Karen M. Kobayashi

Ethnic differences in self-rated and functional health: does immigrant status matter?

The current study examines self-rated health status and functional health differences between first-generation immigrant and Canadian-born (CB) persons who share the same ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Multivariate analyses of data from the 2000/2001 Canadian Community Health Survey indicate that first-generation immigrants of Black and French ethnicity tend to have better health than their CB counterparts, while the opposite is true for those of South Asian and Chinese origins, providing evidence that for these groups, immigrant status matters. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign-born and CB persons generally converge after controlling for sociodemographic, socioeconomic status (SES), and lifestyle factors. Analysis of the data does however reveal extensive ethnocultural disparities in self-rated and functional health within both the immigrant and CB populations. Implications for health care policy and programme development are discussed.

Making Meaningful Connections: A Profile of Social Isolation and Health Among Older Adults in Small Town and Small City, British Columbia

Objective: The objectives of the study are: (a) to develop a profile of socially isolated older adults (SIOA) in British Columbia (BC) based on sociodemographic and health characteristics and (b) to examine whether SIOA under-or overutilize health care services. Method: This study uses telephone interview data collected from a random sample of 1,064 older adults (65+) in BC. The sample was identified using established criteria from the six-item Lubben Social Network Scale. Results: The results indicate that 17% of the sample is socially isolated. To summarize, the strongest predictors of social isolation are income, gender, marital status, self-rated health, length of residence, and home ownership. Further analysis indicates that SIOA were not more inclined to overuse health services. Discussion: The findings underscore the importance of understanding differential profiles of need and service use for SIOA within broader social contexts, and are discussed in terms of their implications for health care policy and program planning for this vulnerable population.

Examining the gender, ethnicity, and age dimensions of the healthy immigrant effect: Factors in the development of equitable health policy

This study expands on previous research on the healthy immigrant effect (HIE) in Canada by considering the effects of both immigrant and visible minority status on self-rated health for males and females in mid-(45-64) and later life (65+). The findings reveal a strong HIE among new immigrant middle-aged men, particularly non-Whites. For older men of color the reality is strikingly different: they are disadvantaged in health compared to their Canadian-born counterparts, even when a number of demographic, economic, and lifestyle factors are controlled. Health outcomes for immigrant women are in contrast to that of immigrant men. Among middle-aged women, immigrants, regardless of their ethnicity or number of years since immigration, are much more likely to report poor health compared to the Canadian-born. And, for older women, recent non-white immigrants are more likely to report better health compared to Canadian-born women, although this finding is explained by differences in demographic, economic, and lifestyle factors. Overall, the findings demonstrate the importance of considering the intersections of age, gender, and ethnicity for policymakers in assessing the health of immigrants.

Examining social isolation by gender and geography: conceptual and operational challenges using population health data in Canada

In 2003, the Canadian Federal/Provincial/Territorial Task Force on Seniors identified social isolation as an important issue for further study and policy development given that socially isolated persons are considered to be more vulnerable to both inappropriate use of the health care system and poorer health outcomes. In order to provide adequate support to this vulnerable population, it is critical to untangle the complex web of relationships that influence the need for care, and the health status and service utilization patterns of socially isolated older adults. Using data from the 2000–01 Canadian Community Health Survey (CCHS), this article explores social isolation as a multidimensional social construct examining in particular the axes of gender and geography to try to tease out some of this complexity and its relationship to health status and service utilization. When individual characteristics like gender are considered together with broader contextual variables like place of residence, a more comprehensive and layered portrait of vulnerability among socially isolated persons begins to emerge with insights into their unique patterns of health and service use. For example, home care may be an extremely critical resource for keeping older women in their homes and out of hospital. On the other hand, among socially isolated older men, those living in rural communities may be particularly ‘invisible’, neither benefiting from home care nor having strong social supports. It seems plausible then that both men and women may be in need of special interventions or targeted programmes to help them to remain, or to become, more socially integrated in their communities as they age in place. In addition, this article addresses some of the limitations of using both a quantitative analytic approach and the CCHS dataset itself in grappling with such complexity.

Revealing the shape of knowledge using an intersectionality lens: results of a scoping review on the health and health care of ethnocultural minority older adults

ABSTRACT This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health-care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health-care systems. Approximately 3,300 source documents were reviewed covering the period 1980–2010: 816 met the eligibility criteria; 183 were Canadian. Summarised findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognises the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canadas two largest immigrant groups – Chinese and South Asians – had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentialises culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.

