The rest were Canadian.

“Most major mental illnesses have an age of onset in adolescence and young adulthood with about 20 per cent of youth experiencing mental illness. Our findings suggest that there are important subgroups of immigrant and refugee children who face barriers in accessing outpatient mental health care,” said study co-author Dr. Astrid Guttmann, chief science officer at ICES and staff pediatrician at Sick Kids.

“Interventions to improve access to the mental health system should consider the needs of specific immigrant populations.”

The gaps between immigrant and non-immigrant youth can be attributed to differences in culture, language proficiency, ability to navigate health services and even referral biases by health care providers, said the report.

While the majority of youth sought help for mental health issues at an emergency department first, the rate was higher for newcomers. The study found 61.3 per cent of refugee youth, 57.6 per cent of non-refugee immigrants and 51.3 per cent of Canadian youth went to an ER first.

Report lead author Dr. Natasha Saunders, a pediatrician at Sick Kids and adjunct scientist at ICES, said the differences are both statistically and clinically significant.

“Emergency services are important for managing acute mental health crises, but for most mental health disorders, primary care would be the most appropriate place for treatment and referral to specialized services,” she explained

“The high proportion of immigrant and refugee youth who have not been previously assessed for mental health problems suggests a need to understand specific cultural and other barriers and enabling factors related to the use of mental health services and access to care.”

Among all immigrants, recent arrivals had the highest proportion (64.3 per cent) of first contact in the emergency department, as did non-refugee immigrants from East Asia (61.7 per cent) and refugees from Africa (65.4 per cent), Central America (64.6 per cent) and East Asia (62.5 per cent).

Those who live in low-income and rural areas and those without OHIP coverage also had higher rates of first contact for mental health in the ER, said the report.

Source: Refugee and immigrant youth more likely to end up in ER during mental health crisis, study shows

Immigrants, fearing Trump crackdown, drop out of nutrition programs

Short-term reaction with longer-term health implications, just as the previous Canadian Conservative government’s cut to the interim federal health program had with respect to refugees (restored by the current government):

Immigrants are turning down government help to buy infant formula and healthy food for their young children because they’re afraid the Trump administration could bar them from getting a green card if they take federal aid.

Local health providers say they’ve received panicked phone calls from both documented and undocumented immigrant families demanding to be dropped from the rolls of WIC, a federal nutrition program aimed at pregnant women and children, after news reports that the White House is potentially planning to deny legal status to immigrants who’ve used public benefits. Agencies in at least 18 states say they’ve seen drops of up to 20 percent in enrollment, and they attribute the change largely to fears about the immigration policy.

The Trump administration hasn’t officially put the policy in place yet, but even without a formal rule, families are already being scared away from using services, health providers say.

“It’s a stealth regulation,” said Kathleen Campbell Walker, an immigration attorney at Dickinson Wright in El Paso, Texas. “It doesn’t really exist, but it’s being applied subliminally.”

Health advocates say the policy change could put more babies who are U.S.-born citizens at risk of low birth weight and other problems — undermining public health while also potentially fueling higher health care costs at taxpayer expense. WIC — formally the Special Supplemental Nutrition Program for Women, Infants, and Children — serves about half of all babies born in the U.S by providing vouchers or benefit cards so pregnant women and families with small children can buy staple foods and infant formula. The program is also designed to support women who are breastfeeding.

Because it benefits babies, the vast majority of whom are U.S.-born citizens, WIC is among the least politically controversial programs that the administration is said to be targeting in its crackdown.

“The big concern for all of us in the WIC community is that this program is really about growing healthy babies,” said Rev. Douglas Greenaway, president and CEO of the National WIC Association. “When any population that’s potential eligible for this program is either driven away by changes in regulation or legislation or simply by political rhetoric inducing fear there are huge personal consequences to those babies and their families.”

The White House did not respond to requests for comment.

The immigration proposal, which White House officials are working on ahead of the midterms as a way to energize the Republican base, would primarily affect legal immigrants already in the U.S. who are seeking a green card and people applying for legal admission to the U.S. It could also affect undocumented immigrants if they want to seek legal permanent residency in the future — a change that would represent a substantial expansion of the definition of public charge.

Under a provision known as public charge, U.S. immigration law has for more than a century allowed officials to reject admission to the country on the grounds that potential immigrants or visitors might become overly reliant on the government. But until now, officials have looked narrowly at whether someone would need cash benefits such as welfare or long-term institutional care. Immigration hawks in the Trump administration are pushing to consider would-be immigrants’ use of a much broader array of services, including non-cash assistance like food stamps, Head Start, Medicaid and WIC, according to versions of the proposed rule that were obtained by news organizations earlier this year.

Undocumented immigrants do not qualify for most government aid programs, but such an expansion of public charge could apply to the whole family. In the past, if a mom was applying for a green card her own use of public benefits might be examined. Under the proposed change, her child’s enrollment in Medicaid or Head Start would weighed as a negative factor, even if that child is a U.S. citizen.

