“The Healthy Immigrant Effect”

• How would you describe the health status of immigrants upon arrival to Canada?

• Immigrants experience a deterioration in their health status which is partly due to transitions in dietary habits.

• Studies have shown that the greatest change in diet and lifestyle occurs within the 5 year period of being in Canada

The Meaning of Food

• Retaining their cultural identity• Family status• Food and gender• Hospitality - community bond• Symbolic meaning of certain foods• Building and strengthening cross-cultural relationships• http://www.youtube.com/watch?

v=cQC6cLJhTek&feature=related

FOOD CUSTOMS AROUND THE WORLD

– Food traditions vary worldwide – A delicacy in one place is inedible elsewhere– Values/beliefs define what is eaten – Similar cultures may have different eating patterns– Age and gender also define relationship to food– Urban vs Rural

Dietary Laws and Taboos: Religion

• Some food beliefs are related to religious beliefs, e.g. Muslims, Orthodox Jews, Buddhism, Hinduism, Jainism

• Dietary practice may vary among those of same faith • Engaging in dietary taboos may have some social

consequences in different cultures

Cultural Challenges

• Immigrant barriers include:• Language • Access to traditional foods and equipment• Limited resources• Embarrassment, community pressure to change eating

habits• Unhealthy eating habits leading to poor health• Embracing fast food as a result of lack of familiarity with host

country’s foods

COMMOM OUTCOMES

• Unhealthy eating habits leading to poor health• Embracing fast food as a result of lack of familiarity with host

country’s foods• Engaging in dietary taboos may have some social

consequences in different cultures

Cultural Responsiveness

• Cultural sensitivity is important for both immigrants and citizens of the host country

• Universally important to choose foods that promote good health

• Nutrition counselling and awareness leads to informed decisions

ENGAGING WITH NEW COMERS

• Importance of keeping traditions• Common hosting traditions in African, Middle

Eastern, Asian Culture; generosity, friendship, pride • Active listening• Viewing the situation through their eyes

Nutrition is dynamic

• Regional food habits do exist, but they also change over time. As people immigrate, food practices and preferences are imported and exported. Families move to other locations, bringing their food preferences with them. They may use their old recipes with new ingredients, or experiment with new recipes, incorporating ingredients to match their own tastes. In addition, food itself is imported from other countries.

• Tinned foods such as baked beans, fish fingers, cereals etc. are imported. Has become the norm to eat breakfast cereal for breakfast across Africa whereas the traditional breakfast would have been Pap which is somewhat like porridge and bean balls.

• Because people and food are mobile, things are always changing. Attempts to characterize a country or people by what they eat are often inaccurate or tend to lump people into stereotypical groups.

Traditional foods:Rural/Urban split

• In Urban areas, traditional foods are not always ‘traditional’. Many countries have been exposed to colonial influences and have had their food choices affected.

• In Sudan, Niger and Nigeria, for example, Nomadic societies live mainly on milk. Moved into cities, no longer possible.

• People in refugee camps long term:• Karen??? Hunter/gathering societies have become more settled and have

lost their connection to their traditional way of gathering food. Diet is always dynamic.

Etiquette – the ‘how’ around eating

• In addition to impacting food choices, culture also plays a role in food-related etiquette. People in Western societies may refer to food-related etiquette as table manners, a phrase that illustrates the cultural expectation of eating food or meals at a table. Some people eat with forks and spoons; more people use fingers or chopsticks. However, utensil choice is much more complicated than choosing chopsticks, fingers, or flatware. Among some groups who primarily eat food with their fingers, diners use only the right hand to eat. Some people use only three fingers of the right hand. Among other groups, use of both hands is acceptable.

• In some countries, licking the fingers is polite; in others, licking the fingers is considered impolite (and done only when a person thinks no one else is watching). Rules regarding polite eating may increase in formal settings. At some formal dinners, a person might be expected to choose the "right" fork from among two or three choices to match the food being eaten at a certain point in the meal.

• The amount people eat and leave uneaten also varies from group to group. Some people from Middle Eastern and Southeast Asian countries might leave a little bit of food on their plates in order to indicate that their hunger has been satisfied (Kittler 2001). Cooks from other locations might be offended if food is left on the plate, indicating that the guest may have disliked the food. Similarly, a clean plate might signify either satisfaction with the meal or desire for more food.

• Even the role of conversation during mealtime varies from place to place. Many families believe that mealtime is a good time to converse and to "catch up" on the lives of family and friends. Among other families, conversation during a meal is acceptable, but the topics of conversation are limited. In some Southeast Asian countries it is considered polite to limit conversation during a meal (Kittler 2001).

Etiquette – the ‘how’ around eating

Barriers to accustomed food consumption

• Fish and seafood not available• Rice not available or expensive• Essential sauces, condiments and spices not available• Beans and other dried goods not available• Fresh veggies not available or not fresh• Not used to using the oven or stove (use of wok)

“The Healthy Immigrant Effect”

• Generally not evident among refugees.• Refugees to Canada often have much lower health

status on arrival than that of voluntary immigrants• Not only do refugees arrive in poorer health, their

health is also more likely to decline after arrival.

Possible Explanations Of Newcomer Health Advantage

• Healthier diets, habits and behaviors inherited in the country of origin.

• Access to better food variety• Required to pass a health exam prior to entering Canada.

Challenges to Nutrition Among Newcomers

• Language barriers• Limited finances • Limited availability of traditional foods• Differences in cooking methods and use of appliances• Unfamiliarity with large grocery store• Unfamiliarity with the variety of foods available• Lack of time to shop and cook

FOOD SECURITY

• Food availability: sufficient quantities of food available on a consistent basis.

• Food access: having sufficient resources to obtain appropriate foods for a nutritious diet.

• Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation.

• Food insecurity is one of the critical problems influencing the health and well-being of vulnerable populations such as refugee newcomers

Dietary Acculturation

Process by which newcomers adopt the dietary practices of the host country

Risk factors for Chronic Disease

Level of dietary acculturation

• Learn risks and benefits of traditional/ethnic foods• Adapt nutrition messages and develop flexible approaches• Use effective health promotion strategies• Refer to outreach to immigrants can access • Ask about food choice in immigrant families • Encourage clients to get recommended amounts of physical

activity by assessing their interests and suggesting culturally relevant pursuits

Moving Forward

Family Nutrition program – Food for Thought

SODS Programs

Parents talk and nobody’s perfect.

Community Garden

Collective Kitchen

Men’s group Men’s cooking class.