Chasing a healthy dream

A friend of mine arrived in Brownsville from Tabasco, Mexico when her kids were 3, 5 and 7 years old. She came with her husband, a U.S. citizen, but within a couple of years he had left them.

“When we arrived we were healthy and energetic — grateful for the opportunity to live in the United States.” After her husband left, she decided to stay since her kids were in school here, learning English and adjusting pretty well. She knew her family in Mexico was very poor and she and her kids would be a huge financial burden to them. She didn’t have any work or career to go back to, so she decided to try and make a go of it here, hoping it would increase opportunities for her children in the future.

She found work cleaning houses and caring for the elderly. It was hard work, especially managing her three kids, without a car, or any family around to help. “We barely made it, but thank God, my kids were healthy. They ate breakfast and lunch at school. I would buy the cheapest food I could find from the dollar store down the street, which didn’t include fruits and vegetables. I was used to eating a lot of fresh fruit in Mexico and I missed that. Fortunately I walked all over town since I didn’t have a car so I was pretty active. I finally saved enough to buy an old car, so now I don’t walk as much.”

Over the years she and her kids started gaining weight. “I assumed they were eating healthy food in school but I have since come to find out that wasn’t always the case. I knew they didn’t get much exercise because they were mostly inside our tiny, one room apartment. There was nowhere safe for them to play outside and the closest park was about 4 miles away across a busy street.

I would come home late and exhausted from my two jobs and often they would have to stay with my neighbor/friend and would end up watching T.V. for hours while I worked. It really wasn’t the life I had dreamed of for them. In Mexico I grew up playing outside, and eating fresh fruit off the trees.

My oldest daughter developed asthma and this was a huge struggle for us since we didn’t have documents and didn’t qualify for any health coverage or assistance. I couldn’t afford the medication or doctor visits and often I had to rely on friends to bring me medication from Mexico. My health has deteriorated too. Frankly I have gained weight, now have high blood pressure and suffer from depression, which I never thought I would have.”

“Yet I am so grateful that my kids have done well in school and now, ten years after we arrived here, my daughter is going to college, since she finished 3rd in her high school class. My other son and daughter are also top students and play in the school band. I would love to return to Mexico but now I feel like my kids are so American. They don’t even remember our first home since we haven’t had the opportunity to return.”

Mari describes a common tale of healthy, vibrant immigrants arriving in the U.S. but over time, often a generation, the health advantage is gone. Study after to study, in both the U.S. and Canada has revealed this phenomenon that has become known as the “Healthy Migrant”.

Scientific research shows that on many measures first generation immigrants are often healthier than U.S. (or Canadian)-born residents who share the same or similar racial and ethnic backgrounds. Overall, however, with time this health advantage decreases. This has been called the paradox of assimilation (Rumbaut). This is particularly surprising because immigrants tend to have higher rates of poverty than U.S.-born residents, and because many come from countries that have lower median household income than the U.S. (Singh and Siahpush), yet they start out healthier.

The length of time an immigrant spends in the U.S. is directly correlated with increased rates of obesity, lower infant birth weight, adolescent risk behaviors, cancer, anxiety and depression and general mortality. Changes in diet and increased use of tobacco, alcohol and drugs account for some of the increases in health problems among immigrants.

Acculturation to an unhealthy American diet is associated with obesity, diabetes and cancer (Mazur et al). In fact, Health Survey Data on over 196,000 respondents from 1997-2002 found that foreign-born residents had lower levels of obesity, hypertension, diabetes, cardiovascular diseases and serious psychological distress than U.S.-born residents (Muening and Fahs).

This reality should serve as a useful mirror for all of us to acknowledge how our environment, mass media, lifestyle and culture strongly affects our behavior and health and how economic pressures, social isolation and access to healthy options can directly impact our health, often more so than “advanced medicine”.

There are many compelling reasons for folks to come to this country, like escaping war and violence, for educational or employment opportunities or simply wanting to work hard and make a living to survive. These are all the reasons my relatives from prior generations arrived on US shores from Europe. The factors that influence the shift from very healthy to less healthy in just one generation are many of the same that are making all of us unhealthy. We all have immigrants in our families, many just a generation or two ago. We can learn healthy lifestyles by looking back at how our own relatives and ancestors lived — or from our neighbors and new arrivals from other places and cultures. While we can boast modern technology, pharmacology and an expensive and complex health care system that can work miracles in some medical emergencies, we have a lot to learn about healthy day-to-day living, mobility, diet, physical activity, and family/social support systems that can ultimately improve our health and quality of life, because Tu Salud ¡Si Cuenta! (Your Health Matters!)

Rumbaut R. Paradoxes of assimilation. Social Perspective 1997;40(3):483-511.

Palinkas LA, Pickwell SM, Brandstein K, et al. The journey of wellness: Stages of refugee health promotion and disease prevention. J Immigr Health 2003;5(1):19-28.

Singh GK, Siahpush M. All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health 2001;91(3):392-399

Muening P, Fahs M. Health status and hospital utilization among immigrants to New York City. Prev Med 2002;35:225-232