Black health needs to become a priority

2017/03/01 Leave a comment

While I support most of Dalon Taylor’s recommendations, there is no mention of the role that the community and individuals can and do play apart from advocating government action:

Why should we need to consider Black health in particular? Consider these facts:

  • The rates of diabetes are highest among blacks and South Asians with more than 8.5 per cent affected compared to approximately 4.2 per cent among whites.
  • Close to 110,000 black individuals in Ontario alone were identified as sickle cell carriers with more than 60 newborns identified with full blown sickle cell disease annually.
  • Black communities are disproportionately affected by health-related issues such as mental health, HIV/AIDS, heart disease, sickle cell, stroke and hypertension. But they have yet to be adequately addressed effectively within the Canadian health-care system.

These all create an enormous burden on our health-care system, which can be greatly reduced with effective solutions.

The reasons why black Canadians face significantly disproportionate health prospects are complex and not fully explored. Certainly, we know that social determinants of health, which includes education, housing, employment and poverty, as well as racism and violence, are taking a toll on the health of black communities across Canada.

A vast array of research distinctly connects disparities in poor health with the experiences of prejudice and discrimination that individuals from marginalized and racialized populations encounter. Research also shows that negative interactions based on race leads to distrust in both the health-care systems and toward health-care providers.

By ignoring how these factors limit black health, we only perpetuate the racism that the heroes we celebrate during Black History Month sought to end. If Canada is serious about acknowledging the contributions that have been made by people of African and Caribbean ancestry, a good starting point would be to address the health-related issues that predominantly impact black Canadians.

For politicians and policy-makers, that would mean implementing relevant and “targeted” approaches in the health-care sector at all levels of government to address the health disparities and increase access to specific health services for blacks in Canada.

This includes creating a tool to measure equity within our current health-care system. Additionally, policy-makers need to recognize that racism and violence along with the social determinants of health play a role in the health outcomes of black communities in Canada. As such, specific measures should be developed to address these barriers to health.

It is also crucial for politicians and policy-makers to work with black communities and organizations to develop solutions that are relevant and meaningful to black communities. Part of this process must include investment in research to better understand the health issues that affect black Canadians so effective measures can be identified and acted upon.

Politicians must support the implementation of a black health strategy within the health-care system that outlines approaches to responding to the gaps within the system and commitment to take serious action.

For black communities, we need to work together to ensure decision makers are held accountable. Our votes are a significant tool to ensure our voices are heard. We need to rally communities to use our votes effectively and strategically. If politicians aren’t hearing us, we need to pool our votes and support candidates who will listen and respond.

We also need to support each other in creating clear and consistent messages on the challenges and barriers we face, and how they can be overcome. We should not stop short of anything but equitable access to health care, education, housing and all the other social determinants of health that we should have access to as human beings, regardless of our race.

It is time for all of us to take meaningful steps and concrete actions to give back to black Canadian communities. The blood, sweat and tears that our ancestors have poured into building this country, and the contributions that racialized immigrants continue to make, require acknowledgement in the present. A good starting point would be towards our health. So let’s not wait to find another month Canada; let’s start now.

Source: Black health needs to become a priority | Toronto Star

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The stem-cell struggle: Multiracial patients’ hunt for a match

2016/11/16 1 Comment

As someone who has undergone this gruelling treatment, and who did not have the same challenges in finding a donor (mine was from Germany), important to encourage minorities to consider being a donor to improve the chances of those who need this treatment:

Hundreds of Canadians are waiting for stem-cell transplants, but only half of them will find a donor, according to Canadian Blood Services. For multiracial patients, the chances of finding a match are infinitely smaller. As Vancouver filmmaker Jeff Chiba Stearns discovers in his new documentary Mixed Match, it is akin to finding a needle in a haystack or winning the lottery.

Stem cells, which are typically collected from blood or bone marrow, are cells that can develop into other types of blood cells, including the white blood cells that make up one’s immune system. For those with blood disorders and cancers, such as leukemia, a stem-cell transplant can be life-saving.

For Mixed Match, which is showing at the Toronto Reel Asian International Film Festival on Nov. 15, Chiba Stearns spent six years filming multiracial recipients, donors and families who’ve searched the world over for a match. The Globe spoke with Chiba Stearns about why patients’ chances of survival are linked to their lineage.

Why is it so hard for people of mixed race to find suitable donors?

A lot of people think of it as blood. You know, like, I have type O-negative blood. But this has to do with your genetic background, what you would call a “genetic twin.” Basically, when you’re trying to find your genetic twin, a lot of times, it’s someone who has similar ancestry, so someone who comes from the same place you came from because that would mean your immune systems would be very similar.

