According to Statistics Canada, the South Asian visible minority group is broadly defined as any person who reports an ethnicity associated with the southern part of Asia or who self-identifies as part of the South Asian visible minority group. This definition encompasses people from a variety of backgrounds.

Cardiovascular disease and diabetes

In general, individuals of South Asian, Chinese, African, and Latin ancestry have an increased genetic susceptibility to insulin resistance, resulting in higher rates of metabolic syndrome, impaired glucose tolerance (IGT), abdominal (central) obesity, insulin resistance, type 2 diabetes in childhood, gestational diabetes mellitus, and diagnosed and undiagnosed type 2 diabetes with onset at a younger age (Gupta & Misra, 2004).

International migration can increase one’s risk for diabetes. For instance, the adoption of a sedentary lifestyle, changes in dietary habits, and obesity are common amongst international migrants (Gupta & Misra, 2004).

South Asian origin men and women have a higher prevalence of type 2 diabetes than indigenous populations (Barnett et al., 2006). They also have the highest rates of morbidity and mortality from diabetes-related cardiovascular disease (CVD), with 40% higher age-standardized mortality from coronary artery disease than Caucasians (Harvey et al., 2008). Such disparities in diabetes prevalence amongst South Asians are well documented in the United States (US) and the United Kingdom (UK).

In the US, the prevalence of type 2 diabetes among first generation Indian immigrants, is about two to three times higher than in the general US population (Gupta & Misra, 2004). Similarly, in the UK, the risk of type 2 diabetes increases four to six times for South Asian (Barnett et al., 2006). The age of diagnosis is significantly younger than the general population and is undiagnosed in up to 40% of South Asian individuals (Barnett et al., 2006).

The Canadian Diabetes Association suggests using ethnic-specific body mass index (BMI) and waist circumference cutoffs to improve risk stratification and targeted risk management strategies for high-risk ethnic populations such as South Asians (Harvey et al., 2008). South Asians tend to have a higher percentage of body fat for the same BMI when compared to Caucasians (Smith et al, 2006). Using lower BMI cut-off points will better evaluate overweight and obese South Asian people, since increased body fat at a lower BMI is associated with negative metabolic consequences (Smith et al, 2006). Ethnic-specific community based diabetes prevention programs that focus on lifestyle modification, prevention, and early detection of risk factors as well as targeted health promotion outreach programs are important (Gupta & Misra, 2004). As Indian immigrants acculturate to living in Canada, promoting positive health beliefs, attitudes, and behaviours require targeted educational programs about food choices in the western environment (Gupta & Misra, 2004). Mainstream western diets are usually higher in saturated fat, protein, simple sugars, and cholesterol. Combined with psychosocial stressors associated with working and living in a new environment, Indian immigrants are more predisposed to obesity, alcoholism, diabetes, and smoking (Gupta & Misra, 2004).

Mental health

Although over two-thirds of all South Asian Canadian females have regular access to a family physician, many do not utilize this source as a pathway to mental health care. Some report that South Asian women are more likely than the general Canadian population to exhibit psychosomatic expressions of depression and mental burden, such as frequent headaches, back pain, joint pain, hair loss and fatigue (Ahmad et al., 2004).

Acculturated stress

South Asian women are at greater risk for acculturated stress than their male counterparts (Ahmad et al, 2004). Acculturated stress surfaces when cultural and lifestyle changes exceed the individuals’ capacity or resources to cope. Unmanaged acculturated stress can often lead to psychological disturbances, such as clinical depression and elevated levels of anxiety (Ahmad et al, 2004).

Acculturative stress is more prevalent when there are vast socio-cultural differences between the country of origin and the host country. Higher socio-cultural distance and limited resources may escalate a cycle of discord impeding adjustment to life in Canada (Ahmad et al, 2004).

The loss of social or familial support also contributes to decreased levels of self-esteem and self-efficacy (Ahmad et al, 2004). Family systems play an essential and multipurpose role in the lives of most South Asian women. Family provides the basis of a South Asian individual’s identity and serves as the main support system. Social support also buffers symptoms of anxiety and depression (Ahmad et al, 2004). Strengthening social networks to facilitate adaptation and reduce acculturative stress after immigration is an important consideration for community agencies when developing community education and outreach initiatives for such groups.

Barriers to care

Many South Asian groups express dissatisfaction with long waiting periods in emergency departments, and/or to see specialists; lack of control in the referral process; and the lack of a private health sector (Ahmad et al, 2004). Limited knowledge about available health services, language difficulties, and costs of medication also impede the health of many new groups (Ahmad et al, 2004).

There is also widespread concern amongst newcomers about the availability of social health insurance during the initial three months of settlement in Canada (Ahmad et al, 2004). Many recent South Asian immigrants brought medication from their home country to overcome their lack of social healthcare coverage (Ahmad et al, 2004).

References:

Ahmad, F., Shik, A. Vanza, R., Cheung, A., Cheung, A.M., George,U. & Stewart, D. (2004). Voices of South Asian women: immigration and mental health. Women & Health, 40, (4).
Barnett, A., and Dixon, A. Bellary, S., Hanif, M., O’Hare, J., Raymond, N. & Kumar, S. (2006). Type 2 diabetes and cardiovascular risk in the UK South Asian community. Diabetologia, 49.
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.
Harvey, E., Harris, S. & Sohal, P. (2008). Type 2 Diabetes in High-risk Ethnic Populations. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association, 32, (1).
Smith, J., Al-Amri, M., Sniderman, A. & Cianflone, K. (2006). Leptin and adiponectin in relation to body fat percentage, waist to hip ratio and the apoB/apoA1 ratio in Asian Indian and Caucasian men and women. Nutrition and Metabolism, 10, (3), 18.