1. Health and Mental Health of Visible Minority Seniors and Their Health Care Utilization Pattern Juhee V. Suwal, PhD Department of Family Medicine University of Alberta, Canada (35th NAPCRG Conference, Vancouver, October 2007)

2. Introduction Similar to general population belonging to visible minority group, senior population belonging to this group is also increasing in Canada Similar to general population belonging to visible minority group, senior population belonging to this group is also increasing in Canada Thus study of health, mental health, and healthcare utilization pattern of visible minority seniors is important for an overall healthy Canada Thus study of health, mental health, and healthcare utilization pattern of visible minority seniors is important for an overall healthy Canada

3. Introduction (cont’d) As well as For understanding the health, mental health, and health services utilization situations of visible minority seniors For understanding the health, mental health, and health services utilization situations of visible minority seniors For the provision of adequate health services in meeting the demand of this increasing population group For the provision of adequate health services in meeting the demand of this increasing population group

4. Introduction (cont’d) Different cultural background Different cultural background Perceptions of health and mental health Perceptions of health and mental health Perception of aging Perception of aging Perceptions of food and eating habit Perceptions of food and eating habit Cultural, social, economic adjustment in a new place Cultural, social, economic adjustment in a new place Language barrier Language barrier Change in health status (HIE) Change in health status (HIE) Double/multiple jeopardy situation Double/multiple jeopardy situation

5. Objectives Compare health and mental health, and health care utilization patterns of visible minority and White seniors Compare health and mental health, and health care utilization patterns of visible minority and White seniors Examine the healthy immigrant effect of visible minority seniors Examine the healthy immigrant effect of visible minority seniors Revisit the double/multiple jeopardy thesis Revisit the double/multiple jeopardy thesis Provide valuable policy implications to health and social policy planners Provide valuable policy implications to health and social policy planners

6. Methods Source: PUMF of CCHS Cycle 3.1, 2005 Source: PUMF of CCHS Cycle 3.1, 2005 Total respondents in the survey: 132,221 aged 12 years and older Total respondents in the survey: 132,221 aged 12 years and older Response rate: 78.9% Response rate: 78.9% Sub-sample selected for this study: visible minorities and Whites aged 65+ years; Sub-sample selected for this study: visible minorities and Whites aged 65+ years; visible minority, N = 1625 (8.5%) Whites, N = 16,781 (87.6%) Data analyzed using Pearson’s χ 2 test Data analyzed using Pearson’s χ 2 test

7. Findings Graphical Graphical Tabular Tabular

8. Table 1 Demographics of Visible Minority and White Seniors, Canada, 2005 Indicators Seniors aged 65 and over Visible minorities N (%) Whites N (%) Gender: Male Female 706 (43.4) 919 (56.6) 7,472 (44.5) 9,310 (55.5) Job: Full-time Part-time 70 (61.4) 44 (38.6) 744 (56.9) 563 (43.1) Education**: Less than secondary Secondary grad/other post-secondary Post-secondary graduates 705 (44.2) 264 (16.5) 627 (39.3) 6,973 (42.2) 3,185 (19.3) 6,352 (38.5) Language***: English/French with/wt other No English/French 1,179 (73.8) 440 (27.2) 16,536 (98.6) 224 (1.4) Living arrangement***: Unattached/alone With spouse/partner Parent spouse child Parent and child 253 (15.6) 545 (33.7) 207 (12.8) 63 (3.9) 5,078 (30.3) 8,961 (53.5) 893 (5.3) 634 (3.8) Household size***: 1 person 2 persons 3 or more persons 253 (15.6) 642 (39.5) 730 (45.0) 5,078 (30.3) 9,888 (58.9) 2,327 (10.8) Personal income***: < 15,000 or none 15,000-49,000 50,000 over 760 (61.4) 397 (32.1) 80 (6.4) 4384 (32.9) 7,561 (56.6) 1409 (10.6) Note: Percentages in each cell show those who responded to that particular question; *** p < 0.001, ** p < 0.01.

