Trudeau, Ontario health minister say they’re looking at collecting race-based pandemic data

Long overdue. But this needs to be national in scope, with consistent definitions and practices across all provinces and publicly available through CIHI (Quebec will predictably not play along, unfortunately):

The federal and Ontario governments say they’re now working toward collecting race-based health data as part of their response to the COVID-19 pandemic.

Human rights commissions from across Canada have added their voices to those of municipalities, health advocates and elected officials calling for the collection of raced-based COVID-19 data to ensure that vulnerable groups are protected.

“Colour-blind approaches to health only serve to worsen health outcomes for black, Indigenous and racialized people because we can’t address what we can’t see,” said B.C.’s Human Rights Commissioner Kasari Govender.

Federal, provincial and territorial human rights commissions say that collecting pandemic data without breakdowns by race leaves public health officials with no window into COVID-19’s impact on vulnerable populations.Earlier today, both the federal and Ontario governments said that while they typically do not collect race-based health data, they are working on plans to start doing so now.

Prime Minister Justin Trudeau says the government has invested millions of dollars towards improving the collection of race-based data. 2:17

“We recognize that there have long been challenges in Canada about collecting disaggregated data … which is why a number of years ago, we invested millions of dollars towards Statistics Canada to start improving our ability to collect race-based data,” Prime Minister Justin Trudeau said Friday in Ottawa.

“We’ve flowed greater funding to community organizations and grassroots organizations that are helping out people who we already know to be more vulnerable and marginalized … But yes, we need to do a much better job around disaggregated data and that’s something that we’re going to do.”

Ontario Health Minister Christine Elliott said that local health agencies in the province can collect race-based data legally now, should they choose to do so, providing they respect privacy and confidentiality.

‘We haven’t traditionally collected race-based data in health but there are a number of organizations that have come to us to ask us to do that,” Elliott said.’We are working with the anti-racism directorate to set up a broader framework in order to collect that in a meaningful way. It is something that we are working on as an active project.”

Ontario Health Minister Christine Elliott says that while her province has not traditionally collected race-based health data, it is working on a plan to start. 0:41

Canada does not collect race-based pandemic data. Both the United States and the United Kingdom have started doing so.

Earlier this week, Toronto City Council called on provincial health authorities to begin collecting province-wide data on COVID-19 cases, broken down by race, occupation and other “socioeconomic factors.”

“The old adage of ‘what gets measured gets done’ is especially relevant right now. In order to tackle COVID-19, we must fully understand it and who is most at risk,” Toronto City Coun. Joe Cressy said in a media statement.

“Toronto’s data has shown that while we’re all susceptible to the virus, parts of the city are more impacted than others. In order to protect our residents and beat COVID-19, we need the Ontario Government to collect and share disaggregated data.”

Basic data not collected: Trudeau

One of Canada’s leading experts on the social causes of disease told CBC Radio’s The House last week that Canada’s failure to collect race-based data on COVID-19 infections amounts to discrimination by “neglect.”

“Discrimination is not necessarily about what you do. It’s often about what you don’t do,” said Dr. Kwame McKenzie, a psychiatry professor at the University of Toronto and CEO of the Wellesley Institute, a think tank that studies urban health issues.

“It’s not about people being actively discriminatory or racist. It’s sometimes about just neglect,” he said. “And the fact that we haven’t collected this data seems neglectful, because everybody really knew we should be collecting these data but it was never at the top of anybody’s list of things to do.”

Liberal MPP Mitzie Hunter, who represents the provincial riding of Scarborough-Guildwood, said the lack of information about who is getting the virus now, and who is most in danger of getting sick, puts people in her community at greater risk.

“One of the weaknesses in the Ontario Public Health Response is the lack of the collection of disaggregated data based on race and other demographic profiles that could help track the progress of this virus by individuals, where they work, where they live and income levels,” she told The House last week.

“All of those factors … could help to save lives.”NDP Leader Jagmeet Singh also has called for the collection of race-based data to improve health outcomes for vulnerable groups.

