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Why Coming to America Can Be Bad for Your Health

by Caroline Smart, CloudView Editor

Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic’s best storytelling on America’s population health revolution.  If you missed the first story in our series, you can find it here. In today’s story, we explore how Lowell’s multi-pronged approach to minority outreach—including healthy eating initiatives, a public access television show, and community health fair—has improved health outcomes and helped reign in costs. 

The Community Health Needs Assessment for Lowell in 2013 included one particularly troubling observation by local health workers: “[N]ew refugees tend to be the healthiest in their community, but as they assimilate to the American diet and lifestyle, they become some of the unhealthiest in the area.”
As it turns out, what they saw is not unique to Lowell. Across America, health care practitioners are noticing that the longer immigrants spend in the United States, the greater their risk for poor health. As Robert A. Hummer, a social demographer at the University of Texas at Austin, told the New York Times, “There’s something about life in the United States that is not conducive to good health across generations.”

As the U.S. immigrant population has more than quadrupled, from 9.6 million in 1970 to more than 41 million today, researchers in the field have developed a theory known as the acculturation hypothesis: While adjusting to life in the U.S., immigrants tend to adopt American lifestyle habits associated with greater risk factors, including smoking, drinking, a sedentary lifestyle, and an unhealthy diet.

The problem is particularly acute for Latinos, whose consumption of fruits and vegetables falls as they live in the U.S. Five years after arriving in the United States, the health of Latino immigrants shows notable increases in rates of obesity, high blood pressure, heart disease, and diabetes. For those who have been in the country five years or more, the obesity rate jumps from 16 percent to 22 percent and the diabetes rate from 6.9 percent to 7.5 percent. 
To begin to address this issue in Lowell, public health officials studied retail food options in the area. Researchers found that 60 percent of stores sold only three varieties of fruit, and 30 percent of stores sold no fruit at all. Residents cited cost as one of the biggest barriers to purchasing fresh food, with many relying on canned or instant options instead.

In response, officials in Lowell recently introduced the Health Corner Store initiative, which encourages storeowners to sell more fruits and vegetables and put healthy food at the front of the store, and junk food toward the back. So far, officials have been able to sign on seven community stores, and they continue to work with local business owners to expand the program.

Such public health initiatives attempt to tackle not only health-care challenges but also to rein in health-care costs. The U.S. Department of Agriculture estimates that healthy eating could save the U.S. $71 billion in healthcare spending annually.

A recent community health needs assessment showed that the availability of high-quality care is Lowell’s biggest asset. But for Lowell, as well as hospital systems across the country, the standard of care is only half of the population-health equation: It must get to as many people as possible. Programs that target specific groups historically lacking access to primary care play a pivotal role in engaging Lowell’s diverse communities in their own health care. 

To produce that level of engagement, though, requires an extensive, multifaceted network of educators and partners that reaches much deeper into the community than the hospital and the doctor’s office.

Lowell has extended its outreach to these communities by establishing a public access television show and creating a community health fair.

Once a week, Sonith Peou, the director of the Metta Health Center, appears on the local public access television channel in a program designed specifically for the Cambodian community in Lowell. The show raises awareness of particular symptoms and illnesses that warrant medical attention.
Another example of a simple but effective form of outreach is Lowell’s community health fair. Last spring, Lowell General Hospital hosted a health fair with the Housing Authority. In a three-hour period, they screened 125 people with limited or no regular access to medical care, checking on their blood pressure, blood sugar level, body mass index, and nutrition. They were able to provide advice on ways to get healthier—including, for smokers, the best ways to quit.

This kind of engagement has proven it can both lower costs and improve health outcomes—one reason why patient engagement has been called “the blockbuster drug of the century.”

The proof is in the numbers.  Lowell General’s community health workers reach nearly 13,000 individuals every year, and 10 to 20 percent of them continue to seek care within the system. The result is an engaged community of people more informed about their medical conditions and aware of when it makes sense to see a doctor.  That means fewer costly ER visits and fewer expensive diagnostic tests. 

Tune next week to read about how Lowell is harnessing these results to build a sustainable, virtuous circle of care.

To experience an interactive feature along with access to the full Population Healthier content series, visit The Atlantic.

Caroline Smart is a Senior PR Associate and CloudView Editor.

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