By Sony Poulose (Guest Contributor)
Canada is one of the most “ethno-culturally” diverse countries in the world. According 2011 census Canada has closer to 7 million people born outside of Canada and they represent about 21% of the total population. Amazingly, 200 different ethnic origins were reported in 2011 statistics. The three largest visible minorities in Canada are South Asians, Chinese and Blacks and together account for about 61% of the visible minority population. Another interesting fact to be noted is that the median age of the visible minority is 33 where as, that of the general population is 40.
There is no doubt that these diverse population bring tremendous cultural and social diversity to Canada and at the same time, it’s reflecting on our patient population. As people migrate to other countries they try to adapt to the culture and food of the main stream community. It is also difficult for them to find their traditional food choices and life styles. Unknowingly, this change of food habits and life style put them in high risk of developing several health problems including diabetes and heart problems.
Unfortunately, our health system is not equipped to deal with this diverse patient population. Often health care professionals struggle to understand their patient’s diverse lifestyle and food choices. Even though, some of the new treatment guidelines try to incorporate these ethnic diversities it’s not complete or comprehensive.
Why the ethno-cultural background of the patients matters?
Several Risk assessment tools are used by clinicians in preventative medicine. The factors considered to increase the risk for cardiac disease or diabetes may not be the same for patients from different ethnic background. So applying a particular assessment tool may underestimate or overestimate the risk resulting in withholding intervention or unnecessary intervention respectively.
Drug metabolism and drug effects also varies in different ethnic populations causing some drugs to be less effective and some drugs to cause serious side effects. The classic example is the blood pressure lowering agent beta blockers, which is more effective in white population than blacks. Similarly, another class of blood pressure lowering drug namely ACE inhibitors is more effective in whites than blacks in lowering blood pressure. Cardiovascular drugs such as statins needs a dose reduction in South Asian population. Pharmacist play a major role in selecting the right drug and as well as the dose in these patient population. They also can monitor the therapy effectiveness of the drugs.
The cardiac risk of a South Asian patient could be completely different from their Caucasian counterpart even though they have the same attributes. When we assess the risk factors of these two patients based on our traditional scores, we may end up with the same score. But, several studies have shown that the South Asian patient is at a higher risk to develop a cardiac event.
Another interesting phenomenon seen among South Asian population is, as soon as they move to urban area or immigrate to western countries their risk for developing diabetes grows exponentially. This is due to the combined effect of genetic predisposition and environmental effects called “thrifty gene” hypothesis. Several studies have proven this fact especially the SHARE (Study of Health Assessment and Risk in Ethnic groups) study.
What should we do?
It is important that all the health care professionals customize their treatment plan towards patients with diverse ethnic background. Clinicians should take time to understand the cultural background of their patients. Ethnic diversity should be considered during risk assessment and life style modification counselling. Special attention should be made not to underestimate their risk based on the standard risk assessment scorings.
Often, patients find it hard to find health care professionals who understand their life style and food habits. It’s relevant when it comes to role of dieticians where standard main stream food choices may not be applicable to patients from a different ethnic background. Understanding the food habits of patients from the various ethnic background will help clinicians in providing appropriate dietary counselling.
We need to act quickly to address this huge health care gap. Health care professionals should be provided adequate training on the ethnic difference in their patients and customizing treatment for them.