Trump administration officials have argued that they are simply trying to clarify and enforce current immigration law.

“The goal is not to reduce immigration or in some diabolical fashion shut the door on people, family-based immigration, anything like that,” said Francis Cissna, director of U.S. Citizenship and Immigration Services, at the National Press Club earlier this month.

Cissna said the rule the administration is working on is “rational and reasonable” and will go through the full and “proper” regulatory process.

Enrollment in WIC has been going down for a variety of reasons as the economy has improved and the birth rates decline. When Trump took office there were approximately 7.4 million women and children in the program. As of May, the last month for which there is data, the number had dropped to 6.8 million.

Government officials aren’t able to track exactly how many people have dropped from WIC or declined the benefits because they’re afraid of the public charge rule, in part because the program is immigration blind. But providers say anecdotal evidence shows the proposal is contributing to the drop-off.

POLITICO interviewed more than a dozen WIC providers nationwide who serve tens of thousands of children from Washington state, Kansas and New York state. Almost all said they have seen immigrant mothers and their children drop from WIC, citing public charge concerns. They also said they’ve fielded inquiries about whether participating in WIC could put a family at risk of either deportation or at a disadvantage in immigration proceedings.

Jennifer Mejias-Martinez, who works on WIC at the Shawnee County Health Department in Topeka, Kan., recalled getting a call earlier this year from a family who’d seen a report on Univision about public benefits being a threat to immigration proceedings.

“They were very, very scared,” Mejias-Martinez said of the family. She said she tried to calm them down and assure that the policy had not changed, but they dropped from the program anyway. “It made me very sad, and quite frankly upset,” she said.

In some cases, immigration attorneys are recommending that families drop out of all government programs, including WIC, to avoid any chance that using the benefits could negatively affect their chances of getting a green card — or even prevent a family member from being able to get a visa to visit, according to caseworkers.

Public health and immigration advocates say they now find themselves debating the ethics of encouraging people to enroll in the program to improve their children’s health while there’s so much fear the benefits might one day jeopardize their ability to stay in the United States.

“Without a draft rule being released, we don’t think it’s wise to frighten people or tell them that they’re in the clear,” said Zach Hennessey, vice president of programs and services at Public Health Solutions, a large health non-profit in New York City.

The leaked version of the proposed rule suggests benefits used before the rule is final wouldn’t be used against an applicant.

Nearly two-thirds of WIC providers, from 18 different states, reported they have noticed a difference in immigrant WIC access in the wake of the news about potential changes in the public charge rules, according to a March survey by the National WIC Association. Seventeen of the agencies reported that participants had asked to dis-enroll or be deleted from WIC records.

An agency in Longview, Texas, reported it’s losing an estimated 75 to 90 participants per month to public charge fears. In Beacon, N.Y., an agency estimated it’s lost 20 percent of its caseload. In St. Louis, Mo., a provider said it’s seen a few dozen drop in the last year.

Public Health Solutions, the largest WIC provider in New York state, said WIC caseloads fell after press coverage of the proposed public charge changes. The non-profit said it saw more than six times the normal attrition rate after initial news reports about a potential executive order in the first quarter of 2017. The drop rate spiked again twice more in the wake of additional news reports about the coming proposed rule.

The group cautioned that the numbers don’t prove that public charge fears drove households from the program, but said that the unusually large declines appeared to correspond with the timing of the news reports.

The USDA, which oversees the WIC program, is conducting several studies to explore why eligible families are either not enrolling in WIC or discontinuing their participation, according to a spokesperson.

“The USDA is committed to the health and well-being of all WIC eligible mothers, infants and children and supports families seeking assistance,” a spokesperson said in a statement to POLITICO.

The department did not comment on whether officials are concerned about public charge fears driving participation down.

The drops in WIC enrollment stemming from public charge concerns come alongside broader fears about the Trump administration’s crackdown on both legal and illegal immigration.

Maria Isabel Rangel, a graduate student at the University of California, Berkeley, recently interviewed ten farmworker families in California whose households included both legal and undocumented immigrants. She said they described dealing with “constant anxiety,” even when they’ve decided to keep using programs like WIC, Medicaid and food stamps.

“They’re worried that their documentation status will be somehow be jeopardized by participating in these health programs,” Rangel said. “They say: ‘I can’t stop using these programs because my children need them, but I know I’m risking my future and the future of my children.’”

“They’re making these decisions basically based off fear,” she said.

WIC has been largely immigration-blind since it was created in 1974, most of the infants it serves are citizens born in the U.S. regardless of their parents’ immigration status. Despite that, providers say parents’ fear of deportation may also be driving declining enrollment in WIC.

False rumors that federal agents are planning to raid WIC clinics have circulated in immigrant communities, to the point that providers in places like King County, Wash. have posted signs designating their clinics as “private” areas and have statements on their websites that immigrants should access services “without fear.”

