The diversity of the Canadian population of Indian heritage (by way of language, region, and ethnic composition) can make it difficult to ascertain the health needs of this group. But in general, the health implications faced by Indian immigrants to Canada include: increased risk of chronic diseases; self-care capacity challenges; low treatment responses; heightened predisposition to some genetic disorders; and language barriers to health care services (Gupta & Misra, 2004).
Anemia
Iron-deficiency anemia is a major nutritional problem in India. Although the daily iron intake of many Indian adults reach upwards of 30mg/day, high intakes of anti-nutrients such as phystate, dietary fiber, and tannins combined with low intakes of meat related products affect iron absorption (Bindra & Gibson, 1986).
Indian Canadians often retain traditional food patterns; eating diets rich in grain-related products. The non-heme iron contained in grains is not readily absorbed by the body compared to the heme iron found in meat, poultry and fish; the primary source of iron for Canadian adults (Bindra & Gibson, 1986).
For instance, Indian Punjabi’s have an especially high prevalence of iron deficiency compared to the general North American population. A major source of cereal grains in the Punjabi diet consists of unleavened chapatti bread made from whole-what flour, high in phytic acid and dietary fiber (Bindra & Gibson, 1986). Both phytate and dietary fiber depress iron absorption. And iron absorption from whole-meal flour chapatti is less than 5% (Bindra & Gibson, 1986). Regularly used condiments, spices (tamarind, chillies, turmeric, coriander), and tea, are high in tannins, which also inhibits iron absorption (Bindra & Gibson, 1986).
Cancer
Changes in cancer incidence rates associated with immigration show that the most frequent cancer sites for Indian immigrants to Canada are more similar to the Canadian general population than that of their counterparts in India (Hislop et al., 2007).
The most frequent cancer sites for Indo-Canadians include the prostate (in males), breast (in females), colorectum and lung (Hislop et al., 2007).
Cancer patterns vary among the different regions in India.
For males, stomach cancer is the leading cancer site in Chennai and Bangalore, whereas oral cancer is the leading site in Delhi and Mumbai (Hislop et al., 2007).
For women, breast and cervical cancer together account for over 40% of cancers in urban areas and over 65% in the rural registry of Barshi (Hislop et al., 2007).
The age-adjusted incidence rate for gall bladder cancer amongst Delhi women is one of the highest in the world (Hislop et al., 2007).
Foreign birthplace as a barrier to cancer screening
Currently, breast health practices such as breast self-examination, clinical breast examinations, and mammography are low for Indian immigrants to Canada. This is influenced by their limited knowledge of breast cancer in general (Hislop et al., 2007).
Cultural barriers have also contributed to lower rates of cervical cancer screening amongst Indo-Canadian women (Brotto et al., 2007). Obstacles to regular HPV screening for cervical cancer includes a general reluctance amongst Indo-Canadian women to undergo the test in the absence of symptoms; fearing the diagnosis of cervical cancer (Brotto et al., 2007).
Other obstacles include self-denial; the cultural prioritization of the male gender; lack of knowledge; insufficient contact with the healthcare system; personal modesty; a lack of time, social support, and transportation (Brotto et al., 2007).
Additionally, screening for HPV — a sexually transmitted virus – is strongly associated with cervical cancer, so there is a fear amongst this group that screening for cervical cancer might create suspicions of infidelity and sexual promiscuity amongst families, and communities (Brotto et al., 2007). Furthermore, conservative cultural attitudes towards sexuality may underlie barriers to Pap test screening.
References:
Bindra, G. & Gibson, R. (1986). Iron status of predominantly lacto-ovo vegetarian East Indian immigrants to Canada: a model approach. The American Journal of Clinical Nutrition, 44, 643-652.
Brotto, L., Chou, A. Singh, T. & Woo, J. (2008). Reproductive Health Practices Among Indian, Indo-Canadian, Canadian East Asian, and Euro-CanadianWomen: The Role of Acculturation. J Obstet Gynaecol Can, 30, (3), 229–238.
Gupta, R. & Misra, R. (2004). Predictors of health promotion behaviours among Asian Indian immigrants: implications and practitioners. International Journal of Sociology and Social Policy, 24, (12), 66-86.
Hislop, T., Bajdik, C., Ram Saroa, S., Bhika Yeole, B., Barroetavena, M. & Barroetavena, C. (2007). Cancer incidence in Indians from three areas: Delhi and Mumbai, India, and British Columbia, Canada. Journal of Immigrant and Minority Health, 9 (3), 221-227.
