Keeping immigrants and all of us healthy is a social task

The Health Toll of Immigration, by Sabrina Tavernise in the May 19 New York Times, documents the decreased life expectancy and worse overall health that accompany immigration to the United States. Focusing on Mexican immigrants in the border city of Brownsville, Texas, but drawing on data about other ethnicities and even time periods, the article provides convincing data that descendants of people who immigrate from Mexico and other, poorer, countries, have, in general, worse health, greater rates of obesity and diabetes, and shorter life expectancies than their parents or those who stayed. The numbers are impressive:  “A 2006 analysis by Gopal K. Singh, a researcher at the Department of Health and Human Services, and Robert A. Hiatt, a professor of epidemiology and biostatistics at the University of California, San Francisco, found that immigrants had at least a 20% lower overall cancer mortality rate than their American-born counterparts. Mortality rates from heart disease were about 16%  lower, for kidney disease 18%  lower, and for liver cirrhosis 24% lower.” It seems to get worse for later generations; “Elizabeth Arias, a demographer at the National Center for Health Statistics, has made exploratory estimates based on data from 2007 to 2009, which show that Hispanic immigrants live 2.9 years longer than American-born Hispanics.”

Some, perhaps most, of this is related to the prosperity of the US, and the easy availability of cheap, high fat, high sugar, high calorie food. One woman, who came to the US at 26 and has since developed diabetes, says she was amazed at seeing hamburgers as big as dinner plates; “I thought this really is a country of opportunity! Look at the size of the food!” Grueling work hours, both parents working (when both are here) make time for preparation of healthful food scarce, and more cash in their pockets allows the purchase of tasty-but-bad-for-you fast food. In addition, there is evidence of increased smoking and drinking as immigrants move into the US underclass, a group particularly targeted by marketing efforts for these substances of abuse.

Traditional diets for most people, including Mexicans, are based on food that is grown or found wild (vegetables, cactus) or bought in bulk (rice and beans). These are high fiber and low in empty calories. Robert Valdez, from the Department of Family and Community Medicine and Economics at the University of New Mexico, is quoted as saying “All the things we tell people to do from a clinical perspective today — a lot of fiber and less meat — were exactly the lifestyle habits that immigrants were normally keeping.” There is some evidence that there may be a genetic predisposition to diabetes in some Latinos, particularly Mexicans, as there is in American Indians; after all, Mexicans are largely a mestizo people with much Indian “blood”. Of course, these observations may be related; the natural diet of native peoples did not provide the environmental  factors (high calories, obesity) needed to trigger clinical diabetes, and so the genes for this did not “die out” as readily as in other groups. The same model is seen in South America; the remote Xingu Indians of the Amazon now have extremely high rates of diabetes where it never existed before the introduction of “white” food (used to refer to the color of the food as well as of the people who introduced it).

The other big factor is physical activity. While many immigrants work in physically demanding jobs, the prevalence of physical activity is not as great as for those living on farms in Mexico. One man talks about losing 75 pounds motivated by the image on the wall of his grandfather, who is 93 and still rides his bicycle every day. Yet, 4 of the 6 siblings of the grandson are obese and have diabetes. Another immigrant talks about walking in her early years in the US and feeling so conspicuous (“a bean in rice”) that she was afraid people would think she was here illegally. This has also been described in African-Americans moving from the agricultural (and very poor) South to a more prosperous, but sedentary, life in the North, and in most families a generation or two removed from farms, whatever their ethnicity. Concepts of what is “enough” food, what is a “good” breakfast or dinner for our children, did not change as quickly as lifestyles did. Our culture does not require physical activity as part of daily life the way farming, including subsistence farming, did, but we fed our children the same number of calories as we did (if we were prosperous farmers) or would have liked to, or more, because it is more easily available. Indeed, these changes are not limited to the US; things are changing for the worse (in terms of health) in Mexico as well; citing the fact that up to 40% of the rural diet in Mexico comes from packaged foods, “Researchers are beginning to wonder how long better numbers for the foreign-born will last.”

These are all factors in the “social determinants of health” – how we eat, how we exercise, how poverty grinds us down and how marketing of harmful substances like tobacco, alcohol, and high-sugar foods take their toll at even greater rates on the poor. This is not to romanticize rural poverty, of people, including children, having to do excessive physical labor in order to survive and thus burn up more calories than they consumed, or to minimize the difference between a rural/farming life which provided enough income to supply those calories and those in which malnutrition claimed lives and health. It is, rather, to point out that some of these terrible conditions ironically protected the health of its victims. This has been observed in the past; beri-beri occurred more in wealthy Chinese who ate hulled white rice than in the poor who ate the rice with hulls that contained the thiamine. In England in the early 20^th century alcoholic cirrhosis was a disease of the rich who could afford highly-taxed spirits, while workers drank watered beer. The image of the wealthy many as obese – and suffering from gout, "The disease of kings1" (all that high-protein food) persists in cartoons.

Dr. Arias, cited above, observes that the health status of immigrant families “…may indeed improve as they rise in socioeconomic status, which in the United States is strongly correlated with better health.” Of course, there is no guarantee that longer time in this country will cause a rise in socioeconomic status; the last decade shows a persistent decrease in the socioeconomic status of most Americans, despite a “recovery” measured by Wall St. stock prices. The answer is not to regress to rural poverty, but it is to address these social determinants. It is to build towns that encourage walking and other physical activity. It should be to make fresh, healthful food widely available. It should involve education in schools about healthful eating, not undercut by junk food available in machines. It should limit advertising for poisons such as tobacco and alcohol. It should make clean air and water a priority, and ensure everyone has access to good health care.