Aliya Haq, a nutrition supervisor at International Community Health Services, a large health non-profit in Washington state, recalled a terrified father calling in earlier this year asking that his wife be dropped from WIC, citing fears about getting deported.

“He was literally begging us requesting that we remove his family from the WIC program. … it was very heartbreaking,” Haq said.

The WIC program is broadly supported on both sides of the aisle because it’s been shown to lead to better health outcomes for mothers and babies, and pays dividends in savings to Medicaid. A 1988 USDA study found that for every dollar spent on WIC, there is between $1.77 and $3.13 in Medicaid savings for the infant and mother in the first 60 days after birth.

Rep. Roger Marshall, a conservative Kansas Republican who was an obstetrician before he ran for Congress in 2016, says the program is “crucial.” When he saw pregnant women during his three decades in practice, he said, “This nutrition helped prevent birth defects, led to healthier outcomes, and healthier infants.”

Marshall noted he hasn’t seen the changes the administration is considering. “I will stand beside WIC and say they’ve been a great use of federal dollars,” he said.

Even as they’re considering the proposed rule change, Trump officials have already begun enacting some new restrictions. In January, the State Department instructed embassies and consulates to look at potential use of nutrition and health benefits when deciding whom to admit to the U.S.

A spokesperson from the State Department said the changes “clarify current regulations and policy guidance.”

Immigration lawyers are watching very closely to see whether the updated guidance leads to more denials based on public charge grounds.

Immigrant advocates are expected to mount a court challenge if the expanded public charge rule is finalized, but public health advocates say the damage is already being done to women and families who are afraid to use WIC.

“One way or another society is going to pay for this,” said Hennessey of Public Health Solutions in New York City. “It’s very expensive for a baby in the NICU. It’s very expensive when a child’s developmental needs aren’t met, or there’s a severe maternal morbidity event.”

Source: Immigrants, fearing Trump crackdown, drop out of nutrition programs

Making The Case That Discrimination Is Bad For Your Health : NPR

Another in a good series of articles and studies on the impact of discrimination on health, this time on the concept of “weathering:”

When Arline Geronimus was a student at Princeton University in the late 1970s, she worked a part-time job at a school for pregnant teenagers in Trenton, N.J. She quickly noticed that the teenagers at that part-time job were suffering from chronic health conditions that her whiter, better-off Princeton classmates rarely experienced. Geronimus began to wonder: how much of the health problems that the young mothers in Trenton experienced were caused by the stresses of their environment?

It was later, during her graduate studies, that Geronimus came up with the term weathering — a metaphor, she thought, for what she saw happening to their bodies. She meant for weathering to evoke a sense of erosion by constant stress. But also, importantly, the ways that marginalized people and their communities coped with the drumbeat of big and small stressors that marked their lives.

At first, lots of folks in academic circles rolled their eyes at her coinage, arguing on panels and in newspapers that poor, black communities had worse health outcomes than better-off white communities because of unhealthy life choices, and immutable genetic differences. But as the science around genetics and stress physiology became better understood, Geronimus’ “weathering” hypothesis started picking up steam in wider circles.

We spoke to Geronimus, now a public health a public health researcher and professor at the University of Michigan’s Population Studies Center, on the latest episode of the Code Switch podcast about how weathering works, and why it took so long for people to come around to what Geronimus and other public health professionals had been saying for years. [This interview was edited for clarity and length.]

CS: Can we get into the science of weathering a little bit?

AG: There have been folk notions and laypeople have thought that health differences between populations — such as black versus white in the U.S. — were somehow related to differences in our DNA, that we were, in a sense, molecularly programmed to have this disease or that disease. But instead, social and environmental factors, can through what’s called DNA methylation, which occurs — I don’t know how technical you want to get — but that occurs when a group of molecules attach methyl groups to specific areas of a gene’s promoter region, and either prevent the reading of certain genes and sort of forms the gene’s product, and you have genetic expression of that gene. That’s a pretty powerful idea, and it sort of refutes the kind of more DNA-centric one, that you are destined by the literal DNA you have to have certain diseases or not.

But what I’ve seen over the years of my research and lifetime is that the stressors that impact people of color are chronic and repeated through their whole life course, and in fact may even be at their height in the young adult-through-middle-adult ages rather than in early life. And that increases a general health vulnerability — which is what weathering is.

I heard an interview with Emerald Snipes Garner, who was talking about the death of her beloved sister Erica. She used a metaphor that I think would also be a great description of weathering. She talked about the stresses that she felt led to Erica’s death at age twenty-seven as being like if you’re playing the game Jenga. They pull out one piece at a time, at a time, and another piece and another piece, until you sort of collapse. I’m paraphrasing her, but I thought that Jenga metaphor was very apt because you start losing pieces of your health and well-being, but you still try to go on as long as you can. Even if you’re disabled, even if it’s hard, that you have a certain tenacity and hope, and sense of collective responsibility whether that’s for your family or community. But there’s a point where enough pieces have been pulled out of you, that you can no longer withstand, and you collapse.

