Social Determinants of Health for Immigrant Youth: Experiences from St. James Town Initiative

Social Determinants of Health for Immigrant Youth:

Experiences from St. James Town Initiative

Nasim Haque, MD, DrPH

Director, Community Health

Wellesley Institute

1 November-30-11 | www.wellesleyinstitute.com

Adolescent Medicine Rounds

Hospital for Sick Children

November 30, 2011

Overview: Immigrant Youth Children and youth make up a significant portion of immigrants into Canada

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Status of Immigrant Youth: Where are they settling?

• 17% refugees, 32% independent category, and 40% family-class immigrant

• ~ 200,000 non-status in Canada of which 50% reside in Toronto & their age demographics are not known

• Among all immigrant youth in Canada in 2006, over 2/3rd live in Toronto, Vancouver or Montreal

Salehi, R. 2010. Intersection of Health, Immigration, and Youth: A Systematic Literature Review. J. Immigrant Minority Health 12:788-797.

November 30, 2011 www.wellesleyinstitute.com | www.sjtinitiative.com

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SJT Initiative is a 5 year CBPR Initiative of WI

Research Question:

What implications do neighbourhoods have on the health & well-being of immigrants?

Results:

Inform policy & support social change at neighbourhood level

About St. James Town Initiative


Community Action

Strategies & Activities

Participatory Action

Research

Skill enhancing opportunities

Student internships

Work with multiple

stakeholders

SJT Initiative website

1) Adult Photovoice

2) Community Mapping

3) Concept Mapping

5) Focus groups/interviews (CAC)

SJT Residents Action Group

COMMUNITY ENGAGEMENT

6) Sample Survey (CIHR funded)

4) Youth Photovoice

Multi-pronged Approach

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14,666 Residents

64,636 People / km2

(Unofficial Estimate: 25,000)

64% Immigrants

18 Aging High-Rise Buildings

Production of Health

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The social & economic

environment

The physical environment

Person’s individual / biological

characteristics & behaviours


H E A L T H

Immigrant Youth have Added Burden of Migration Experience

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Migration Experiences

• Complex, dynamic and context bound process that take place over time

• Psychosocial integration: • Acculturation, assimilation, settlement, adaptation

• Important to understand pre and post-migration experiences

of youth to address their health issues


What factors influence adolescent health and wellbeing?

Risks factors include, but are not limited to:

• Poverty, social exclusion, peer rejection, isolation, and lack of

family support

• Growing up in disadvantaged circumstances

• The migration process in countries of destination & origin

• Lack of positive social and community networks and

environments

9 November 30, 2011 | www.wellesleyinstitute.com/sjtinitiative.com

Voices of Multicultural Youth: Impact of urban neighbourhood on

health and wellbeing (2010)

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Research Example

November 30, 2011 | www.wellesleyinstitute.com/sjtinitiative.com

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Photovoice participants – SJT youth residents

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Photovoice to understand youth perception on neighbourhood and health & wellbeing?

Photovoice asks you to take photographs of things that are important to you - and to tell the story of why these things are

important. The visual images and accompanying stories are the tools used

to reach policy- and decision-makers.

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PHYSICAL ENVIRONMENT Parks and Green Space

© Wellesley Institute

In a community school field, this picture shows a number of children playing soccer on a

summer day. It reflects back to my life as it was a school I use to attend and school field I use

to play on as well. These activities are strengths in our community as children are kept away

from trouble. It should be part of any child’s childhood memory as they spend their summer

days having fun, rather than getting into trouble. (SJT Youth, 2010)

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As a child, one way I kept myself occupied with my time was through playing basketball. It not

only kept me off the streets, but also wasted the majority of my time, keeping me active. If more

community programs ran such activities, it would bring the community closer and keep children

off the streets away from any type of violence. These activities are strengths in our community

as children are kept away from trouble. (SJT Youth, 2010)

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PHYSICAL ENVIRONMENT Recreational Facilities


In a community where 73 percent of the population is immigrants, parents have to work to

put food on the table and so the kids are home alone. They will eventually go out in the

summer when it is extremely hot and if the swimming pool is packed, it is likely the child will

leave and play somewhere in the street. When they are in the street, they are exposed to

bits and pieces of bad things. Eventually they will get curious and see why they are so bad

themselves and they become criminals, drug dealers or even drug addicts...... Also

swimming is way to prevent child obesity (SJT Youth, 2010)

PHYSICAL ENVIRONMENT Recreational Facilities

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PHYSICAL ENVIRONMENT Plants and Gardens

This image gives the neighbourhood a vibrant, peaceful and beautiful effect. It also relates to

our lives because it is said flowers can help ease tension and mellow the mind. A reason that

these flowers are related to health apart from the calming aspect is that it also increases plant

life, breeds new ecosystems, and reduces some of the harmful gasses in our atmosphere. (SJT Youth, 2010)

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PHYSICAL ENVIRONMENT Plants and Gardens

This flower may look like an ordinary flower, however it represents so much more. It is

unfortunate that we don’t see many gardens around or plants being planted around the

neighbourhood. This also relates to our health in a bad way because our neighbourhood is filled

with only buildings making it look depressing to walk through.

Flowers give humans a chance of breathing fresh air, thus, it’s useful for health. By seeing

different flowers our mind get energized (SJT Youth, 2010)

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... In a neighbourhood such as St. James Town where most people live in high rise buildings and come from low income families it may not seem like the best idea to build more buildings when we don’t already have that much green space around. This issue relates to your lives because we need more things than buildings around our community, such as more parks, centres for youth but instead we invest in building and more buildings.