“We need to make sure we have the data, that there is race-based data that allows us to make the evidence-based decision making to remedy these injustices,” Singh told the House of Commons earlier this week.

On Friday, Trudeau admitted that during the early days of the COVID-19 outbreak, public health officials were not always collecting basic demographic information, such as age and gender.

“We know we need to do much better to properly understand where things are hitting hardest in this COVID-19 crisis,” he said.

Source: Trudeau, Ontario health minister say they’re looking at collecting race-based pandemic data

Health agency reveals race-based data guideline as calls grow for nation-wide collection

Yes!

Will take some time given the coordination required to ensure consistent data across provinces, with Quebec unlikely to play ball unfortunately (CIHI data does not automatically include Quebec data. When I asked the Ministère de la Santé et des Services sociaux for the comparable birth tourism (non-resident) birth statistics, I was met by bureaucratic obfuscation and had to go to major hospitals directly):

In response to calls for better demographic data to understand health inequities and COVID-19, this week the Canadian Institute for Health Information is releasing an interim race data standard that public health agencies can use.

Many advocates, though, are pushing for more than advice, saying the federal government has a leadership role to play to ensure there’s consistent data, regardless of jurisdiction. That gap in information affects the provincial, territorial, and federal response to the pandemic and until the country moves forward with race-based and disaggregated income data, Canada “can’t possibly target resources” and care where they’re most needed, said Dr. Jennifer Rayner, an epidemiologist and director of research at the Alliance for Healthier Communities.

“It’s ignorance and blindness to where there’s gross inequities. Until we know where the discrepancies and inequities in health are, we can never tackle them,” she said, saying communities need action and the work needs to start somewhere. “I hate to keep waiting until we get it all perfect.”

The alliance is part of a national working table headed by Canadian Institute for Health Information (CIHI)—which the institute notes are not formal—that’s considering two things: what data to collect, and how to train health professionals so they’re comfortable asking these questions. While this work has been going on for years, the report on the interim standard noted a “heightened awareness and interest” in collecting such data to better understand COVID-19’s spread.

The lack of data on race in Canada makes it difficult to monitor racial health inequalities and CIHI’s interim standard was created in an effort to “harmonize and facilitate collection of high-quality data,” according to a copy shared with The Hill Times of the standard, “Race-Based Data Collection and Health Reporting,” to be released later this week.

It proposed two questions asking patients to identify their race categories (also giving the option of “prefer not to answer”) and whether they identify as First Nations, Inuit, or Métis.

Though the Public Health Agency of Canada (PHAC) has said it is looking into the possibility of collecting more demographic data related to COVID, most said it’s a matter of political will, under the direction of Health Minister Patty Hajdu (Thunder Bay-Superior North, Ont.) and Indigenous Services Minister Marc Miller (Ville-Marie–Le Sud-Ouest–Île-des-Soeurs, Que.).

When asked, neither of the ministers’ offices, the PHAC, or CIHI offered a position on whether such data should be collected nation wide.

However, Ms. Hajdu’s spokesperson, Cole Davidson, said in an email that “[d]emographic data collection and data sharing between the federal and provincial/territorial governments is crucial to advancing our knowledge of COVID-19 and understanding potential inequalities in our health care system. We’re working with provinces and territories to ensure we’re collecting the data we need to better understand this pandemic.”

And while these conversations are happening, advocates say it’s not leading to the outcome that is becoming more urgent by the day—a commitment and timeframe for nationwide data collection.

“As a national strategy, if you don’t value gathering the data it’s hard to motivate other places to do so,” said Aimée-Angélique Bouka, the College of Family Physicians of Canada vice-chair-elect for residents. “You’ll see disparity across the board if you don’t see proper federal leadership in the project.”

‘It’s all about political will’

Canada has a blind spot regarding its treatment of racialized groups and immigrants, despite the evidence, she said.

COVID-19 was thought to be “the grand equalizer,” but some populations have proved more vulnerable. In the United States, by mid-April nearly one-third of those who died were African American, an Associated Press report revealed, though Black people represent about 14 per cent of the population where they reported. Such disparities exist in Canada, though Dr. Bouka said society is uncomfortable with painful questions that reveal a pattern of neglect.