9. Figure 1 Comparison of Status in Canada, 2005

10. Figure 2 Length of Stay of Seniors in Canada, 2005

11. Health related findings – About 90% of both visible minority and White seniors had a chronic condition About 90% of both visible minority and White seniors had a chronic condition Almost all (about 96%) of both groups had a regular medical doctor Almost all (about 96%) of both groups had a regular medical doctor

12. About 11% of visible minority seniors and about 6% of White seniors consulted alternate health providers About 11% of visible minority seniors and about 6% of White seniors consulted alternate health providers Higher percentage (18.5%) of visible minority seniors who could not converse in either of the official languages consulted alternate health provider than those (7.8%) who could converse in one of the languages Higher percentage (18.5%) of visible minority seniors who could not converse in either of the official languages consulted alternate health provider than those (7.8%) who could converse in one of the languages

13. About 91% visible minority seniors who had lived in Canada for 10 years or more reported having chronic condition compared to 74% who had lived for less than 10 years. About 91% visible minority seniors who had lived in Canada for 10 years or more reported having chronic condition compared to 74% who had lived for less than 10 years.

14. Figure 3 Comparison of Health Characteristics of Seniors by Culture, Canada, 2005

15. Table 2 Perceived Health & Mental Health of Visible Minority & White Seniors, Canada, 2005 Population 65 and over Perceived health* Excellent/very good N (%) Good N (%) Fair/poor N (%) Visible minority549 (33.8)565 (34.9)507 (31.3) Whites6785 (40.6)5679 (33.9)4278 (25.6) Perceived mental health* Population 65 and over Excellent/very good N (%) Good N (%) Fair/poor N (%) Visible minority891 (62.8)408 (28.8)119 (8.4) Whites11005 (69.5)4075 (25.7)747 (4.7) Source: Computed from the Canadian Community Health Survey Cycle 3.1 Note: * results significant at p < 0.001

16. Table 3 Perceived Health of Visible Minority Seniors by Gender, Education, Income, Language Proficiency, and Years of Stay in Canada, 2005 VariablesExcellent/very good N (%) Good N (%) Fair/poor N (%) Gender** Male Female 269 (38.3) 280 (30.5) 239 (34.0) 356 (35.5) 195 (27.7) 312 (34.0) Education*** Less than high school High school + some university University graduates 202 (28.6) 86 (32.6) 253 (40.5) 215 (30.5) 98 (37.1) 241 (38.6) 288 (40.9) 80 (30.3) 210 (20.8) Personal income*** Less than $30,000 $ 30,000 and over 290 (27.5) 108 (58.4) 397(37.7) 58 (31.4) 366 (34.8) 19 (10.3) Language proficiency** English/French w/wt other No English/French 427 (36.3) 119 (27.0) 401 (34.1) 164 (37.2) 347 (29.5) 158 (35.8) Years of stay in Canada < 10 years 10+ years 54 (35.5) 373 (32.5) 59 (38.3) 394 (34.4) 39 (25.7) 379 (33.1) Note: Percentages in each cell show those who responded to that particular question; *** p < 0.001, ** p < 0.01.

17. Table 4 Perceived Mental Health of Visible Minority Seniors by Gender, Education, Income, Language Proficiency, and Years in Canada, 2005 VariablesExcellent/very good N (%) Good N (%) Fair/poor N (%) Gender* Male Female 418 (64.6) 474 (61.4) 189 (29.2) 219 (28.4) 40 (6.2) 79 (10.2) Education*** Less than high school High school + some university University graduates 295 (51.0) 150 (64.1) 437 (75.1) 206 (35.6) 65 (27.8) 126 (21.6) 77 (13.4) 19 (8.1) 19 (3.3) Personal income*** Less than $30,000 $30,000 and over 528 (59.3) 145 (80.6) 276 (31.0) 27 (15.0) 86 (9.7) - Language proficiency*** English/French w/wt other No English/French 710 (67.4) 178 (49.6) 280 (26.6) 126 (35.1) 64 (6.1) 55 (15.3) Years of stay in Canada <10 years 10+ years 95 (68.8) 601 (61.6) 35 (25.4) 284 (29.1) - 91 (9.3) Note: Percentages in each cell show those who responded to that particular question; *** p < 0.001, * p < 0.05; “-“ denotes “cases less than 15, not appropriate to report.”