So, say, in Japan, which is a very homogeneous country, they have a very small pool of people in their registry, but you can still find a match most of the time. What happens when we start mixing is our genetics get a little more complex.

….Why do some people object to recruiting donors by specific ethnic groups?

When it comes to race and ethnicity, the idea of filling out the box and categories can be a little challenging to some people because maybe they don’t want to be labelled or put in boxes.

But at the same time, this is how we categorize people because we need to know, if I am part Japanese and part European, where do we need to start looking? Do we look in Japan’s registries? Do we look overseas?

And sometimes these categories may not be as accurate as people think because it’s self-identified race and identity. We don’t always know. Sometimes it opens up skeletons in the closet, like people may not have realized their great-grandma was Korean, for example, and nobody talked about that.

The idea of race in medicine is sometimes controversial because there have been drugs targeted specifically to African-Americans. Or when people say cystic fibrosis is mainly a “white people” disease, or certain types of diseases are more common in certain races, I think that’s when you get racial scholars coming up in arms because it’s dividing people by race.

It gets complicated, though. As you showed in your documentary, someone with Latino heritage might end up being a good match for someone who’s Asian.

This is why it’s tricky because we often say, if you’re Chinese, you need to find another Chinese donor. But there are rare cases, where, let’s say, an African-American person has donated to someone who’s Caucasian. It may not be a perfect match, and that’s probably what’s happening: These probably aren’t perfect matches.

That’s why I think we always encourage anybody and everyone to sign up. And because registries ask for self-identified race, sometimes you just don’t know whether there’s some kind of mixing in one’s heritage.

Source: The stem-cell struggle: Multiracial patients’ hunt for a match – The Globe and Mail

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Stigma, shame behind ethnic delays in seeking help for mental illness

2016/08/19 Leave a comment

Not the first study that I have seen but appears to be one of the more comprehensive.

Noteworthy in that it applies to both first and second-generation immigrants:

Chinese and South Asian patients experience more severe mental health problems by the time they seek professional help, says a new study that looked at severity of psychotic symptoms and ethnicity.

“When compared to patients from other populations, Chinese and South Asian patients were on average much sicker by the time they got to hospital,” said Dr. Maria Chiu, lead author of the study, “Ethnic Differences in Mental Health Severity,” to be released Wednesday.

“Cultural factors play a big role in these findings. While Asian people tend to have stronger family support, they are also faced with a higher level of stigma and it prevents people from seeking help early. Families may try to cope and keep the illness within the family until there is no choice but to go to hospital.”

Based on the Ontario Mental Health Reporting System database, researchers with Toronto’s Centre for Addiction and Mental Health and the Institute for Clinical Evaluative Sciences examined information on more than 133,000 patients — including 2,582 Chinese and 2,452 South Asians — hospitalized for psychiatric conditions, such as schizophrenia, bipolar disorder and depression, between 2006 and 2014.

Chinese and South Asian patients represented 2 per cent and 1.9 per cent respectively of the in-patient population in the study, while they respectively account for 5.6 per cent and 7.9 per cent of the overall Ontario population.

Researchers assessed the severity of the subject groups based on four measures: if they were admitted to hospital voluntarily, whether they demonstrated aggressive behaviour, and the number and frequency of psychotic symptoms (hallucinations, delusions and abnormal thought process) they presented.

The study found that involuntary admissions were significantly more common among Chinese (67.1 per cent) and South Asian (59.7 per cent) patients than among the general population (46 per cent).

Both groups were also more likely to demonstrate aggressive behaviour at 20.4 per cent for Chinese and 16.3 per cent for South Asian patients, compared to just 14 per cent among other patients.

Patients from these two groups were also significantly younger than other populations being hospitalized and were more likely to experience multiple psychotic symptoms (55 per cent of Chinese versus 49 per cent of South Asian patients versus 38 per cent of other populations.)

Although immigration experience has often been linked to stress and mental health challenges, the study found both immigrants and Canadian-born patients of Chinese and South Asian descent shared similar illness severity when admitted to hospital.

“We need to consider Chinese or South Asian ethnicity, independent of immigration and diagnosis, as an important determinant of multiple dimensions of illness severity,” said the study published in the August edition of the Journal of Clinical Psychiatry.

The report suggests Chinese and South Asian communities may be more reluctant to seek help due to shame and stigma as well as cultural differences in the recognition and conceptualization of mental illness and mental health care.

Those challenges, it said, can be further compounded by language barriers and culturally insensitive health services.