CS: When you coined the term weathering, there was a lot of pushback. Where was the locus of that pushback?

AG: There were actually several loci. Many in the medical community really seemed to think that there was just something intrinsic or genetic: that black-white differences in health must be [caused] by some hypertension gene. Or if it wasn’t a literal gene back in Africa, then maybe something about how hard theMiddle Passage was, that people who survived it had this gene for salt retention. It’s been very well debunked both on anthropological grounds but also on if you compare hypertension rates, for example, between American blacks and blacks in the Caribbean. The American blacks have far higher rates of hypertension, yet both [populations] went through the Middle Passage.

Others didn’t necessarily think in those terms, economists were thinking more behaviorally and sociologists sensed that there was an essential pathological culture that led to bad behaviors and weak families. And that was a very strong narrative in the ’70s, ’80s, and I think it’s a narrative that still exists [today], though more contested.

So this idea of weathering, and its metaphysical aspects, didn’t sound technical enough, and it didn’t fit any of those narratives.

GD: What was that like for you when people were dismissing your work?

AG: It was not fun! [laughs] It was very hard especially because some of them dismissed it very publicly. Another reason people dismissed it is that I first observed that young black women were more likely to have poor pregnancy outcomes if they were in their mid-twenties than if they were in their late teens. And this flew in the face of a lot of advocacy organizations that were working very hard to prevent teen childbearing. I think there was a Time magazine cover at one point that said, something like, “all social problems stem from teen childbearing.” [The cover story’s subhead read: “Teen pregnancies are corroding America’s social fabric.” — ed.] There was certainly a whole narrative that teen motherhood somehow caused perpetual poverty, lack of education, and poor birth outcomes. [But] the data spoke for themselves — that the risks were higher in black young women the later they waited to have children, and that was not true for whites. Whites, by comparison, had the lowest risks around their mid-twenties and the highest risk in their teens.

GD: And the rates were higher because the black women who waited just a few years later were more weathered.

AG: Exactly. The impacts on their bodies had been happening for a longer period of time.

So when did this concept of weathering start to gain more traction?

AG: It’s been two steps forward, one step back rather than there being a time when it gained traction. It was a hypothesis for me at first and then I started with colleagues doing studies to test it. As the years went by, we had more and more studies that seemed to be consistent with it.

In addition, I think the idea of stress — and not just, “I feel so stressed” but this broader sense of stress actually being this physiological process that impacts your health, or the strength of your various body systems — that became better understood sort of in the ’90s. A variety of neuro- endocrinologists at Rockefeller University, and Robert Sapolsky at Stanford talked about these stress reactions, what they do to your body and how they happen.

And I don’t want to sound cynical, but because it was about physiological reactions in human beings, discovered by, you know, two men — it was many more men, and it was women, too, but the two people who got, I think the most credit, and deservedly, were men who were lab scientists — it had more credibility in our society than talking about weathering and lived experience and racism.

GD: I want to go back to your Jenga metaphor. If weathering is this process by which the blocks are pulled away and your health becomes more and more tenuous, is there any way to put the blocks back?

AG: It’s hard to say. I certainly don’t believe that there isn’t anything that can be done. One thing that can be done and is done — and this benefits in particular people who are weathered but in the middle class or more highly educated — is access to healthcare. So you may be hypertensive from weathering but if you have good access to healthcare, you get diagnosed early, you get it treated. You learn what you need to do with your diet to make it a little less likely to turn into its more pernicious and life-threatening form. We’ve seen evidence, in some of our studies where we’ve compared blacks in very high-poverty areas to blacks in more middle-class neighborhoods, and what we’ve seen is that those in the higher-class neighborhoods do have much longer life expectancy than those in the poor neighborhoods. But they spend most of that extra life with chronic conditions and possibly disabled. Or, with a variety of morbidities than whites with the same incomes and educations, living in the same neighborhoods. So certainly, having a longer life expectancy and averting death and averting hypertension, or diabetes, or their complications are good things. But without dealing with the kind of more structurally rooted factors that lead to weathering across class, we’re not going to end weathering.

via Making The Case That Discrimination Is Bad For Your Health : Code Switch : NPR

Racism’s Chronic Stress Likely Contributes To Health Disparities, Scientists Say : NPR

Interesting series of studies and analyses:

A poll recently released by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that roughly a third of Latinos in America report they’ve experienced various kinds of discrimination in their lives based on ethnicity — including when applying for jobs, being paid or promoted equally, seeking housing or experiencing ethnic slurs or offensive comments or assumptions.

Amani Nuru-Jeter, a social epidemiologist at the University of California, Berkeley, is another researcher working to find out how, as she puts it, racism gets under the skin. “How does the lived and social experience of race turn into racial differences in health — into higher levels of Type 2 diabetes or cardiovascular disease or higher rates of infant mortality?”

