Melting pot harmful to health?

Mark Kaplan, associate professor of community health, will be going to Ottawa, Canada, under a Fulbright grant to consider, in part, why Canadians tend to live longer than U.S. residents.

In Kaplan’s expectation, it’s not due entirely to the fact that Canada has a universal health care system while the United States does not. Rather, he believes it may be attributed to Canada’s public health system in contrast to the U.S. system.

Most people emphasize the Canadian health care system, he said, “but public health is more than just sickness care. The fact that prenatal care is universal in Canada seems to have a greater impact on the health of the population than sickness care.”

Kaplan’s work in Canada will relate to research he’s been doing at Portland State over the past three years, and working with Canadian colleagues, others at PSU and at Oregon Health and Science University.

He said when we rank life span in the United States with industrialized countries such as Japan, France and other European countries, Americans fall behind in terms of average longevity.

“One intriguing idea, in my mind, is perhaps the greater emphasis in Canada on the nonmedical determinants of health,” he said. He mentioned air quality and questions of income inequality.

“When you add it all up, sickness care contributes far less than what we thought to the health of the population,” Kaplan said. Long-term studies, he recalled, have shown that mortality rates of some diseases began to decline well before the development of medical technology to treat those conditions.

The development of antibiotics, he said, was a significant part, but not the only part.

“Some would argue in the final analysis it’s cleaning up the environment and improving the quality of life, including dietary practices, including the nutrition of the population,” he summarized.

Kaplan said improving the public health infrastructure might have a greater impact than simply providing people with more medical care.

“We spend more than other advanced industrial countries in health care per capita, a lot more than what Canada spends, and yet the outcomes do not reflect that investment.”

Kaplan has attracted attention recently for a study he did on immigrant population health, in collaboration with Jason Newsom, senior resident associate in the PSU Institute on Aging; OHSU researcher Benston McFarland; and others. Their work suggests that a shift of immigrants toward a Western lifestyle could have adverse effects on health.

“In a world that’s becoming more diverse, more movement from one country to another – specifically when you look at a group of the Asian population – what happens to a population with traditional culture that becomes Westernized?” he asked. The effects often seem to be negative.

“There is a whole host of studies that have shown this to be the case with groups that have over time began to change their belief systems, their values, their dietary practices and language patterns,” he recalled.

In Kaplan’s Canadian study, the team looked at one phase of this, the increase in hypertension or high blood pressure in an Asian immigrant population as it acculturated.

“If we looked at the immigrant population over time and measured that by recency of immigration, what surprised us was that in Canada the Asian population was healthier in terms of lower rates of blood pressure when they first arrived,” he said.

High blood pressure is considered a major health problem, a risk factor in stroke and heart disease.

In Kaplan’s view, the increase could be due to changes in lifestyle, changes in dietary practices, meal pattern changing or food choice changing, among other influences. The American habit of snacking may have some influence, as may the American habit of solitary eating – ducking into a fast food restaurant for a quick hamburger, for example.

Kaplan is especially interested in the nonmedical determinants of health.

“The question for a society such as ours – that still lives on the principal of the Melting Pot theory – that we want all societies to blend in and assimilate – is how do we protect those qualities of a culture that have beneficial effects?” he said. “How do we minimize the negative effects of acculturation?”

The question applies to populations other than Asian immigrants. He did a study on Mexican-Americans’ mental health. He found that as young adults, the more Mexican-Americans become acculturated in this country, the more they become prone to psychological distress and depression. Discrimination may play a part in these results. The loss of group identity may also play a part in all immigrant populations.

He sees some potentially simple solutions, but politically they are challenging, due to anti-immigrant sentiment both in North America and Europe.

Kaplan’s hypertension study has resulted in substantial media attention, including interviews on “Voice of America” and CBS Radio Network.