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Mental health, youth and racism. Kwame McKenzie MD. Mental capital the new frontier. If we are to prosper and thrive in our changing society and in an increasingly interconnected and competitive world, both our mental and material resources will be vital.
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Mental health, youth and racism Kwame McKenzie MD
Mental capital the new frontier • If we are to prosper and thrive in our changing society and in an increasingly interconnected and competitive world, both our mental and material resources will be vital. • Encouraging and enabling everyone to realise their potential throughout their lives will be crucial for our future prosperity and wellbeing.
EQ = social skills • Emotional intelligence (EQ) is not a new concept; • Around since Socrates: “ Know Thyself”. • Studies show that EQ is the best predictor of a child's future achievement; better than any other single factor. • EQ is a better predictor of success than IQ and technical skills combined • Robin Stern NYU
Mental illness is costly • 4 of the top 10 leading causes of disability • 30% of disability claims and 70% of the total costs • estimated cost of mental illness to the Canadian economy is $51 billion • At least 50% starts before age of 14
Mental illness prevention • Evidence based, cost-effective strategies documented • Ontario legislature concluded for every $1 spent on mental health promotion you get $7 return • But we do not do this very well.
Clusters of research • Rates • Social determinants • Barriers and facilitators of care
Canadian-Born Population and Immigrants Reporting "Fair" or "Poor" Health, Source: Newbold KB. Self-rated health within the Canadian immigrant population: Risk and the healthy immigrant effect. Social Science and Medicine, 2005.16
More likely to develop poor health if you are non-European * Significantly different from estimate for Canadian-born (p <0.01).Note: All explanatory variables are based on the situation in 1994/95. Because of rounding, some confidence intervals with 1.0 as upper/lower limit are significant.Data source: 1994/95 to 2002/03 National Population Health Survey, longitudinal file.
Ratio of earnings of recent immigrants to Canadian people is decreasing over time
Most children in Toronto live in City 3 1/3 of people in City 3 live under low income cut off 50% of the housing for families in City 3 is high rise Poverty is color coded City1 City2 City3
A problem in the future? • City 3 is high poverty and high immigrant • Our population growth is due to people in City 3 • If we are going to move forward and be competitive we need to invest in City 3 • Parents doing a good job buffering children from problems • But what happens if we want to move forwards and integrate economies so that children can get access to resources and help build our future?
Recorded racially aggravated crime England and Wales (data Home Office)
Pathways to racism’s health impact • Socially inflicted trauma • mental, physical, or sexual • Economic and social inequality • Decreased mobility due to racism (education, employment) • Inadequate, inappropriate or degrading medical care • Targeted marketing of commodities and lifestyles that can harm health: alcohol, tobacco, drugs
US Surgeon general report mental health pathways • Internalization of racial stereotypes & negative images which denigrate individuals’ self-worth and adversely affecting their social and psychological functioning; • Institutional racism resulting in stressors that can affect mental health due to living conditions, crime, violence, poverty …
Racism effects – getting under the skin • Acute stressor (life events) • Chronic stressor (micro-aggression) • Body: • adreno-corticoids • t-cell change • early aging • weathering • foetal growth • Cognitive development • Long term change in cognitive focus eg / increased vigilance • Personality/ identity • (resilience/ vulnerability)
Racism stress is different 3 stage model: 1) Stress because of life event 2) Stress because life event considered unfair 3) Stress because of inability to do anything about it
Pascoe and Richman • Links between racism and health occur through the mechanisms of stress responses and health behaviors. • Our synthesis of existing literature also suggests that social support, active coping styles, and group identification were most likely to serve a protective function in these pathways.
Stress of Migration increases risk of schizophrenia. Cantor Graae and Selten 2005
Stress • Increased rates of schizophrenia if you: • live in neighborhoods that are stressful • have numerous daily hassles
Racism psychosis risk factor cross sectional • Odds of suffering from a psychosis: • Verbal abuse victims • 2.86 (1.69-4.83) • Racist attack victims • 4.77 (2.32-9.80) • Thinking most employers racist • 1.57 (1.02-2.42) • Karlsenn & Nazroo Am J Public Health. 2002
Racism psychosis risk factor – cross sectional • Karlsenn et al Psychological Medicine 2005
Racism ecological risk factor for psychosis • South London: rates of psychosis in ethnic minorities by ward taking into account age, sex, deprivation • Ethnic minorities more likely to suffer from psychosis: • in areas 28-60% ethnic minorities = 2.4 • in areas 13-28% ethnic minorities = 3.6 • in areas 8-12% ethnic minorities = 4.4 • Boydell et al BMJ 2001
Discrimination psychosis risk factor - longitudinal • The Netherlands: • 4722 people asked about discrimination (age, sex, handicap, appearance, ethnic group and sexual orientation). • Followed up for 3 year • Rates of psychosis increased in ethnic groups • Discrimination, not being an ethnic minority most important factor. • Janssen et al British Journal of Psychiatry 2003
conclusion • We know that there are difference sin health • We know what keeps people in healthy • We know we have to integrate Toronto if we are going to move forward • We know that this may be at a cost to the diverse population because of racism • What are we going to help develop resilience?