“COVID is only a snapshot and a clear representation of what happens in our country in a systematic way.”

She said she would add a question about immigrant status, and how long a person has been in Canada as other important markers that influence health, said Dr. Bouka, who wrote about that blind spot for Policy Optionsthis month.

Because we don’t have this self awareness we are slow to accept it, but once the outbreaks became evident, demographics became impossible to ignore, she said.

For more than two decades, Independent Senator Wanda Thomas Bernard has been calling for race-based data collection.

“It’s so frustrating and infuriating,” said Sen. Bernard (East Preston, N.S.), a former social worker and researcher who co-authored a 2010 book, Race and Well-Being, which she said demonstrated racism is an everyday experience for Black Canadians and has an impact on all forms of their health.

“I can’t help but ask myself, ‘How many more casualties do we have to see before there’s a true appreciation for why the collection of this data across all provinces and territories [is] essential?’”

Sen. Bernard said she has been asking these questions of Liberal ministers and their aides—she’s not comfortable divulging the details of these conversations—and while she remains hopeful, she said it’s “all the more urgent to make the decision now.”

“We need to be on the same page with this, and let’s cut through the politics,” she said, and look at COVID-19 as a starting point, an “awakening” for the inequities in health that long predated the pandemic.

Unfortunately, it takes more than proof to shift policy, said Dr. Bouka and it becomes about building more evidence and raising enough voices to make inaction impossible.

“It’s mostly us being reminded so politicians can’t ignore it. Ultimately, it’s all about political will. If your weaknesses are shown repeatedly, then you can’t just pretend that you didn’t know,” she said.

Though it’s left up to the individual jurisdictions, Sen. Bernard said it’s important to have data that’s consistent across the country, which requires leadership so that it is collected in the same way.

Alex Maheux, CIHI spokesman said by email it’s up to the provinces and territories to decide how to proceed, but it has expressed willingness to support jurisdictions in that data collection and is currently working with partners to understand race and ethnicity data needs.

Earlier this month, Manitoba became the first province to track the ethnicity of COVID-19 patients while Quebec and Ontario have said they will as well. At a local level, Toronto has also said it tracks demographics.

In mid-July, CIHI said it will also publish a broader discussion document, followed by ongoing engagement with relevant stakeholders to “refine” the standard, if needed.

Public Health Agency of Canada spokesperson Maryse Durette said by email the government is committed to working with the provinces and territories—as well as other partners—to improve data completeness and access, including demographic information.

“These indicators will help to further our understanding of COVID-19 among different population subgroups and to monitor trends going forward,” she said, and it plays “a critical role” in helping to understand disease severity and risk factors, to monitor trends over time, and to ensure that public health measures can be effectively designed and delivered where needed.”

Data collection on Indigenous people ‘distinct’

CIHI’s standard notes that though Indigenous groups are often considered alongside racial and ethnic categories, First Nations, Inuit, and Métis have “inherent and collective rights to self-determination,” including ownership and governance of their data. That warrants “distinct consideration” and must include engagement with Indigenous communities and data governance agreements.

Canada tracks on-reserve cases of the coronavirus, but with nearly half of First Nations living off-reserve, the picture is incomplete. Yellowhead Institute independently researched, and on May 12 published findings revealing more than triple the cases reported by Indigenous Services Canada. Mr. Miller has acknowledged the department’s data is insufficientand on May 9 announced $250,000 towards improving data collection—not enough, according to Yellowhead researcher Courtney Skye.

“If we’re going to recognize First Nations, Indigenous, and Inuit are more impacted and more at risk for poor outcomes because of COVID-19, there needs to be a multi-jurisdictional prioritization of getting proper information available to communities to make informed decisions,” she said.

“Communities have a right to that information and the federal government has a fiduciary responsibility to make sure this work is adequately funded.”

