Starting over in a new country means new ways to stay healthy

Immigrants are usually healthy when they arrive but soon fall behind. Louisa Taylor reports on efforts to turn around that distressing trend

Just off Park Avenue in Manhattan, outreach workers in the Mexican consulate give migrants free blood pressure checks and referrals to doctors. At John F. Kennedy Airport in New York, cabbies - most of whom are from South Asia, West Africa and the Caribbean - learn exercise techniques at a health fair in the taxi holding lot. In Ottawa, Chinese seniors gather for exercise and socializing, and the city trains settlement workers to share healthy living messages with new arrivals.
Research suggests that immigrants in many Western countries arrive healthier than the native born population, but their mortality rates rise over time. Innovative programs are trying creative ways to get the prevention message to newcomers.
Josana Tonda is the national coordinator of Ventanillas de Salud, a program that brings medical outreach to more than 50 Mexican consulates in the United States. Mexicans who visit the consulate on East 39th Street in Manhattan can't help but notice a corner of the waiting room filled with posters and pamphlets in Spanish about diabetes, women's health and finding a doctor. Several times a week nurses and outreach workers are there with screening tests, flu vaccines or referrals to clinics.
The Ventanillas de Salud - Windows on Health - program began in two California consulates in 2003 to help Mexican immigrants get access to health care. It now has partnerships with more than 500 local agencies providing services through more than 50 consulates throughout the United States. Discussions are under way about expanding to Canada.
"The majority of our clients are undocumented and uninsured, more men than women, with an average age of 25 to 35," says Tonda. "They are dry cleaners, restaurant workers, house cleaners, and many of them haven't been to a doctor for years except for visits to the ER.
"This is a very mobile population, very hard to reach. But people come here because they need to get documents, so we grab their attention and engage them on a health topic."
Tonda says their research shows the Ventanilla program is reducing emergency room visits by Mexican migrants and increasing the use of preventive services.
"Taking care of yourself is part of being adapted to a place," says Tonda. "We bring them confidence about really connecting to the health-care system."
Tonda says the Mexican government wants to help Mexicans already in the United States put down roots, but there's another motivation as well. "There's always a message of not losing the relationship with communities of origin," says Tonda. "What happens here has an impact there."
Recent immigrants often come from countries where preventive health care was not available, and once they resettle, traditional prevention messages pass them by. As a result, many health agencies have made reaching specific cultural communities a top priority.
In Ontario, the Heart and Stroke Foundation has programs for four: South Asians, First Nations, African and Chinese. Firdaus Ali is the "community mission specialist" in charge of reaching South Asians, whose risk of cardiovascular disease is much higher than the average Caucasian Canadian. Ali organizes health fairs and sends Hindi or Urdu-speaking community ambassadors to Diwali or Eid festivals to talk about tweaking traditional dishes to be heart-healthy. She also works with ethnic media, including Ottawa's Mirch Masala drive-home show on CHIN Radio, to get the word out.
"So far, the knowledge level is there but it hasn't translated into action; that is the biggest challenge," says Ali. "People are aware, 'If I eat a lot of oil or rich meals it will impact my heart.' What is lacking is how we change our lifestyles to be healthy."
In New York, one of the world's most diverse cities, Dr. Francesca Gany was looking for a way to go even further, and she hit on the idea of taxi drivers.
"There are 43,000 cabbies in New York, and most of them are immigrants," says Gany, an immigrant health expert at Memorial-Sloan Kettering Hospital. "Many are driving 12-hour shifts, taking just one day off. When they are so focused on providing money for their families, preventive care falls by the wayside."
Gany's team organized the STEP program, Supporting Taxi Drivers to Exercise through Pedometers, a 12-week program for 74 South Asian taxi drivers. The aim was to lower the drivers' risk of cardiovascular disease by encouraging walk more and change their diets. The program gave the drivers pedometers and sent out weekly phone reminders to walk 12,000 steps a day.
The next phase of the program was STEP On It, a five-day health fair in the holding lot at John F. Kennedy Airport last September. The team set up a tent and offered, among other things, health counselling with on-site doctors, free blood pressure and glucose screenings, stretching classes specific to a driver's aching muscles and a nutrition workshop showing how to make healthier choices on fast food menus. Although many drivers were from Africa and the Caribbean, most were South Asian. Translators were on hand so the team could serve clients in Hindi, Punjabi, Bengali, and Urdu.
