Why do Caribbean’s experience disparities in health outcomes when compared to the larger Canadian population?

BY SIMONE J. SMITH

A multitude of studies have shown that African Caribbean’s experience disparities in health outcomes when compared to the Canadian population at large. Heart disease and stroke are among the leading causes of death among Canadians and African-Caribbean communities and are among those with the greatest increases in risk factors for: heart disease and stroke such as hypertension, diabetes, chronic stress, and obesity.

One suggested on-going stressor is anti-Black racism, which we believe is a major contributing factor to the disparities in health that African-Caribbean people experience. Living with both societal and personal racism has been shown to worsen multiple chronic illnesses.

Another theory is one that surrounds the “Health Immigrant Effect,” in which foreign-born individuals arrive in Canada in better health than Canadian natives, but experience significant health declines as they settle in, and immerse themselves into the Canadian lifestyle.

In a research study titled, “Chronic health disparities among refugee and immigrant children in Canada,” adult newcomers aged 15 years and older self-assessed their health status and noted that they experienced significant health declines within as little as 2-4 years after their arrival in Canada.

Compared with those born in Canada, recent newcomers experienced a lower incidence of chronic diseases including: heart disease, cancer, and diabetes; however they experienced a slow increase in the incidence of chronic diseases over 20-25 years until it was at the same rate as those who were Canadian born.

When and where ethnic Caribbean’s migrate to and emigrate from matters in health statuses. Knowing this has implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada.

Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes.

The Healthy Immigrant Children study examined the health and nutritional status of 300 immigrant and refugee children aged 3–13 years who had been in Canada for less than five years. Many newcomers spoke about their struggles to attain their desired standard of living.

In another study titled, “National origins, social context, timing of migration and the physical and mental health of Caribbeans living in and outside of Canada”, analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses.

Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region.

Then there is the mental health aspect of this. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established.

Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Mood disorders were highest among new immigrants compared to older immigrants.

I looked at a final study titled, “Common mental health problems in immigrants and refugees: general approach in primary care, and the spoke of migration trajectory being divided into three components: pre-migration, migration and post-migration resettlement, with each phase being associated with specific risks and exposures.”

The prevalence of specific types of mental health problems is influenced by adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include:

• Communication difficulties because of language and cultural differences
• The effect of cultural shaping of symptoms and illness behaviour on diagnosis
• Coping and treatment
• Differences in family structure and process affecting adaptation
• Acculturation
• Intergenerational conflict
• Aspects of acceptance by the receiving society that affect employment, social status and integration.

In order to address these issues, a comprehensive policy model has been recommended to make immigrant health a priority for both federal and provincial governments, including a migrant sensitive health strategy complemented by mandatory cultural sensitivity training for providers and administrators, and the inclusion of migrant-specific variables in the national health census.

Included in this model there could be a systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of: social, vocational and family functioning over time that will allow clinicians to recognize problems in adaptation and undertake: mental health promotion, disease prevention or treatment interventions in a timely way.