Rose LeMay, CEO of the Indigenous Reconciliation Group and regular Hill Timescolumnist, penned a plea in April for COVID-19 data that notes background and Indigeneity. A month later, she said she remains baffled there’s been limited movement to close the data gap.

“This is a once-in-a-lifetime data dump, if we were to access it, because this shows the inequities of the system”, she said, noting Canada has “substantial work” to build trust given its problematic history collecting information on Indigenous people, and declaring who is and isn’t status.

That could be addressed by involving organizations perceived as objective to lead the way alongside Indigenous groups, and would likely require building new partnerships to do it well.

The lack of trust shouldn’t stop this work from happening, she said, adding the “how” is a “purely technical exercise” that she said she thinks Canada’s health-care system is capable of managing.

Ms. Skye said the patchwork approach isn’t working and it needs to be led by Indigenous people and be properly resourced. She added that this is another indication that the Liberal government’s approach to reconciliation is more for “show” than addressing “tangible barriers,” like health, that impact the daily lives of Indigenous people.

“These realities are known, are well-documented, and have existed for a long time, and there hasn’t been enough of the practical work done on behalf of the federal government and provinces,” she said. “It does come down to the will of the government.”

Source: Health agency reveals race-based data guideline as calls grow for nation-wide collection 

Who’s Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

More on disparities in health outcomes:

As data emerges on the spectrum of symptoms caused by COVID-19, it’s clear that people with chronic health conditions are being hit harder.

While many people experience mild illness, 89% of people with COVID-19 who were sick enough to be hospitalized had at least one chronic condition. About half had high blood pressure and obesity, according to data from the Centers for Disease Control and Prevention. And about a third had diabetes and a third had cardiovascular disease. So, what explains this?

“Obesity is a marker for a number of other problems,” explains Dr. Aaron Carroll, a public health researcher at the Indiana University School of Medicine. It’s increasingly common for those who develop obesity to develop diabetes and other conditions, as well. So, one reason COVID-19 is taking its toll on people who have obesity is that their overall health is often compromised.

But does obesity specifically affect the immune system? Perhaps.

Prior research has shown that people with obesity are less protected by the flu vaccine. They tend to get sicker from the respiratory disease even if they’ve been immunized. In fact, researchers have found that as people gain excess weight, their metabolism changes and this shift can make the immune system less effective at fighting off viruses.

“What we see with obesity is that these [immune] cells don’t function as well,’ says Melinda Beck, a health researcher at University of North Carolina, Chapel Hill. Basically, she explains, obesity throws off the fuel sources that immune cells need to function. “The [immune cells] are not using the right kinds of fuels,” Beck says. And, as a result, the condition of obesity seems to “impair that critical immune response [needed] to deal with either the virus infection or [the ability] to make a robust response to a vaccine.”

So this is one explanation as to why people with obesity seem more vulnerable to serious infection. But, there are many more questions about why some people are hit harder, including whether race is a factor.

The CDC found that 33% of people who’ve been hospitalized with COVID-19 are African American, yet only 13% of the U.S. population is African American. Some local communities have found a similar pattern in their data. Among the many (26) states reporting racial data on COVID-19, blacks account for 34% of COVID deaths, according to research from Johns Hopkins University.

This disproportionate toll can be partially explained by the fact that there’s a higher prevalence of obesity, high blood pressure and diabetes among African Americans compared with whites.

And as Dr. Anthony Fauci of the National Institutes of Health said last week at a White House coronavirus task force briefing, this crisis “is shining a bright light on how unacceptable that is, because yet again, when you have a situation like the coronavirus, [African Americans] are suffering disproportionately.”

There are several factors, including some genetic ones, that may make African Americans more vulnerable to COVID-19. There have been a few studies that have pointed to African Americans potentially having genetic risk factors that make them more salt-sensitive,” says Renã Robinson, a professor of chemistry who researches chronic disease at Vanderbilt University. This may increase the likelihood of high blood pressure, which, in turn, is linked to more serious forms of COVID-19. “It could be a contributing factor,” she says, but there are likely multiple causes at play.