“The longer mental illness goes without treatment, the more difficult it can be to get people back on track,” said Dr. Paul Kurdyak, psychiatrist and researcher with CAMH’s mental health policy research and lead scientist for the ICES mental health and addictions research program.

“This study highlights that ethnicity and culture are factors that should be considered when developing outreach strategies and treatment approaches, particularly at earlier stages before a patient’s illness worsens and hospitalization becomes necessary.”

Source: Stigma, shame behind ethnic delays in seeking help for mental illness | Toronto Star

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Wary of Mainstream Medicine, Immigrants Seek Remedies From Home – The New York Times

2015/11/16 Leave a comment

Likely similar in Canada and some readers may be more familiar with any comparable initiatives here:

With the help of a $130,000 grant from the Cigna Foundation, the Botanical Garden offers training for doctors to help them better understand their patients’ cultural beliefs. So far, 740 medical students and practicing physicians have gone to the garden’s tropical conservatory to learn about medicinal plants and to participate in role-playing exercises. “It is all about promoting increased trust between health care providers and their patients,” Dr. Vandebroek said.

Issues of trust and culture are not the only things that have made some immigrants leery of mainstream medicine. Doctors’ visits are expensive, and herbs, selling for a few dollars a bag, are cheaper than prescription drugs.

According to a study by the Commonwealth Fund, 43 percent of Hispanics in the United States do not have a primary personal care physician or health provider. More than one-third lack health insurance, nearly double the rate for blacks and triple that for white Americans.

High costs and cultural differences have created a troubling disconnect between many Hispanics and the health care system. It is a rift that Dr. Roger Chirurgi, program director for the emergency medicine residency for the New York Medical College at Metropolitan Hospital Center in Manhattan, would like to heal.

“There’s a lot of people who we’ll see at repeat visits, and they’ve never taken their medicine,” Dr. Chirurgi said. “That’s why I’ve been taking my residents to the Botanical Garden for the past three years, to try to become more culturally sensitive and to be able to break through that barrier.”

Dr. Chirurgi now routinely asks patients if they are using herbals when he takes their medical history. He worries about the dangers of unregulated remedies that lack dosage guidelines and scientific evidence of their efficacy. “I want to make sure that they are safe, and don’t interact with the drug that I am prescribing,” he said. Still, he conceded that herbals may be helpful, if only as placebos. “If you believe that something will work,” he said, “it may actually work in some cases.”

Source: Wary of Mainstream Medicine, Immigrants Seek Remedies From Home – The New York Times

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Canadian living takes toll on immigrant hearts: Study

2015/09/02 Leave a comment

Not surprising. As new Canadians integrate and adopt our sedentary lifestyle and poor nutrition habits, their health worsens. One of the downsides of integration:

Is living in Canada bad for your heart?

A groundbreaking new study has found that recent immigrants have a 30 per cent lower rate of major heart problems, such as heart attacks and strokes, than long-term residents, but that gap shrinks the longer they spend in Canada.

While newcomers are known to have better health than the general population because they must pass rigid health screening, Dr. Jack Tu, lead author of the study, says “part of it can be explained by most immigrant groups having lower rates of smoking and obesity than Canadian-born individuals.”

But after 10 years in Canada, and some of the negative impacts of Western culture, like fast-food and cigarettes, that “healthy immigrant effect” diminishes, the study shows.

While recent East Asian immigrants, predominantly Chinese, had the lowest incidence of major heart problems overall (2.4 in men and 1.1 in women per 1,000 person-years), South Asian immigrants from India, Pakistan, Bangladesh, Sri Lanka and Guyana had the highest rates, at 8.9 in men and 3.6 in women.

However, after 10 years in Canada, the rates among East Asians increased by 40 per cent for men and 60 per cent for women, said the study released by the Institute for Clinical Evaluative Sciences in the American Heart Association journal Circulation on Monday.

“East Asians — Chinese from China, Hong Kong and Taiwan — are the most sensitive to the acculturation of Western culture. The overall incidence rate of the other (ethnic) groups is only up by 10 per cent after 10 years,” said Tu, a cardiologist at the Sunnybrook Schulich Heart Centre.

…Other key findings of the study:

  • The rate of heart attacks and strokes varies drastically among the eight ethnic communities studied, but the differences diminish the more time they spend in Canada.
  • While 5.6 per 1,000 immigrant adult males and 2.4 of females had major heart problems, long-term Ontarians had a rate of 8.1 for men and 3.4 for women.
  • Among immigrant men, East Asians had the lowest rate of heart disease, followed by black, white-Western European, Southeast Asian, Latin American, West Asian/Arab, white-Eastern European and South Asian.
  • Among immigrant women, the order was somewhat different, though East Asian females still shared the best cardiovascular health. They were followed by white-Western European, Southeast Asian, white-Eastern European, black, Latin American, West Asian/Arab and South Asian.

