pathways to health for immigrants to the...
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Shir ik i Kumanyika, PhD, MPH Pres ident , Amer ican Publ ic Heal th Associat ion P r o f e s s o r E m e r i t a , U n i ve r s i t y o f P e n n s y l v a n i a P e r e l m a n S c h o o l o f M e d i c i n e F o u n d e r a n d C h a i r , A f r i c a n A m e r i c a n C o l l a b o r a t i v e O b e s i t y R e s e a r c h N e t w o r k C o - C h a i r , P o l i c y a n d P r e v e n t i o n S e c t i o n , W o r l d O b e s i t y F e d e r a t i o n C U N Y F o r u m o n I m m i g r a t i o n a n d H e a l t h , N e w Yo r k C i t y , J u n e 3 , 2 0 1 5
PATHWAYS TO HEALTH FOR IMMIGRANTS TO THE UNITED STATES
Place of origin Socio-political history Socio-cultural background Reason for migration Health history Health status at arrival
Health insults Health behaviors Access to health services Appropriateness of health services Quality of health services
ADVERSE SITUATIONS POOR
HEALTH OUTCOMES
INFLUENCES ON HEALTH EQUITY
Immigration policies Other public policy Public health policy Health care policy
GOOD HEALTH
OUTCOMES
Source: The Newest New Yorkers, 2013 edition
• 37% of New Yorkers are immigrants • Nearly 6 in 10 are immigrants or children of immigrants
WHO ARE THE PEOPLE AND WHERE DID THEY COME FROM?
ADVERSE SITUATIONS
INFLUENCES ON HEALTH EQUITY
EXAMPLE: OBESITY
Associated with diabetes, heart disease, some cancers, mobility problems; discrimination
Requires life course perspective Sociocultural importance of food for immigrant
populations Sociocultural influences on food and physical
activity, e.g., preferences, gender-related roles and constraints
Generally increases with exposure to US environment
OBESITY PREVALENCE
Source: NYC Department of Health and Mental Hygiene. The Health of Immigrants in New York City, 2006
OBESITY AND DIABETES
Source: NYC Department of Health and Mental Hygiene. The Health of Immigrants in New York City, 2006
Influences on Obesity-related Health Inequities Applicability Situations Health Implications(Obesity)
All racial/ethnic minority populations
Racial/ethnic category • Cultural food preferences • Neighborhood access (segregation) • Targeted marketing of unhealthy foods • Mobility (freedom of movement)
Socioeconomic status; social position
• Neighborhood access (poverty) • Food purchasing power • Affordability of physical activity options • Transportation
Language/literacy • Access to nutrition information • Access to quality education
Cultural assets and protection • Buffering from aggressive promotion of unhealthy foods and beverages
Environmental context • Access to and affordability of healthy food and physical activity options
Structural empowerment and resilience
• Ability to benefit from new opportunities • Social capital and social support
Immigrant populations
Immigration experience • Disruption of social support systems; food insecurity
Residence or citizenship status • Access to federal nutrition and social welfare programs
MITIGATION: OBESITY- RELATED POLICY CONTEXT
Major focus of federal, state, and local policy
Embedded in social structure
More difficult to address in socio-economically disadvantaged
Environmental pathways involve multiple societal sectors and types of policies
FACTORS INTERNATIONAL
Development
Globalization of
markets
School Food & Activity
WORK/ SCHOOL/
HOME
Infections
Labour
Worksite Food & Activity
Leisure Activity/ Facilities
Agriculture/ Gardens/ Local markets
COMMUNITY/ LOCALITY
Health Care
System
Public Safety
Public Transport
Manufactured/ Imported Food
Sanitation
NATIONAL/ REGIONAL
Food & Nutrition
Urbanization
Education
Health O
I T Y
P R E V A L E
INDIVIDUAL
Energy Expenditure
POPULATION
%
OBESE
OR
UNDERWT Social Security
Transport
Family & Home
National perspective
Media & Culture
Food intake :
Nutrient density
Media programs
& advertising
Source: International Obesity Task Force [www.iotf.org] see Kumanyika S et al International Journal of Obesity 2002;26:425-36
Built environment Physical activity resources, facilities, and opportunities Food marketing environment Government nutrition assistance programs Endorsement, social support, and social capital for physical activity and healthy eating
Home food availability Food choices and feeding Electronic media use Physical activity opportunities Health care provider advice
Food choices and eating behaviors Electronic media use Involvement in physical activity Weight control behaviors Awareness and advocacy
Communities
Homes and families
People
Kumanyika S, Taylor WC, Grier SA, Lassiter V, Lancaster KJ, Morssink CB, Renzaho AM. Community energy balance: a framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations. Prev Med. 2012 Nov;55(5):371-81.
OBESITY RELATED POLICY TARGETS
ADVERSE SITUATIONS
─ Health insults ─ Health behaviors ─ Low access to health services ─ Inappropriate health services ─ Poor quality of health services
Racism; Discrimination
Education; Income; Jobs Fair labor practices
Family and social support Neighborhood conditions Access to resources
Life course and intergenerational perspectives
Humane treatment Immigration reform
MITIGATION
─ Immigration policies ─ Other public policy ─ Public health policy ─ Health care policy
INFLUENCES ON HEALTH EQUITY
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