Another issue to consider, she says, may be high stress levels. She says when a person experiences racial discrimination, it can contribute to chronic stress. She points to several studies that link discrimination and stress to higher levels of inflammationamong black adults. “And chronic stress can make one more vulnerable to infection because it can lower your body’s ability to fight off an infection,” she says.

Chronic stress is linked to poverty — so this could be a risk factor for low-income communities. In fact, research has shown that people who report higher levels of stress are more likely to catch a cold, when exposed to a virus, compared with people who are not stressed.

According to a new survey from Pew Research Center, health concerns about COVID-19 are much higher among Hispanics and blacks in the U.S. While 18% of white adults say they’re “very concerned” that they will get COVID-19 and require hospitalization, 43% of Hispanic respondents and 31% of black adults say they’re “very concerned” about that happening.

And other aspects of structural racism could contribute to the elevated risk for black Americans.

“Every major crisis or catastrophe hits the most vulnerable communities the hardest,” say Marc Morial, president and CEO of the National Urban League. And he points to several factors that help to explain the racial divide.

“Black workers are more likely to hold the kinds of jobs that cannot be done from home,” Morial says. So, they may be more likely to be exposed to the virus, if they are working in places where it’s difficult to maintain social distancing. In addition, he points to longstanding inequities in access to quality care.

“There also is bias among health care workers, institutions and systems that results in black patients … receiving fewer medical procedures and poorer-quality medical care than white individuals,” he says. He says an expansion of Medicaid into those states that still haven’t expanded would be one effective policy to address these inequities.

The characteristics of the communities where people live could affect risk, too especially for those who live in low-income neighborhoods. The roots of chronic illness stem from the way people live and the choices that may or may not be available to them. People who develop the chronic illnesses that put them at higher risk of COVID-19 often lack access to affordable and healthy foods or live in neighborhoods where it’s not safe to play or exercise outside.

“Let’s take a patient with diabetes for example. They are already at high risk for COVID-19 by having a chronic condition,” says Joseph Valenti, a physician in Denton, Texas, who promotes awareness of the social determinants of health through his work with the Physicians Foundation.

“If they also live in a food desert, they have to put themselves in greater risk if they want access to healthy food. They may need to take a bus, with people that have COVID-19 but aren’t showing symptoms, to get access to nutritious food or even their insulin prescription,” he says.

Poor nutrition, and the obesity linked to it, is a leading cause of premature death around the globe. And, this pandemic brings into focus the vulnerability of the millions of people living with lifestyle-related, chronic disease.

“We’re seeing the convergence of chronic disease with an infection,” says UNC’s Beck. And the data suggest that the combination of these two can lead to more serious illness. “We’re seeing that obesity can have a great influence on infection,” she says.

So, will this shine a spotlight on the need to address these issues? “Hopefully,” Beck says. “I think paying attention to these chronic diseases like obesity is in everybody’s best interest.”

Source: Who’s Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

Paradkar: Unlike Canadians, Americans at least know how Black people are faring with COVID-19 (very badly)

Agreed but not only a Black issue.

Need better health data on all visible minority groups (and Indigenous) given that poorer health outcomes generally go hand-in-hand with more vulnerable socioeconomic outcomes:

“Let me rant,” said Angela Robertson, “because you’ve sparked me.”

As executive director of the Parkdale Queen West Community Health Centre, Robertson has long been a front-line witness to the lives of the most marginalized in the city — the homeless, the undocumented, the working poor — all of whom are also disproportionately racialized.

We are discussing the horrendous data streaming from the U.S. on the rates at which COVID-19 is infecting and killing Black people. In Chicago, African-Americans account for 70 per cent of the 86 recorded deaths, but make up 29 per cent of the city’s population. Louisiana saw the same 70 per cent of deaths among African-Americans who constitute just 32 per cent of the population.

What about Black people in Canada, I ask her. Are they better off here compared to the U.S because of universal health care and because — here I wave the red flag — Canada is not as bad as the U.S.?

“As much as we have critiques of the health-care system in America, they have done data collection, they can disaggregate by race within health care,” she said.