For example, black children are about twice as likely as white children to develop asthma, health statistics suggest. And racial and ethnic gaps in infant mortality have persisted for as long as researchers have been collecting data. People with diabetes who are members of racial and ethnic minorities are more likely to have complications like kidney failure, or to require amputations.

Genetics might partially explain some of the differences, Nuru-Jeter says. Research has suggested that different populations may respond differently to some asthma drugs, for example.

“But it’s not an adequate explanation for the very persistent dramatic differences we see in health outcomes between racial groups,” she says. And public health researchers have found that health disparities remain even after they take into account any differences in income and education.

Nuru-Jeter and others hypothesize that chronic stress might be a key way racism contributes to health disparities. The idea is that the stress of experiencing discrimination over and over might wear you down physically over time.

For example, let’s go back to how Montenegro remembers feeling that night when strangers assumed he was a valet. He said he was “turning red,” his heart was “pounding.” Those are signs his body was feeling acutely stressed.

“When you start to worry about something, whether that’s race or something else, then that initiates a biological stress response,” says Nuru-Jeter.

Hormones like adrenaline and cortisol shoot up, readying your body to flee or fight. Those hormones can help you kick into action to escape a wild animal, for example, or to run after a bus. Under such circumstances, the ability to experience stress and quickly respond can be benign — and valuable.

Whatever the source of the perceived threat, the physical response — higher levels of stress hormones, a faster heart rate — usually subside once the threat has passed.

“That’s what we expect to happen,” says Nuru-Jeter.

But research suggests bad things happen when your body has to gear up for threats too often, consistently washing itself in stress hormones.

“Prolonged elevation [and] circulation of the stress hormones in our bodies can be very toxic and compromise our body’s ability to regulate key biological systems like our cardiovascular system, our inflammatory system, our neuroendocrine system,” Nuru-Jeter says. “It just gets us really out of whack and leaves us susceptible to a bunch of poor health outcomes.”

A number of small studies have documented similar stress reactions in response to racism, and even in response to the mere expectation of a racist encounter.

In studying black women, for example, she has found that chronic stress from frequent racist encounters is associated with chronic low-grade inflammation — a little like having a low fever all the time. Nuru-Jeter thinks it might be a sign that experiencing discrimination might dysregulate the body in a way that, over time, could put someone at a higher risk for a condition like heart disease.

Now, this kind of research is complicated. There’s no thermometer that measures degrees of racism, and it’s not like scientists can take a group of people, expose some of them to discrimination, and then see how they fare compared with others.

“Unless we could experimentally assign people to racist or nonracist experiences over a life course, we can’t make causal connections,” says Zaneta Thayer, a biological anthropologist at Dartmouth, who is currently looking into how discrimination experiences might influence multiple aspects of stress physiology, including cortisol and heart rate variability.

So, researchers find correlations, not causal links.

For example, Thayer studied 55 pregnant women in Auckland, New Zealand, and found that women who said they experienced discrimination had higher evening stress hormone levels late in pregnancy than other women who didn’t cite frequent discrimination. Another study, at Duke University, found that black students had higher levels of stress hormones after they heard reports of a violent, racist crime on campus.

The connection isn’t just with hormones. Other scientists have found correlations between discrimination and various measures of accelerated aging, including the tips of people’s chromosomes and subtle alterations in gene activity.

Individually, such studies are rarely conclusive, Thayer says. “There are always more questions to ask.”

But collectively, she says, they form a compelling picture of how discrimination, stress and poor health might be related.

And sometimes, in rare situations, researchers do get a slightly sharper glimpse of how such a connection may be playing out.

On May 12, 2008, about 900 agents with the U.S. Immigration and Customs Enforcement — including some who arrived in a couple of Black Hawk helicopters — raided a meat processing plant in Postville, Iowa. They were looking for people who were working illegally in the U.S.

“You could time exactly when it happened,” says Arline T. Geronimus, a behavioral scientist at the University of Michigan who has studied the event. “It was a surprise, and it was quite extreme.”

According to some witnesses, the agents handcuffed almost everyone they encountered who looked Latino. They ended up arresting more than a tenth of the town’s population, detaining many for days at a fairground.

According to Zoe Lofgren, a California representative who chaired a congressional hearing on the Postville raid, detainees were treated “like cattle.”

“The information suggests that the people charged were rounded up, herded into a cattle arena, prodded down a cattle chute, coerced into guilty pleas and then [sent] to federal prison,” Lofgren said at the hearing. “This looks and feels like a cattle auction, not a criminal prosecution in the United States of America.”

 The people arrested were charged with criminal fraud for knowingly working under false Social Security numbers, despite allegations of judicial misconduct and reportsthat few of the employees were actually guilty of that crime.

“People lost their jobs,” Geronimus says. “People were afraid to go home in case there would be raids in their homes. They were sleeping in church pews. Some fled the state.”

By all accounts, it was an extremely stressful event for the approximately 400 people who were arrested and their families.