STEP On IT's co-ordinator, Pavan Gill, says more than 480 drivers used the services over five days, and the team was able to do a 15-minute survey with 400 of them.
"We saw a lot of abnormal blood pressure and glucose tests and were able to refer people for care," says Gill, a Canadian who graduated from the University of Toronto. "We've done follow-ups and it has been really great to see the improvement. The drivers have told us 'You guys saved our lives.'"
Gill believes one of the reasons for the success of Step On It was the focus on providing information and services to immigrants in their environment, in a way that made sense to their lives.
"We said things like, 'Get out of your car and walk the perimeter of the holding lot while you're waiting, park a few blocks away from the restaurant where you're going to pick up food, use the stairs instead of the elevator'." says Gill. "We didn't tell them to get a gym membership, we talked about simple, easy, everyday things."
Settlement workers meet immigrants and refugees soon after their arrival, and help them with housing, jobs, school registration and other services. Health Skills, Health Smart is an Ottawa Public Health program that builds health information into that relationship by giving the settlement workers two-day seminars on nutrition, exercise, shopping, when to see a family doctor, and when to go to hospital.
The program has trained 32 settlement workers at the Catholic Immigration Centre and plans to train another 68 across the city.
"Our staff are now having conversations with people about the importance of Vitamin D, or why going for an annual checkup is important, or why they should use those free blood pressure machines at the pharmacy," says Carl Nicholson, executive director of Catholic Immigration Centre. "They have a much better ability to refer people to the services they need, not to mention our staff get better health practices, too."
Nicholson's agency has an innovative project of its own in the newly renovated basement of its Argyle Street office building, The Wellness Centre for Refugees is a one-stop service for government sponsored refugees, run by staff seconded from Somerset West Community Health Centre.
A team of nurse practitioners, doctors and support staff screen refugees for communicable diseases, provide vaccinations and arrange referrals to primary care physicians. The centre's funding includes $100,000 from the Champlain Local Integrated Health Network, money that Nicholson argues is very well spent.
"We assess the health status of every government-assisted refugee who comes to Ottawa," says Nicholson, adding that the centre sees about 500 clients a year.
"They have a complete workup of their health status and, if we find something wrong with somebody, we set about fixing it. We keep them out of the emergency rooms and we put them through a process of understanding how to keep their health and how to use the health care system."
Other programs focus on the social side of good health, by trying to break down the isolation some immigrants can feel, particularly seniors. Five days a week, the Yet Keen Seniors Day Program hosts 40 to 50 Chinese at the Bronson Centre for exercise, lunch and classes, including calligraphy, Chinese opera, or field trips (they recently went to Gatineau Park to learn how to snowshoe).
"It's a matter of breaking down social isolation," says Yet Keen coordinator Anna Yip. "We focus on healthy and active living as one way to help them stay in their homes and avoid hospitalization."
Another program run out of the Bronson Centre, the Club Casa de Los Abuelos, has similar programming to help Spanish-speaking elders stay active.
"Our world is becoming increasingly diverse and mobile, cities are receiving immigrants that have never had any before," says Gany. "It's not one-size-fits-all. We really have to think about who we're seeing and develop services that meet their needs."
New Canadians, old assumptions: The challenge to Canada's health care system.
Reaching Out: Bringing health to newcomers.
Health Delayed: Campaign against the three-month wait for OHIP.
See videos, slide shows, graphics and links to more information at unhealthywelcome
In 2011, the Citizen's Louisa Taylor won a fellowship from the Canadian Institutes of Health Research that allowed her to research and write about immigrant health in Nepal, India, the United States and Canada.
"In my work I often hear about the 'healthy immigrant effect,'" says Taylor. "The idea that newcomers get sicker when they move here seems like an alarming trend in a country built on immigration. This fellowship was my chance to find out what we know about it and what it means for health care."
Unhealthy Welcome runs in the Citizen until Tuesday.

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