“We in Canada have been glacial in our movement in the collection of race-based data in our health-care system. As a result we will not be able to identify the disproportional access challenges, deaths, illnesses that Black communities will experience as a result of COVID-19.

“My fear is that the real health impact on Black community will be hidden.”

COVID-19’s impact on Black people is highlighting the similarities and differences between the U.S. and Canada. They collect data. We don’t. We have universal health care. They don’t. But underlying structures in both nations are deeply racist, which means Black people on both sides of the border live in circumstances that leave them more vulnerable to illnesses at the best of times — and now make them susceptible to the ravages of the pandemic.

These structures are unleashing what the American author and anti-racism scholar Ibram X. Kendi called “a racial pandemic with the viral pandemic.”

Last Friday, Black health leaders in Toronto released a statement that identified the underlying risk factors that COVID-19 would amplify. “Ontario is home to the largest proportion of Black people in Canada. Here too, as in the rest of Canada, race is a determinant of health,” they said.

Who are the people who still need to use public transport to get to work? Who hold precarious jobs? Who don’t have the luxury to shelter at home and buy healthy provisions for a week or two? Who need rent relief? Who are most at risk from higher policing on the streets? Who are at risk in the prison system?

While race-based data exists around these social factors, hospitals and clinics don’t collect detailed demographic data including race as a matter of routine. Advocates have long railed against this lack of data, calling it harmful to Black women after research found they may be underscreened for breast and cervical cancer.

Andrew Pinto is a doctor at St. Michael’s Hospital. He is also the director of the hospital’s Upstream Lab — a research group that looks at interventions or remedies to the socio-economic factors that affect health.

The St. Michael’s Hospital Family Health Team, and other groups in Toronto including Toronto Public Health, was part of a pilot program to ask patients questions on income, race, gender, housing, religion, etc., and then use this data to identify health inequities, Pinto said. Researchers found doing such a survey was “feasible and acceptable.”

“Social factors are definitely associated with health outcomes,” he said. Many studies show income and race play a big role. “We lack the data that we need in Canada to really be able to pinpoint inequity by race. That’s what our work is trying to move toward.”

Why do we need the data if we know discrimination already exists? “Data helps with accountability. It’s not just to document inequity. We need to anticipate the inequity and think about how do we hold our systems to account.”

On the plus side of the ledger against the U.S, Canada has universal health care. Even then there are gaps.

While Ontario advocates who campaigned under OHIP For All managed to open health care for people regardless of their immigration status, “what we are concerned about while policy has changed, practices on the ground have not changed,” Robertson said.

Even during the pandemic, Robertson heard reports of people turning up in emergency departments and being asked to pay $500 for treatment.

What about the people who don’t turn to agencies for support? “For folks who because of fear walk away, they walk away ill,” she said.

Pinto points out that the “danger of data collection is it can convey that something is being done. Data alone is not sufficient. There has to be commitment that it should come with change.”

In a crisis like this, governments at all levels have to look at their response policies through the eyes of the most vulnerable and account for bias. This is particularly important for Black people who are among the most discriminated people here.

If this is not done, as the Black leaders’ statement said, “Black people will be exposed to greater harm.”

Fear over coronavirus prompts school board in Ontario to warn parents about racism against Chinese community

Not unexpected and always the challenge in communicating the origins of a specific risk and the impact on the community, irrespective whether historical tropes are involved or not. And I assume that some of these fears are shared by many Chinese Canadians:

The message York District School Board staff had been sending to parents on the coronavirus was pretty standard: Wash your hands; stay home if you’re sick; cover your mouth and nose when you sneeze. Then they saw the petition.

More than 8,000 people were calling for school boards in the region north of Toronto – a region in which the top reported ethnic origin is Chinese – to not allow students whose family members had travelled to China within 17 days to come to school.

On Monday, the York board released a note to parents to address another virus: anti-Chinese xenophobia.

“We are aware of an escalated level of concern and anxiety among families of Chinese heritage,” wrote Juanita Nathan, the board’s chair, and Louise Sirisko, its education director. “Individuals who make assumptions, even with positive intentions of safety, about the risk of others, request or demand quarantine can be seen as demonstrating bias and racism.”