Source: Canadian living takes toll on immigrant hearts: Study | Toronto Star

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Our health needs a healthy civil service: Picard

2015/08/19 Leave a comment

André Picard on the importance of a strong regulatory capacity and public service. His comment on Blueprint 2020 (highlighted) is unfortunately all too true:

Among other things, we need drug regulators who can regulate rigorously, free of political and corporate pressures. More broadly, we need a public service that works, and is free to work, in the public interest.

It’s not enough to have laws – let’s not forget that drug regulations were similar in Canada and the U.S. at the time thalidomide came along – we need people who can give those laws life, to embrace the spirit and not just the letter of the law, especially when it comes to ensuring public safety.

In short, we need to foster a new generation of Dr. Kelseys.

Sadly, we are doing exactly the opposite.

We have a public service that is muzzled, emasculated, derided and decimated.

There are about a quarter-million federal public servants in Canada, a considerably lower figure than from a decade ago. They serve a broad variety of functions from, overseeing national parks to ensuring aviation safety, and everything in between.

It is in our best interest, economically as well as socially, that every one of those workers serves a useful function.

Yet consultations with the public servants show that they feel mired in red tape and frustrated by cumbersome processes that leave them unable to do their jobs. That’s why the Privy Council has undertaken an initiative to transform the public service, dubbed Blueprint 2020.

The plan features some lovely rhetoric, such as Conservative Leader Stephen Harper saying in the introduction: “An agile, efficient and effective Public Service is essential to the well-being of Canadians.” And it is chock-full of good intentions.

But Blueprint 2020 lacks of a clear philosophical bent and strong political commitment to an independent, empowered public service.

What is required, especially in these difficult economic times, is a scientific, non-partisan approach to drafting and implementing policy.

While it is fashionable to bad-mouth the bureaucracy and sing the praises of free market, public regulation plays an essential role as a ballast to corporate excesses driven by self-interest.

The role of government, duly elected, is to formulate legislation and other policies in what it believes is the best interests of citizens. But its role is not to micromanage and bark orders down the line. Rather, elected officials should depend on civil servants for thoughtful, independent advice, especially on scientific matters.

What we need today is evidence-based policy-making if, for no other reason than it produces better policy.

Public servants should not be toadies, singing the praises of ill-conceived or partisan initiatives. Nor should they be muzzled. They should be offering constructive criticism to ensure policies are workable and fair, and analysis and insight that helps avoid unintended consequences.

For this, we need to create an atmosphere where public servants can innovate, take risks, and, as Dr. Kelsey did, call B.S. when necessary.

If we want better government and more sensible public policies, we need to give public-sector employees autonomy, authority and responsibility.

That, rather than a celebration of individual heroics, should be Frances Kelsey’s legacy.

Our health needs a healthy civil service – The Globe and Mail.

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Some minorities more likely to see heart health deteriorate: study

2015/08/12 Leave a comment

Some_minorities_more_likely_to_see_heart_health_deteriorate__study_-_The_Globe_and_MailInteresting new study on how lifestyle in Canada affects different minority groups, as they integrate and adopt unhealthy Canadian food and lack of exercise habits:

The study looked at data from nearly 220,000 Canadians who took part in Statistics Canada’s Canadian Community Health Survey. The researchers focused on individuals belonging to Canada’s four major ethnic groups: white, South Asian, Chinese and black.

The results add to a growing body of evidence suggesting health problems affect ethnic groups at different rates. While genes certainly play a role, they do not tell the entire story, Chiu said.

“I like to think of it as genes load up the gun and environment pulls the trigger,” she said.

Her study helps explain why some ethnic groups appear to be more vulnerable to certain health conditions. Overall, the ethnic minority groups included in the study had household incomes that were as much as $30,000 lower than those of their white counterparts.

Those groups also reported that they ate fewer fruits and vegetables. At the same time, smoking rates among all of the groups studied fell, with the exception of black women and Chinese men.

“This is another wakeup call,” said Dr. Sonia Anand, professor of medicine and epidemiology at McMaster University in Hamilton and a spokeswoman for the Heart and Stroke Foundation. “We have to get going or we’re going to end up with an epidemic of obesity and type 2 diabetes in the next 20 years.”

Anand was not involved in this study, but much of her research focuses on the causes of heart disease in ethnic groups. She said the evidence is clear the differences exist, but there is no clear strategy on how to solve this complex problem.