But the event also sent ripples throughout the state. Apparently, as Geronimus and her colleagues reported this year in the International Journal of Epidemiology, it may even have affected the unborn children of some Iowa residents who were pregnant at the time.

In the months after the raid, Geronimus says, some Latina women living in Iowa started giving birth to slightly smaller babies.

The researchers looked at birth certificates of more than 52,000 babies born in Iowa, including those born in the nine months following the raid, and in the same nine-month period one and two years earlier. They found a small but noticeable increase in the percentage of babies who weighed less than 5 1/2 pounds — the definition of what pediatricians term low birth weight — born to Latina moms.

“Pregnant women of Latino descent throughout the state of Iowa — including those who were U.S. citizens, including those who were not right at Postville — experienced, on average, about a 24 percent greater risk of their babies having a low birth weight than they had in that very same period of time the previous year,” Geronimus says.

Before the raid, 4.7 percent of babies born to white moms were low birth weight. After the raid, that number dropped to 4.4 percent. Meanwhile, the percentage of babies with a low birth weight born to foreign-born Latina moms went up from 4.5 percent (76 babies) to 5.6 percent (98 babies). And it went up for the babies of U.S.-born Latina moms, too — from 5.3 percent (42 babies) to 6.4 percent (55 babies).

Overall, that’s a difference of just a few dozen children, each probably born just a few ounces underweight. But at that stage of life, a few ounces can make a difference, Geronimus says. Babies born small are at higher risk of dying in infancy and of having health and developmental problems later on.

“Low birth weight in general is not higher in the Latino population than in the white population,” Geronimus says. “And in Iowa it was not higher before the raid, and it was not higher years after the raid. But there is a spike that happens to be exactly when the raid was.”

And it’s worth noting, she says, that the effect even occurred among babies born to Latina moms who were U.S. citizens — people who shouldn’t have been worried about being arrested or deported.

“So why did it suddenly spike?” Geronimus asks. “Well, there’s a lot of research that suggests that stressful events during pregnancy can result in some complex immune, inflammatory and endocrine pathways and can increase the risk of low birth weight.”

She and her colleagues think the poor treatment of people who “looked Latino” to the immigration agents might have caused additional stress among women outside the immediate area of the raid who were pregnant around that time.

“People could begin to worry this could happen to them or to people they know or in their communities,” she says. “And those worries alone can activate these physiological stress responses, even if they never did have a raid in their own hometown.”

In fact, other researchers have noticed similar connections.

In the six months following the Sept. 11 attacks in the Eastern U.S., babies born in California to moms with Arabic-sounding names had a higher risk of being born small or preterm than observed in that group during the same time period the year before — a change that didn’t apply to other babies born in the state.

Both studies investigated the impacts of specific, dramatic events — and the results were consistent.

“You could time exactly when it happened,” says Geronimus. “We could measure before and after.”

But she views such events as merely slivers of insight into patterns that may quietly be happening on a much larger scale among many populations. Patterns that are harder to tease out and measure — like the effects of centuries of racism against black Americans, or a persistent series of incidents involving police brutality against minorities.

Maybe, Geronimus says, the cascade of stress that such events initiate sets the stage for health disparities in a generation of children — before they even enter the world.

via Racism’s Chronic Stress Likely Contributes To Health Disparities, Scientists Say : Shots – Health News : NPR

Dalhousie medical school struggling to attract black and Indigenous students

Review of systemic barriers and ways to address them. The chart above shows the visible minority breakdown for the Atlantic provinces – for Nova Scotia, the NHS shows 50 Black Canadians out of some 3,400 working in doctors’ officers (1.5 percent):

Dalhousie University’s medical school is struggling to attract African-Canadian and Indigenous students, and its admission process is partly to blame, a review committee has found.

The committee’s 12-page report was submitted last August to the medical school’s dean, Dr. David Anderson, but it was just recently made public.

“The committee speculates that potential candidates from diverse backgrounds might not apply because of an apprehension of bias against them within the admissions process,” said the report.

Both African-Canadian and Indigenous people are under-represented in the medical profession, said the chair of the review committee, Dr. Gus Grant. He’s also the registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, the body that regulates and licenses doctors in the province.

“I think it’s important that the profession be made up of individuals who represent the communities that are being served,” said Grant.

No figures are available on the number of black and Indigenous doctors practising in Nova Scotia because the college does not ask doctors to self-identify by race.

Last year, Anderson ordered the independent external review of the admissions process in part because of the lack of diversity. The last such review was done a decade ago.

Too much weight given to admission exam

The report also found the admissions committee placed too much weight on the medical college admission test (MCAT) scores and the grade-point average of candidates.

Grant said that while cognitive ability is important for practising medicine, grade-point average and MCAT results aren’t great measures of it.

“Cognitive ability is important for physicians, but I can’t fairly say that it’s more important than empathy, reliability, consistency, earnestness and other characteristics,” said Grant.