Though public-health officials across the country have urged Canadians to take a measured response to the coronavirus, a panic akin to the one from 2003’s SARS outbreak has already taken hold. To date, there is one confirmed and one presumptive case of the new virus in Canada.

Avvy Go felt a tickle in her throat on the subway ride to work Monday, but willed herself to suppress the cough. She feared coughing on public transit as a Chinese woman might make her a pariah as it did for so many other Asian-Canadians during the SARS outbreak.

In Yellow Peril Revisited, a 2004 report about the impact of SARS (severe acute respiratory syndrome) on Canada’s Chinese community, Ms. Go, the director of the Metro Toronto Chinese & Southeast Asian Legal Clinic, detailed the myriad ways SARS affected her clients: Many suffered job losses after Chinese restaurants saw a steep drop in business; Asian claimants who appeared before the Immigration and Refugee Board faced staff wearing masks; and tenants reported being threatened with eviction by their landlords because they were Chinese.

Ms. Go shared much of this when she testified at Ontario’s public hearings on the SARS crisis but she was disappointed to find nothing about racism in the inquiry’s 2007 report. Recommendations on how to respond to racist rhetoric would have been helpful for future outbreaks such as this one, she said.

“As they prepare for the virus, they [should] also prepare for the virus of racism and have everything in place at the same time,” she said.

When Toronto Chinatown Business Improvement Area chair Tonny Louie addressed the crowd at Saturday’s Lunar New Year parade, he felt the need to explain his sore throat.

“I reminded everybody there that I do not have the virus. I just happen to have a cold,” he said.

The next day, he noticed a drop in business throughout downtown Toronto’s Chinatown and its dozens of restaurants – something he blames on fears about the virus. He repeated the message that the district was safe, as was the food, and called on politicians to have meals in Chinese restaurants as then-prime minister Jean Chrétien did during the 2003 SARS outbreak to signal to Canadians that doing so was safe.

But that sort of PR move might not be enough to counter racist messaging, given the power of social media.

In the past few days, video of a woman eating a bat with chopsticks in a restaurant has gone viral, with many suggesting, in posts heavy with racist rhetoric, that Chinese people eating foods seen as unusual to a Western palate has contributed to the outbreak.

The way in which the video has been shared has vilified and othered Chinese people, says Kevin Huang, executive director of the Hua Foundation, a Vancouver-based non-profit that promotes racial equity.

Rather than thinking of the coronavirus as an us-versus-them situation, Mr. Huang suggests using a global lens.

“Removing our Western exceptionalism and … humanizing [Chinese people] allows us to think about a more global concerted effort to try and contain this virus,” he said.

Why people would share misinformation like that while ignoring facts from public-health agencies speaks to how racist content “feeds into already pre-existing underlying biases or prejudices,” York University sociologist Harris Ali said.

In a research paper about SARS and the stigmatization of the Chinese population in Canada, he found that racist sentiments that had previously been internalized or only shared during private conversations “found explicit expression during the outbreak.”

Mr. Huang says the way some have drawn a connection between the virus and Chinese food is part of a long history of “yellow peril” or anti-Chinese sentiment.

Government policy that disenfranchised Chinese people, such as the head tax (an immigration tax imposed on Chinese arrivals), “fed into these tropes of this disgusting, uncivilized cultural grouping,” he said.

He has seen rampant misinformation and panic spread among Chinese-Canadians, too, some of whom are reacting to alarmist Chinese media reports. Last weekend, two Lunar New Year events in Vancouver were cancelled because of fear of the virus’s spread.

Ms. Go feels confident the Canadian health-care system is much better equipped to deal with containing coronavirus than it was with SARS, but she has little optimism about how it will contain the public’s fears.

“Unfortunately, because of the underlying racist attitudes that exist in Canadian society, it doesn’t matter what scientific evidence is there of how the disease has been contained, people will still believe what they believe,” she said.