The Use of Complementary and Alternative Medicine among Chinese Canadians: Results from a National Survey

This study examines the relationship between Chinese Canadian ethnicity and the use of complementary and alternative medicine (CAM) and explores some of the factors that contribute to CAM use among this visible minority group. Using data from cycle 2.1 of the Canadian Community Health Survey (2003), we use multivariate logistic regression to investigate the extent to which CAM use varies among Chinese Canadians and non-Chinese Canadians. Two three-way interactions, which demonstrate how the combination of certain identity markers increases their predictive value within the model, are also examined. The use of CAM varies according to ethnicity, with Chinese Canadians being more likely to use than non-Chinese Canadians. The findings also indicate that cultural factors play a key role in establishing the necessary conditions for increasing the likelihood of CAM use for Chinese Canadians. Findings are discussed in terms of their implications for health care policy and program development.

The Influence of Culture on the Oral Health-Related Beliefs and Behaviours of Elderly Chinese Immigrants: A Meta-Synthesis of the Literature

Neglect of the mouth can lead to impairment, disability, and discomfort; as a result, it can have a negative impact on quality of life in old age. Some minority groups in North America shoulder a disproportionate burden of dental impairment compared to people of European origins, possibly because of different cultural beliefs and a distrust of Western oral healthcare. This paper explores these factors in elderly Chinese immigrants through a meta-synthesis of selected literature that reveals a dynamic interplay of traditional Chinese beliefs about oral health, immigration, and structural factors mediating access to Western dentistry. It also identifies several conceptual issues and gaps in knowledge, offers avenues of research including the cross-cultural application of two recent models of oral health, and discusses various strategies for improving access to dental services for minority populations.

From Motivations to Accounts: An Interpretive Analysis of “Living Apart Together” Relationships in Mid- to Later-Life Couples

Living Apart Together (LAT) relationships involve two people in a long-term, committed intimate relationship who choose to live in separate households. We present findings from one of the first Canadian studies of this phenomenon, also distinct in its use of an interpretive approach to the phenomenon. Fifty-six mid- to late-life participants (28 couples) were interviewed in-person; data were analyzed through the lens of interpretive inquiry. LAT relationships were constructed by participants as protecting personal independence while mitigating relationship risks associated with cohabitation. Participants further justified their arrangements by drawing on ideas about age and/or gender. Though LAT arrangements may help enact the empowering potential of Giddens’ “pure relationship,” they can represent individual-level solutions to broader gendered inequities in cohabiting relationships.

Explaining the Health Gap Experienced by Girls and Women in Canada: A Social Determinants of Health Perspective

In the last few decades there has been a resurgence of interest in the social causes of health inequities among and between individuals and populations. This ‘social determinants’ perspective focuses on the myriad demographic and societal factors that shape health and well-being. Heeding calls for the mainstreaming of two very specific health determinants - sex and gender - we incorporate both into our analysis of the health gap experienced by girls and women in Canada. However, we take an intersectional approach in that we argue that a comprehensive picture of health inequities must, in addition to considering sex and gender, include a context sensitive analysis of all the major dimensions of social stratification. In the case of the current worldwide economic downturn, and the uniquely diverse Canadian population spread over a vast territory, this means thinking carefully about how socioeconomic status, race, ethnicity, immigrant status, employment status and geography uniquely shape the health of all Canadians, but especially girls and women. We argue that while a social determinants of health perspective is important in its own right, it needs to be understood against the backdrop of broader structural processes that shape Canadian health policy and practice. By doing so we can observe how the social safety net of all Canadians has been eroding, especially for those occupying vulnerable social locations.

The Meadows School Project: Case Study of a Unique Shared Site Intergenerational Program

This paper describes a unique intergenerational project that the authors propose to be considered under the banner of “shared site” programs. The Meadows School Project shares important features with many intergenerational shared site programs. Its goals to build community, dispel stereotypes, and increase understanding and meaning in relationships between generations are achieved through intensive, high-quality interaction sustained over time. This case study highlights benefits and challenges in line with those noted in other studies of intergenerational shared sites and underscores the importance of further research on important environmental, community, program, and policy dimensions to inform theory and best practice guidelines.