18. Figure 4 Health Services Utilization by Visible Minority and White Seniors, Canada, 2005

19. Figure 5 Health Services Utilization by Visible Minority Seniors by Income Level, 2005

20. Figure 6 Health Services Utilization by V Minority Seniors by Years of Stay in Canada

21. Conclusions Differences found in perceived health and mental health, chronic conditions, and health care services used by visible minority and White seniors Differences found in perceived health and mental health, chronic conditions, and health care services used by visible minority and White seniors Within visible minority group, differences in outcomes found by gender, education level, income levels, language proficiency, and length of stay in Canada Within visible minority group, differences in outcomes found by gender, education level, income levels, language proficiency, and length of stay in Canada

22. Conclusion (cont’d) Chronic condition and doctors’ visits confirm Healthy Immigrant Effect (HIE) for visible minority seniors Chronic condition and doctors’ visits confirm Healthy Immigrant Effect (HIE) for visible minority seniors There are suggestions that VM seniors may have been disadvantaged because of their minority status There are suggestions that VM seniors may have been disadvantaged because of their minority status VM seniors’ low SES and language proficiency are associated with poor health and these also pose as barriers to health care services use – again low income and language barrier relate to their being minority senior immigrants VM seniors’ low SES and language proficiency are associated with poor health and these also pose as barriers to health care services use – again low income and language barrier relate to their being minority senior immigrants

23. Conclusion (cont’d) Most importantly, a question for health experts, healthcare providers, and policy makers arise: what could be done to improve the double or multiple jeopardy situation of senior visible minority population in Canada and to keep them as healthy as they were when they entered the country! Most importantly, a question for health experts, healthcare providers, and policy makers arise: what could be done to improve the double or multiple jeopardy situation of senior visible minority population in Canada and to keep them as healthy as they were when they entered the country!

24. Implications Keeping track of VMS’s health, mental health, and use of and access to preventive health services helps Canadian health policy makers in their plans Keeping track of VMS’s health, mental health, and use of and access to preventive health services helps Canadian health policy makers in their plans - plans especially to maintain healthy aging, to upgrade economic condition of VM seniors, and to train health professionals in dealing with culturally sensitive “elderly health” related issues - plans especially to maintain healthy aging, to upgrade economic condition of VM seniors, and to train health professionals in dealing with culturally sensitive “elderly health” related issues - to keep visible minority seniors healthy translates into overall healthy Canada and reduced health care cost at the same time - to keep visible minority seniors healthy translates into overall healthy Canada and reduced health care cost at the same time

25. Future Research Effects of various predictor variables on health outcome with regression analysis Effects of various predictor variables on health outcome with regression analysis Is there a relationship between the higher % of visible minority seniors suffering from high blood pressure and their lonely and stressful life in Canada or their changed lifestyle and eating habit? Is there a relationship between the higher % of visible minority seniors suffering from high blood pressure and their lonely and stressful life in Canada or their changed lifestyle and eating habit? Whether the low use of alternate health providers has something to do with the cost involved or the accessibility and availability issues or the changed perception on traditional medication and belief in modern medication Whether the low use of alternate health providers has something to do with the cost involved or the accessibility and availability issues or the changed perception on traditional medication and belief in modern medication

26. Limitations A larger sample size with specific subgroups of visible minority population A larger sample size with specific subgroups of visible minority population A multiple regression analysis is needed to reveal relationships between different predictor variables and perceived health or health care utilization outcome A multiple regression analysis is needed to reveal relationships between different predictor variables and perceived health or health care utilization outcome Qualitative research needed to expose some of the hidden causes of deterioration of health and mental health of VM seniors over time Qualitative research needed to expose some of the hidden causes of deterioration of health and mental health of VM seniors over time

27. Acknowledgement Thanks to three individuals from the University of Alberta: Mr. Chuck Humphrey of the Data Library, for providing the CCHS data, Dr. Earl Waugh, the Director of the Cross-Cultural Study of Health and Healing, for inspiring me to do a research on visible minorities, and Dr. Andrew Cave of the Department of Family Medicine for his suggestions in an earlier version of the paper.

28. Thank you