(SJT Youth, 2010)

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PHYSICAL ENVIRONMENT Overcrowding

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SOCIAL ENVIRONMENT Safety, Crime, Drugs, Fear

The picture shows a memorial of a residence of St. James Town whose life was robbed off him

last year due to gun violence. The person who murdered “Juice” is yet to be found. It just comes

to show that more security is needed in the area. A lot of undercover police are the area

dressing up as drug dealers or buyers but they are usually easily spotted and pin pointed.

(SJT Youth, 2010)

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VIOLENCE AND CRIME

“It is a problem that after 12 a.m. going out alone is kind of suicide to residence. I have been in trouble many times that now I try not to go or if I want to go I go with my friends which is more safe for me.”

“During night time this area is not really safe, because in a neighborhood where a lot of gang plays, bad crime and other bad things happened and a lot of young boys and girls are coming at night time to smoke and sometime when they got drank they start fighting with people and with themselves. In my opinion that area is not safe at the middle of the night and we need more security there.”


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SOCIAL ATTRIBUTES Places of Worship

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In a way this can relate to our health because there are many other things that have to do with

health and not just physicalness but also emotionally. People pray and worship what they do to

make themselves feel better and that has to do with our health. (SJT Youth, 2010)

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This is good for our health because children are getting an education they deserve and will get

so the future could be better. This strength exists because of the strong community involvement

with he school. All the parents are all in the parent council meetings and voice their opinions

which benefit the school. (SJT Youth, 2010)

SOCIAL ATTRIBUTES School

This is related to our lives because every day we are witness to some type of harmful carcinogens produced by these cigarettes. Whether second hand, or first hand smoke, living in St. James Town means a high chance of encountering cigarettes. Because of this more people are exposed to harmful chemicals.

(SJT Youth, 2010)

RESIDENT BEHAVIOUR

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ECONOMIC ENVIRONMENT ©

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Money also leads to better access to health most people living in St. James Town do not have money to go to the doctor and most of them do not have money to pay their rent. The money earned by some people is not even enough to properly feed them. The big issues around in this area are about money including the cost of living income and employment.

(SJT Youth, 2010)

Neighbourhood Quality & Depression (preliminary findings from SJT survey, 2011)

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0.5

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1.5

2

2.5

3

3.5

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Not or A Few Problem Some Problems Severe Problems

Od

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Perceived Neighbourhood Problems Effects on Depression

Non-Immigrant

Chinese

Filipino

Tamil

Concept Mapping results show that residents’ health is affected by a broad range of issues, most of which are outside of the health-care system

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Broad Determinants of Health a CBPR project on Neighbourhood & Health and Wellbeing

Results from Concept Mapping Project

Importance of Neighbourhood Factors on Health and Well-Being

r = .12

Importance Action Potential

4.12

3.56

3.51

3.08

Education Society

Need Social and Protection Lack of Maintenance

Attractions Sense of Pride

Lack of Maintenance &Improvement Green Space

Green Space Education

Safety Attractions

Environment Need Social & Protection

Sense of Pride

Environment Improvement for Health

Safety

Society Improvement for Health

* Absolute values for ratings range from 1-5

Residents rated the importance of various neighbourhood factors that had been identified as influencing their health and well-being.

November 30, 2011 | www.wellesleyinstitute.com/sjtinitiative.com

Results from Concept Mapping Project

29 September 23, 2011 | www.wellesleyinstitute.com/sjtinitiative.com

Important Stakeholders: Training Workshop 2 ©

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Community Forum & Expo: August 17, 2010

© Wellesley Institute

What are the Issues?

Immigrant youth tend to: • Live in low-income households and low-cost neighbourhoods which often

have higher poverty and crime rates and offer poor living conditions

• Lack social support – a contributing factor to the higher rates of depression and social exclusion

• Language barriers – remaining silent, appearing withdrawn, moody, and fearful

• Internalize a new set of cultural norms, and a new value system more quickly than their parents – confrontation with parents

• More likely to have less parental support to avoid risk behaviour and may be more susceptible to peer pressures to engage in risk behaviour

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Addressing the issue

1. Address health inequities: Are services “missing” for young people who, due to low socio-economic status, gender, migrant status, or family structure are at increased risk ? What mechanisms can help reach disadvantaged young people?

2. Involve immigrant youth: Are immigrant youth adequately involved in the design of service delivery? What can be done to further involve them?

3. Engage in inter-sectoral action: Given the importance of the school setting for most adolescents, what is the role of the health system in this regard?


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Estelle Sun: Project Coordinator, Wellesley Institute

Sami, Sarah & Dina: Youth Interns , summer 2009-2010

Ali Moallim : Community Leader, SJT

Sean McIntyre: Constituency Assistant to Area Councillor

St. James Town Youth project participants

Acknowledgement


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These speaking notes, and reports are available on our website at www.sjtinitiative.com

My email: [email protected]

Following - Up

© The Wellesley Institute

www.wellesleyinstitute.com | www.sjtinitiative.com 11/30/2011 35

ST. JAMES TOWN INITIATIVE www.sjtinitiative.com

THANK YOU

Social Determinants of Health for Immigrant Youth: Experiences from St. James Town Initiative

Health & Medicine

Transcript of Social Determinants of Health for Immigrant Youth: Experiences from St. James Town Initiative