Transcript Jewish Russian Immigrants in the US and around the world. Health

Jewish Russian Immigrants
in the US and around the
world. Health Needs.
Part 2: Health challenges
Olga Greg and the Supercourse team
University of Pittsburgh
Somatic problems:
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Acute physical illness
Chronic diseases
Disabilities
Jewish Genetic Disorders
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Mendelian Disorders are the direct result of
mutated genes
Disease Predisposition Genes are disorders
which result from the combination of specific
genes
Mendelian Disorders
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Bloom Syndrom
Canavan Disease
Crohn's Disease
Factor XI Deficiency
Familial Dysautonomia (Riley-Day syndrome)
Fanconi Anemia
Gaucher Disease
Mucolipidosis IV
Niemann-Pick Disease
Non-Classical Adrenal Hyperplasia
Nonsyndromic Hearing Loss
Tay-Sachs Disease
Torsion Dystonia
Disease Predisposition Genes
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Breast Cancer (BRCA1 and BRCA2)
Familial Colon Cancer and BRCA2)
Common diseases seen in immigrants
from Russia include:
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diabetes
hypertension
coronary disease
gastrointestinal problems
tuberculosis
alcohol and substance abuse
Alcohol Problems:
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The alcohol dehydrogenase (ADH2) gene
relates to alcohol dependence, alcohol
consumption, and reported alcohol-related
symptoms. However, the association of
ADH2 with alcohol-related behavior is not
well characterized in Ashkenazic Jews*.
Although alcoholism is a tremendous problem
in Russia, the incidents of alcohol abuse in
Russian immigrants is very low.**
Cultural beliefs influencing health
behaviors
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Some immigrants believe that disability or
illness is caused by something the individual
did not do right, such as not eating well or not
dressing warmly enough.
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Good health is equated with absence of pain.
Illnesses that do not cause pain often go
undiagnosed and under-treated, such as
Type 2 diabetes, hypertension, and high
cholesterol.
Non-somatic problems:
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Stress / Distress
Intergenerational
conflict
Language barrier
Social isolation
Demoralization
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Depression resulting from an
undermining of morale
Upset or destruction of normal
function
A state of disorder and confusion
Symptoms of demoralization:*
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loss of control
loss of hope
anger/bitterness
sense of failure
feeling life was a burden
loss of meaning and a belief that life's
meaning is dependent on health
Stigma around mental illness
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Mental illness is often regarded as
disgraceful.
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Immigrants often do not disclose a family
history of mental illness or past treatment.
Acculturation challenges
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Acculturation to both American and Jewish
cultures is related to psychological
adaptation, peer relations, and school and
family outcomes. Both acculturations
reduce loneliness and increase perceived
support from parents. Different dimensions
of acculturation, such as language and
identity, are differentially related to
adaptation.
Language Problems
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Refugees and migrants from non-English
speaking cultures have little preparation
for their new English speaking
environment
Their limited English language skills
exacerbate resettlement problems
regardless of previous economic and
social status
Communication challenges
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No ability to discuss health promotion issues
such as smoking, diet, physical activity,
vitamins and medication intake with their
physician.
Lack of knowledge of medical terminology
Relying on relatives with lack of medical
knowledge to translate medical documents
Lack of knowledge about preventive
behaviors
Cultural difficulties
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Lack of understanding of US health care
etiquette
Expect more compassion and emotional
closeness with their physician
Rather than appreciating the privacy and
autonomy of the American medical culture,
patients may complain about the quality of
medical treatment they receive
Question the physician’s ability to understand
their problems.
Home remedies use
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Often doctor’s health recommendations are
rejected or substituted by home remedies
and treatments
Home remedies are often used prior to
seeking medical attention
Conclusions and patient care
implications
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It is important to understand patients’
background and cultural norms. Russian
Jewish immigrants might have needs and
cultural norms that are different from other
population groups
Address the physical, emotional, and spiritual
health of individuals and families
Ensure effective patient-provider
communication
Recommendations?
Get to know your patients on an individual level.
Not all patients from diverse populations conform
to commonly known culture-specific behaviors,
beliefs, and actions.
Failing to support and foster culturally competent
health care for racial and ethnic minorities can
increase costs for individuals and society
through increased hospitalizations and
complications.
Conclusions
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Russian Jewish immigrants have unique
educational, cultural, and health background
Several genetic mutations (such as breast
cancer associated BRCA) are more prevalent in
Jewish populations
While public health programs have been tailored
to different ethnic, racial, and cultural minorities,
they rarely addressed the needs of this
population group
This lecture provides a short summary about this
group that would be helpful in guiding public
health interventions and educational programs