Starting in 2018, the medical school will use an online video-based tool to assess potential students for empathy, integrity, resiliency and communication skills.

Grant said it’s been long accepted that standardized tests like MCATs put minorities and people from lower socio-economic backgrounds at a disadvantage and they score lower on these exams. One reason Grant gave is that poorer applicants might not be able to afford to take MCAT preparatory courses.

Recommendations from report

Some of the report’s recommendations were to:

  • Institute a minimum requirement for test scores.
  • Require the 22-member admission’s committee to include gender-diverse representatives of the African-Canadian and Indigenous communities, while also collaborating with these two communities to determine admission criteria.

The first requirement has not yet changed, but the second one has been implemented.

More diversity needed in health-care system

Sharon Davis-Murdoch is co-president of the Health Association of African Canadians, a group that promotes health in the black community. She said for young children of African descent to see themselves in health professions, they need to be aware a career in the field is possible.

“The representation of people of African descent at every level of the health system, including the highest levels of health administration, needs to be in place in order for the system to be improved, for the system to serve appropriately and for the system to be reflective of all of us,” said Davis-Murdoch.

Source: Dalhousie medical school struggling to attract black and Indigenous students – Nova Scotia – CBC News

Doctor Tells A Personal Tale Of Racial Disparity In Organ Transplants : Shots – Health News : NPR

Yet another example of biases at work:

While she was a primary care doctor in Oakland, Calif., Dr. Vanessa Grubbsfell in love with a man who had been living with kidney disease since he was a teenager.

Their relationship brought Grubbs face to face with the dilemmas of kidney transplantation — and the racial biases she found to be embedded in the way donated kidneys are allocated. Robert Phillips, who eventually became her husband, had waited years for a transplant; Grubbs ended up donating one of her own kidneys to him. And along the way she found a new calling as a nephrologist — a kidney doctor.

Her candid new memoir, Hundreds of Interlaced Fingers: A Kidney Doctor’s Search for the Perfect Match, explores her personal story and some troubling statistics. Roughly 1 in 3 of the candidates awaiting kidney transplants are African American, Grubbs learned, but they receive only about 1 in 5 of all donated kidneys. White people account for about a third of the candidates awaiting kidney transplants, but they receive every other donated kidney.

Grubbs writes of accompanying Phillips in 2004 to meet with members of the transplantation team — including a doctor, a nurse and a financial counselor — for a routine evaluation and update. After being on the waiting list for a kidney for five years, he had neared the top of the list.

“We sat in a clinic exam room listening to a series of people whose job it seemed was to talk Robert out of even wanting a transplant,” Grubbs writes. Such meetings may be meant to make sure patients understand the difficult realities of organ transplantation, she says, but, “… the message we took away was, ‘The kidney transplant system doesn’t like black people.’ ”

Grubbs, now a nephrologist at the Zuckerberg San Francisco General Hospital, and assistant professor at the University of California, San Francisco, recently sat down to talk about her experience with NPR.

Interview Highlights

One of the things you write about in the book is that your colleagues did not appreciate that you published a piece in a health policy magazine — Health Affairs — [detailing the inequities in transplantation]. It was called “Good for Harvest, Bad for Planting.” In fact, you got a lot of blowback that you were not expecting.

You know, I’m from a tiny little town in North Carolina, so maybe I was a bit naïve. Because I honestly thought that people would read this piece from a doctor being surprised at how the system was set up, and that they would take a look at it and be reflective and think about what they might be able to do to make the system at least seem more equitable to people on the outside. But clearly that was a naïve thought, because what ended up happening was that people who were very close to the issue became very angry, and they took it personally.

Why do you think that was?

Many doctors can acknowledge that there are race disparities in health care, that people of color do worse across many areas than white people. But I think most of us tend to think that somebody else is responsible for it. So for them, it meant that I was pointing the finger at them. And I think the unfortunate thing that we tend to do is, when we are associated with a bad thing, we spend our time trying to disassociate ourselves from that bad thing, rather than spending our energy in acknowledging that this is a bad thing and we should all work together to try to make it better.

How Prejudice Can Harm Your Health – The New York Times

Good and revealing article by Khullar:

Long before the Rev. Dr. Martin Luther King declared health inequity the most shocking and inhumane form of injustice, W.E.B. Du Bois wrote that “the Negro death rate and sickness are largely matters of condition and not due to racial traits and tendencies.” Before Du Bois made his case, James McCune Smith — the nation’s first black doctor — carefully detailed the health consequences of freedom and oppression.

These men grasped an insight that modern researchers and policy makers often fail to make explicit: Discrimination, especially when chronic, harms the body and the mind. How we treat one another, and how our institutions treat us, affects how long and how well we live.

We tend to think of discrimination as a moral or legal issue, and perhaps, in the case of immigration, an economic one. But it’s also a medical issue with important public health consequences. A growing body of evidence suggests that racial and sexual discrimination is toxic to the cells, organs and minds of those who experience it.

