Health Challenges for the South Asian Population in Ontario/Canada

OMHARN Multicultural Health Conference - March 17, 2012

Dr. Naila Butt – Executive DirectorDoris Rajan- Researcher

Challenges – two areas...

1) How we understand the role and goals of research in relationship to immigrant and racialized people; and

2) Specific challenges older people from diverse ethno-racial backgrounds experience – the South Asian perspective.

The roles and goals of research

The merits of applied/community based research

Recognize lived expertise – letting research “subjects” lead

The social determinants of health – how broader socio-economic environment interplays with health

Careful not to pathologize illness etc.

Goals of research (continued)

For service providers that means person-centred care population-specific systemic discrimination access barriers;

For researchers that means a comprehensive analysis that operates on many levels – individual, community and macro levels

Research Challenges

Research often doesn't recognize the differences in immigration status, i.e. refugees vs. immigrants

Two types of senior immigrants:

a) seniors who immigrated when young andb) newcomer seniors

There are different sets of issues, e.g. isolation, language barriers and stress trauma

Research Challenges – multiple jeopardy Intersectionality of marginalized statuses, i.e.

age, sex, race, class, etc., - compounding effect

Analysis needs to be cross the time spectrum

Populations are diverse - e.g. South Asians are studied as one group, even though they are very diverse, i.e. Punjabi from Pakistan is different from a Punjabi from India

Can’t cluster!

A double whammy for ethnic seniors ...

Immigrant seniors have greater health care needs,

Leading to greater difficulty in accessing/using health care.

The support system struggles to keep up with the demographic changes

Challenges – Example, South Asian Seniors

Lack of English/French language skills Dependency on family members for transportation; Reliance on family members as interpreters which

is often unreliable or inaccurate; Restricted mobility due to childcare

responsibilities; Lack of access to the internet; Social determinants- income level, immigration

status, the migrant experience, gender roles, number of years in Canada, unemployment, changes in family dynamics.

South Asian Seniors Issues ... Older women - widowed, poor English skills, live

in a three generation household Social isolation - weather, lack of income, lack

of English, transportation etc.. Loneliness, stress, emotional problems Changing role of women and elders; Family conflicts due to financial hardships , in-

law conflicts and intergenerational differences. Elder abuse - seniors caring for their

grandchildren, housework, and cooking. Conflict with daughter-in-laws.

Mental Health and lifestyle ... Depression, loneliness and isolation Increased work loads, multiple jobs,

insomnia  Unhealthy eating and life style practices. Introduction of unhealthy fast foods and

an overdependence on low cost foods.  Traditional cooking is often high in

carbohydrates, oil, salt and sugar.

Chronic Disease- South Asians

• Rates of Illness• higher prevalence rates of preventable chronic

conditions and poorer health outcomes compared to other groups.

• Diabetes: Diabetes prevalence rates 11-14% compared to 5-6% for non-racialized Ontarians

• Cardiovascular Disease: an three to five times increase in the risk for myocardial infarction and cardiovascular death

• Hypertension: African-Canadians are 3.3 times and South Asians are 2.7 times more likely than non-racialized people to have hypertension

• Personal loss of loved ones• Torture at the hands of the oppressors• Constant threat of violence• Horror of air attacks• Stress of being displaced and the

experience of confinement• Poor conditions of living in camps• Loss of property and livelihood• Lack of access to information during the

conflict – what is true and what is not?

Tamil Refugees – coming out of war

Post Traumatic Stress •Flashbacks or nightmares of the original trauma•Avoiding places that remind them of the event•Difficulty falling or staying asleep •Trouble concentrating• Irritability•Anger•Blackouts or difficulty remembering things• Increased tendency and reaction to being

startled•Excessive watchfulness to threat•Alcohol abuse

Challenges - Health Services Lack of a person-centred approach not

objectifying clients’ experiences as immigrants and/or from a certain community.

Lack of cultural competency and anti-racist training for health and social services providers;

Lack of linguistically and culturally appropriate services and resources.

Holistic definition of health.. That recognizes the larger systemic barriers

that are having a negative effect on mental and physical health of seniors;

Consider the senior immigrant as a total person with a specific history and social, economic, physical, emotional and spiritual needs.

Examine the specific social and cultural factors, family and inter-personal relationships and living arrangements and conditions.

Solutions Recognize merits of applied/community based

research Acknowledge lived expertise, i.e. that those

most affected lead the way in defining the issue and identifying solutions

Understand how social determinants interplay with health issues

For researchers that means a comprehensive analysis that operates on individual, community and macro policy level

Solutions - multi-level community capacity building approach ...

Influence change at three levels; 1.the individual and family level, 2.mobilizing, educating, and empowering

the community and community based supports, and

3.broader level policy reforms.

Social Services Network

Not-for-profit charitable organization UWYR research that York Region services were

not keeping pace with the changing demographics and needs of the community

Unique service delivery model whereby the services are delivered directly to the community at their places of worship or meeting place.

Services are offered by community mobilizers in Hindi, Gujarati, Punjabi, Tamil, Punjabi and English.

Seniors Programs• South Asian Adult Day Program

▫Partnership with Unionville Home Society▫For SA Seniors who are cognitively impaired and or

frail.• Mental Health Awareness and Support Drop-In

Centers:Provide culturally and linguistically sensitive awareness and support programs on mental health

• Seniors Hub at Armadale Community Centre Partnership with the Town of Markham Wellbeing programs. Programs such as Yoga, Laughing Yoga, Chi- Gong, Mild Mobility Exercises, Bridge Club, Sewing Club

Seniors Programs

• Mobile Computer Lab• Computer skills to seniors in ethnic languages

enabling seniors to communicate with other seniors even in their home countries.

• Taking Care of Me! Toolkit and training• CHATS in collaboration with SSN developed a tool kit

for Facilitating Health & Wellness Workshops for SA Seniors in Tamil and Punjabi.

• workshops included learning about the Health Care System and Community Supports and Recreation Programs, Managing Physical Health –Diabetes & Falls Prevention and – A Healthy South Asian Diet.

The “Impact of Family Violence a South Asian Perspective” Five year project in partnership with Toronto, York,

Peel and Durham Regional Police, York Region CAS. Objectives –

identify barriers, challenges, gaps and opportunities towards sustainable change and

increase awareness amongst community and sectors to address issues of family violence within the South Asian Community

Report publishedNext Conference May 2nd and 3rd at Seneca

College

What OMHARN needs to do?

Convene more opportunities for collaboration between traditional academic researchers with population specific community-based researchers;

Action orientated and focused research that translates knowledge into tools and resources that can be mobilized through community development strategies that reach individuals and families directly.

Inform policy and decision makers Participatory action research that results in a sense of

ownership by all stakeholders. WE ALL NEED TO START WORKING OTHER!