Source: Fear over coronavirus prompts school board in Ontario to warn parents about racism against Chinese community Though public-health officials have urged Canadians to take a measured response, a panic akin to the one during 2003′s SARS outbreak has already taken hold
Fear, fear, fear.

The word appears repeatedly in the headlines and stories about the new coronavirus.

But what is fear? What causes us to be fearful? How can we assuage the public’s distress?

The dictionary definition of fear, the noun, is “an unpleasant emotion caused by the belief that someone or something is dangerous, likely to cause pain, or a threat;” and the verb, “to be afraid of (someone or something) as likely to be dangerous, painful, or threatening.”

In public health terms, “fear” is our perception of risk, of danger.

We tend to be more fearful of new threats to our health, such as coronavirus, than of well-established ones, such as influenza, no matter how irrational that is.

To date, there have been about 4,500 recorded cases of Wuhan coronavirus and 106 deaths. By comparison, three to five million people contract serious flu cases requiring hospitalization annually and somewhere between 290,000 and 650,000 die. Yet, both are respiratory illnesses spread in a similar fashion.

When it comes to being fearful, better the devil we know than the one we don’t, apparently.

If the unknown fuels fear – and it does – then our best weapon against coronavirus is knowledge.

The good news is that the science is advancing at breakneck speed and with an unprecedented level of co-operation.

The coronavirus genome was decoded in fewer than 10 days and the results shared publicly. As a result, researchers are already working on novel treatments and potential vaccine targets.

Scientific journals, normally highly protective of their papers, have agreed to share them with public-health officials prior to publication and lifted their paywalls for articles about coronavirus.

That means we already have a sense of how infectious coronavirus is (moderate) and a sense of who is being infected (a broad range of people) and who is dying (largely patients with underlying chronic conditions).

But, of course, good science alone cannot assuage fear.

The way public-health officials and the media communicate information is key to shaping perceptions. Increasingly, there is a wild card in this equation – social media.

The mainstream media fearmongers, however inadvertently, by using exaggerated language like “killer virus” and by fixating on body counts. When you constantly update the number of cases and deaths, you wildly amplify incremental change. Of course people will be scared. Imagine if we sent out push alerts for every tuberculosis death (1.5 million a year) and every measles death (140,000 annually).

Finding the balance between providing up-to-date information on a new threat and putting that threat into context is not easy.

On social media, there is too often little attempt to do so. From WeChat to Twitter, wild rumours and outright falsehoods fly routinely, as do unhinged demands such as shutting down all air traffic from China, quarantining all travellers and so on, with many of these purported measures driven by thinly veiled racism and xenophobia rather than science. (For the record, there is little evidence that massive quarantines or thermal screening of passengers has any benefit in stemming transmission of diseases like coronavirus.)

The most difficult communications challenge, however, lies with public-health officials who have to simultaneously track the shifting science, ratchet up preparedness and calm public fears.

Peter Sandman, a former professor of journalism at Rutgers University and a risk-communications guru, says the one thing public officials (or the media) should never do is tell people not to panic. That’s because, in crisis situations, people rarely do panic.

Prof. Sandman actually has a brilliant list of tips for those who need to calm people’s fears about unknown threats such as the coronavirus:

  • Don’t over reassure; talk about most likely scenarios rather than worst case ones;
  • Acknowledge uncertainty; paradoxically, saying “I don’t know” reassures the public;
  • Deliver clear, consistent messages;
  • Don’t be dispassionate; when experts speak of their personal fears, it makes them more relatable;
  • Give people things to do to protect themselves, such as urging handwashing; what fuels fear is powerlessness;
  • Don’t worry about panic, as was already mentioned.

What each of these elements has in common is that they are about building trust. What calms people’s fears is not just having information, but trusting the source of that information.

Risk communication is fraught with peril – and more often than not, we won’t get it quite right – but it is also essential.

As Franklin D. Roosevelt famously said, “The only thing we have to fear is … fear itself – nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.”

Source: What should we fear more: Coronavirus or fear itself? During an outbreak such as the coronavirus, building trust through communication is key: André Picard

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