 It should be a no-brainer, but in the politics of the US today, it may not be. Charles Blow in his May 18, 2013 column “Resonance Resistant”, notes that “We all know that anything with ‘social’ in its name activates the conservative gag reflex.” This is crazy; we are social beings. We can do better, and we should.

Immigration and the US: Happy New Year

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I sit in Arizona at Christmas, finishing Dennis Lehane’s novel “The Given Day”[1]. Set in 1919 in Boston and culminating in the landmark Boston police strike of that year, Lehane documents the “red scare” of that period, accompanied by the real number and strength of “reds”, the overt racism of the period along with the early days of the NAACP, the early days of the labor movement, the early days of John E. Hoover and the BI (later, of course, J. Edgar and the FBI), all set to a backdrop of the mid-career of Babe Ruth and the Red Sox (and his ultimate move to the New York Yankees). But from here, in Tucson, what seems most relevant today is that it documents the massive immigration (at that time in Boston mostly of Italians, Russians, and Jews) and anti-immigrant sentiment that accompanied it. So our current anti-immigrant furor is nothing new. It has deep roots, and is now, as it always has been, misguided.

Of course, American anti-immigrant movements go back much farther than 1919. Before the Russians, Italians, and Jews of the late 19th and early 20th century. Before even the Irish immigration, the xenophobic reaction to which was dramatically shown in the 2002 Martin Scorsese film “The Gangs of New York”. Before the Germans, back to the Alien and Sedition Acts of the John Adams administration at the end of the 18th century, and probably before that. Every group of European immigrants I have mentioned and more, Asians from China, Japan and the Philippines, and many others, have been vilified in their time. Each has been attacked by those already here, and ready to raise the drawbridge behind them. And they have made America great.

They come to America to escape grinding poverty or to maximize their opportunity. Most are poor, but some are doctors and engineers who believe they can do even better here than in, say India or Africa. (This is another issue, of brain drain, which I have touched on in earlier posts). Every time there are those “nativists” (some not here long themselves) who want to close the door, who worry that “they” will take “our” jobs. In Lehane’s book immigrants are leaders of the unions (as well as the radical revolutionary groups); immigrants have always mainly been workers. And is it different now, as the main focus of anti-immigrant wrath are those from Mexico? The wrath is centered here in Arizona (although, it should be noted, the sentiment is not uniform; although only symbolic, the Tucson City Council voted to oppose the state anti-immigrant law), and felt not only in the Southwest but all over the country. Does it make a difference that so many Mexican immigrants are “illegal”? Many of our citizens have been illegal. The major secondary characters in “The Given Day”, two older policemen who enforce “order” for the “Big Money” folks, came to the US from Ireland as teens, stowing away on a ship, and literally escaping into the streets of Boston, before later joining the force. Illegals, certainly, who believed themselves to be more "American" than the current generation of immigrants. And fictional, but representative of many real-life characters. Many “illegals” became citizens after serving in our armed forces, especially in World War II, when “we” needed “them”. Of course, America always needs “them”, to build our cities, our railroads, or industries; to be our engineers and storekeepers and cops and firemen and packing-house workers. We are “them”.

And we remain them, and they us, with only few exceptions. American Indians, whose “immigration” may have been in pre-history, and African-Americans, brought here in bondage, arguably the two most oppressed and discriminated-against ethnic groups. We can no more honorably close the door now than the descendants of English colonists who stole Indian land could for the Germans, or Irish, or Chinese, or Russian, or Polish, or Filipino, or Italian, or Jewish immigrants who succeeded them. They have always been the ones who did the work. Who pay taxes (so they are not caught) but receive no benefits, because we pass laws against “illegal” immigrants – denying them health care, denying them safety. Yet they are here; they get sick and injured, in working two and three jobs. And paying into benefit funds such as pensions and Social Security and Medicare for those of us, from earlier immigrations, to retire on, and receive our health care from. We can pass a health reform law that specifically excludes them from health coverage, not even allowing them to buy with their own money, but they will still need health care. We can even, in a gesture worthy of the persecutions of the 1920s, not pass the “Dream Act” so people who were brought up in this country can attend college with their classmates. Vigilantes can “patrol” the border, and fascist thugs like Maricopa County Sheriff Arpaio can terrorize entire communities. We can pass laws that make it a crime to help save the life of a person found dying in the desert. We can talk of children born to immigrant parents as “anchor babies”, and here I need to refer people to Lalo Alcaraz’ Christmas Day cartoon in his strip “La Cucaracha”. We can, and do, do all sorts of mean, short-sighted, and selfish things to oppress people, but this does not make them wise, honorable, moral, or even sensible. We can, however, be better than that.

In the coming year, I hope the Dream Act passes. And I hope that we can define ourselves, as Americans and as human beings, by our wisdom, our foresight, and the nobler parts of our nature, rather than by our narrowness, meaness, and bigotry.

Happy New Year.

[1] Lehane, Dennis. The Given Day. Harper Collins. New York. 2008.
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