The important question for researchers and policy makers, according to Chiu, is how to bridge the gap and reverse the trends.

One solution will be to tailor campaigns to ethnic groups, Chiu said. They need to know they are at risk and what changes they can make to reduce their vulnerability, such as quitting smoking or eating more fruits and vegetables.

And, as Anand noted, “we move less, we commute by car, we don’t live in walkable neighbourhoods.”

That means the necessary solutions are going to require a lot of time, co-ordination, funding and commitment, she said.

Some minorities more likely to see heart health deteriorate: study – The Globe and Mail.

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Cancer fight puts focus on lack of minorities on stem-cell donor lists

2014/08/05 Leave a comment

Periodically, articles emerge regarding the need for more donors from minority communities (e.g., Asian British Columbians less likely to be organ donors). This latest, thanks to a social media campaign launched by Mai Duong, a leukaemia patient in Montreal, pertains to the need for stem cell donations, used to transplant new immune systems to patients with a range of blood-related cancers.

Having benefitted from a stem cell donation to treat my lymphoma, and without the challenges of finding a donor given my European ancestry (my donor turned out to be a nice young German man), I can only urge those of you of whatever extraction to consider donating stem cells. The Canadian link is OneMatch Stem Cell and Marrow Network, in Quebec, Héma-Québec:

But Duong, 34, has discovered that locating the right person can be a needle-in-a-haystack challenge, particularly for those who are from a non-Caucasian background.

“This is a global problem,” Duong, who is of Vietnamese origin, said in an interview from her room at Montreal’s Maisonneuve-Rosemont Hospital.

“We can’t do a scavenger hunt every time someone has this type of problem.”

…. Canada Blood Services, which manages the stem cell and marrow registry outside Quebec, says 340,837 people are currently registered in the rest of the country. Of them, 71 per cent are Caucasian, with the rest qualifying as “ethnically diverse” or of unknown origin.

Hema-Quebec, the organization that manages the province’s list, says about three per cent of the 47,000 stem-cell donors are of Asian descent and only a fraction of those are Vietnamese. The ratios are similar among international donors and Vietnam doesn’t have a registry of its own.

Cancer fight puts focus on lack of minorities on stem-cell donor lists.

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Asian British Columbians less likely to be organ donors

2014/07/05 1 Comment

Ongoing challenge with a number of communities given the need for donors. Similar pattern elsewhere in Canada and USA, although there are likely a few examples of successful campaigns within these communities:

BC Transplant doesn’t ask those who register as donors about their ethnic background. But it does record the ethnicity of actual donors.A University of B.C. study released last year found that the vast majority of organ donors in this province are white, despite the fact Asians make up a significant share of organ recipients.

The study looked at all deceased organ donations in B.C. from 2005 to 2009: a total of 182 donors and 765 recipients a single donor typically donates several organs.

Whites made up 89 per cent of donors but only 69 per cent of recipients.In contrast, East Asians Chinese, Japanese, Korean made up four per cent of donors and 12 per cent of recipients. And South Asians Indians, Pakistanis made up one per cent of donors and eight per cent of recipients.

Put another way, given their overall share of B.C.’s population, whites are three times more likely to be organ donors as East Asians and eight times as likely as South Asians.Last year’s study was a repeat of a similar study conducted in the 1990s, and showed little progress since then in organ donation by Asians, despite a concerted campaign by BC Transplant to reach out to them.

Possible reasons:

Yoshida has a few theories.

While no major religions prohibit organ donation, he said, some Asian families do place importance on the idea of burying their loved ones whole.

The language barrier between health professionals and a patient’s family may also play a role.

“When English is not a first language and you’re hearing things through a translator, maybe it doesn’t come out the way it should,” he said.

Gill said another factor may be immigrants’ level of trust in government.

“Organ donation is a tricky business,” he said. “There are myths that people are not going to have the best care because ‘the system wants to get their organs.’”

Asian British Columbians less likely to be organ donors with video.

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Do the name and ethnicity of your doctor matter?

2013/08/31 Leave a comment

On the practical side of multiculturalism and diversity, choice of doctors.

While most of the long-standing members of my cancer medical team are Caucasian, the newer group of doctors, fellows, interns and nurses are much more diverse. Issues that sometimes comes up, not with the Canadian-born but with some foreign-born doctors, include language fluency and experience in how to discuss difficult medical issues, but both are a matter of learning through doing, not issues of medical competence. And generally, the newbies spend more time with you as part of their development, which can be helpful.

Do the name and ethnicity of your doctor matter?.

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