Research suggests that discrimination is internalized over a lifetime, and linked to a variety of poor health markers and outcomes: more inflammation and worse sleep; smaller babies and higher infant death rates; a greater risk of cancer, depression and substance use. The cumulative burden of discrimination is linked to higher rates of hypertension and more severe narrowing of important arteries in the heart and neck. Even the telomeres at the end of our chromosomes, which act as a sort of timer for aging cells, can shorten.

Discrimination, of course, is only part of the health equation. Individuals are not doomed to disease because of their circumstances. Health and illness are the result of a complex interplay between genetics, behavior and environmental conditions. But experiencing persistent bias can tip the scale.

In one study, researchers asked black women to complete questionnaires on how often they experienced minor “everyday” discrimination, as well as major instances of unfair treatment in housing, employment or with the police. They then followed the women for six years, and found that those who had reported more frequent discrimination were more likely to develop breast cancer. The more pervasive the reported discrimination, the higher their risk.

This remained true even after adjusting for more than a dozen other factors like family history, education level, physical activity and use of hormonal supplements or oral contraceptives. Similar work has found that discrimination is a strong predictor of lower back pain in black patients — but not in white patients, who were less likely to report discrimination and for whom discrimination was unrelated to pain.

Those who endure chronic discrimination not only experience more stress, but may also process it differently. To test this theory, researchers used surveys to assess the extent of lifetime discrimination that black and white patients had experienced. They then injected patients with phenylephrine (a chemical similar to adrenaline) and found that black patients had a larger temporary increase in blood pressure than white patients. Those who had experienced more discrimination had the largest rise of all.

These effects start early. By fifth grade, black and Hispanic children are already more than twice as likely as white students to say they’ve experienced discrimination at school. (About 7 percent of white children also reported discrimination, and online bullying is a growing problem for students of all backgrounds.)

Children who experience discrimination have higher rates of depression, A.D.H.D. and other behavioral problems. And teenagers who endure more discrimination — racial slurs, physical threats, disrespectful behavior, false accusations — are more likely to have disrupted cortisol levels, elevated blood pressure and higher body mass index years later.

Most studies have focused on the health effects of what researchers call interpersonal discrimination, including harassment, “micro-aggressions” or even just the anticipation of prejudice. But an emerging literature is also exploring the role of structural discrimination — the social and economic policies that systematically put certain groups at a disadvantage.

Researchers have tried to calculate structural bias by using racial differences in four domains — political participation, educational achievement, employment and incarceration. Blacks, for example, are 12 times more likely to be imprisoned than whites in Wisconsin, but only twice as likely in Hawaii. In Arkansas, the unemployment rate for blacks is 3.6 times higher than for whites; in Delaware, they’re employed at similar rates.

These unequal social conditions foster unequal health outcomes. Blacks in states high in structural discrimination are more likely to have heart attacks than blacks in low-discrimination states, and black women are more likely to give birth to babies too small for their gestational age. (Data is mixed on whether whites in these states do better or worse.)

In a revealing study of historical data, researchers found that before the abolition of Jim Crow laws, the black infant death rate was nearly 20 percent higher in Jim Crow states versus non-Jim Crow states. This disparity declined sharply after the Civil Rights Act of 1964, such that the gap had essentially closed a decade later. Still, the caustic effects of segregation persist: Blacks in segregated neighborhoods remain at higher risk for hypertension, chronic disease, violence and exposure to environmental pollutants.

Research is also identifying harmful inequities for white Americans along geographic and socioeconomic lines. Whites living in rural areas, compared with those in metropolitan centers, now contend with many of the same structural challenges that worsen health: less education, lower incomes, higher unemployment rates and poorer access to medical care. They increasingly feel that they, too, face significant discrimination. In some counties in the Midwest and South, the death rate for white women in their 40s has doubled since 2000.

Other work has found that gays and bisexuals living in states that institute policies restricting their rights — like same-sex marriage bans or lack of workplace protections — are more likely to develop depression, anxiety and substance use disorders. And a recent studysuggests that the Deferred Action for Childhood Arrivals program, or DACA, conferred large mental health benefits to eligible Hispanic adults, who were nearly 50 percent less likely to report symptoms of major depression compared with noneligible people at risk of being deported.

As important as specific policies may be, the general social and political climate probably has broader and longer-lasting effects. Even if they haven’t experienced bias themselves, members of minority groups may develop a hyperawareness for cues of mistreatment, and this sustained vigilance can lead to chronic stress, mood problems and poorer health outcomes. For example, amid a sharp rise in anti-Arab sentiment after the Sept. 11 attacks, women with Arabic names — but not other women — had an increased risk of preterm birth and low-birth weight babies.

If Dr. King’s moral arc does in fact bend toward justice, it still has a long way to go. When people are marginalized, even unintentionally, it inflicts a toll. Discrimination raises many moral concerns — but also, it seems, many medical ones.