A recent article in the New York Times discussed an important connection between health disparities and demographics in the United States: Immigrants, particularly in the Latino community, often have worse health outcomes after coming to the United States.
Unfortunately, however, the article focused almost exclusively on one lifestyle change that comes along with immigrating to the United States—a change in diet—and overlooked what may be an even more important contributing factor: racism.
The article outlines what many of us already know. The American diet is full of highly processed, cheap, and easily obtained foods, and immigrants are not immune to the pull of these choices, or the economic factors that make these foods so prominent in our diets.
Within the context of the supposed “American dream,” it may seem surprising that people who make major sacrifices to come to this country, often risking their lives to do so, don’t actually experience a better life. But for those of us who know more about the actual lived reality of immigrants, particularly those who are people of color, it may not come as a surprise.
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What infuriates me about these kinds of perspectives is that they often overlook the larger systemic elements at play in exchange for a focus on what seems to be a problem resulting from bad choices by individuals. Obesity, although its correlation with shorter life expectancy, as implied in the article, is often disputed, is a convenient scapegoat for a whole host of health disparities. It’s used to explain the growing rates of maternal mortality and morbidity, for example.
Meanwhile, there is a growing body of research documenting the impact of racism on our health, implying that there may be a much more nuanced and systemic answer to the question of why second-generation Mexican-Americans have higher rates of high blood pressure and diabetes than their parents. These possible explanations could include everything from the stress that results from experiencing racism to the ways in which racism affects health care. A recent survey of women who gave birth in the United States, noted, “About one in five black and Hispanic women report poor treatment from hospital staff due to race, ethnicity, cultural background, or language. Compared with 8% of white mothers, 21% of black mothers and 19% of Hispanic mothers perceived such poor treatment while hospitalized to give birth.”
The New York Times article only once hints at how racism may play a factor in immigrants’ health care—in a description about how immigrants in one town stopped walking for exercise because they were afraid of being perceived as undocumented:
The lifestyle takes its toll. The county in which Brownsville is situated, Cameron, has some of the highest rates of obesity and diabetes in the country. The numbers are made worse by a lack of physical activity, including walking. Immigrants said they felt so conspicuous during early attempts to walk along the shoulder of the roads that they feared people would suspect they were here illegally. Ms. Angeles recalled that strolling to a dollar store provoked so many stares that she felt like “a bean in rice.”
This isn’t a question of “lifestyle”—it’s about the lived reality of racism. A white person would likely have no such fears of walking around their neighborhood or to a local business, or fears of being profiled or singled out as undocumented. This is just one example of many that we could likely point to to demonstrate the effects of racism on the health of immigrants and other people of color.
These systemic analyses of health disparities are crucial if we’re ever going to get to the root causes of health disparities. There is even a new movement to shift away from “cultural competency” and toward “structural competency” for medical providers to improve health-care delivery for individuals affected by these disparities.
I can’t wait for the day when estimable journalistic outlets like the New York Times look past the tired tropes of individual choice and toward the larger systemic elements at play. Stop ignoring the elephant in the room.