Title: ‘’Becoming American” from the California Newsreel Documentary
Series Unnatural Causes: Is Inequality Making Us Sick?1 – A Discussion
Guide for Health Professional Students
Prepared by: Olivia Carter-Pokras PhD, Alexander Fischer, Elizabeth Lee-Rey
MD, Ana E. Núñez, MD; Candace Robertson, MPH
Acknowledgements: The authors gratefully acknowledge funding from the
National Heart Lung and Blood Institute’s Cultural Competence and Health
Disparities Academic Award grant program, as well as comments by dental,
medical, and nursing students at the University of Maryland Baltimore, and public
health students at the University of Maryland College Park.
(For students)
Session Goals(s):
This small group discussion is intended to acquaint health professional students
with examples of specific health disparities that affect communities in the United
States, bring to their attention the role that social determinants of health play in
these disparities, and foster discussion regarding solutions and action that can
be taken to eliminate these health disparities.
Learning Objectives:
1. Describe the nature, extent, and type of health disparities in the United
States.
2. Describe and assess health disparities experienced by immigrants and
their children.
3. Evaluate social determinants of health and other underlying factors related
to disparities for immigrants and their children.
Session Summary:
This is a 28 minute film segment entitled “Becoming American” from the
California Newsreel documentary series Unnatural Causes: Is inequality making
us sick?, followed by a 30 minute small group discussion to explore examples of
health disparities and pathways by which social conditions affect physiology.
The video explores why recent Mexican immigrants, though poorer, tend to be
healthier than the average American. But the longer they're here, the worse their
relative health becomes even as their socio-economic status improves. This is
known as the "Hispanic/Latino Health Paradox." Is there something about life in
America that is harming their health? Conversely, what is protective about new
immigrant communities that we can learn from? The small group case
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UNNATURAL CAUSES: Is Inequality Making Us Sick? Produced by California
Newsreel with Vital Pictures. Presented by the National Minority Consortia.
www.unnaturalcauses.org; www.newsreel.org
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discussion will be facilitated by medical, health professional, and/or epidemiology
faculty or graduate students. Facilitators will have familiarized themselves with
material in the video and readings as well as the provided Unnatural Causes
Discussion Toolkit. Facilitators may also have completed “A Physician’s
Practical Guide to Culturally Competent Care” and/or “Culturally Competent
Nursing Care: A Cornerstone of Caring,” training programs designed for
providers to increase cultural competence through case studies about awareness
of racial and ethnic disparities in health, and through curricula about
accommodating increasingly diverse patient populations and improving the
quality of health care services given to diverse populations (available at:
http://www.thinkculturalhealth.org). Students will be provided the background
readings at least one week in advance of discussion.
Readings:
1. Taningco MTV. Revisiting the Latino Health Paradox. Tomas Rivera Policy
Institute Policy Brief. August 2007. Available at:
http://trpi.org/PDFs/Latino%20Paradox%20Aug%202007%20PDF.pdf
2. Palloni A, Arias E. Paradox lost: explaining the Hispanic adult mortality
advantage. Demography 2004;41(3):385-415.
3. Gushulak BD, MacPherson DW. The basic principles of migration health:
population mobility and gaps in disease prevalence. Emerging Themes in
Epidemiology 2006;3:3 doi:10.1186/1742-7622-3-3.
4. Viruell-Fuentes EA. Beyond acculturation: Immigration, discrimination,
and health research among Mexicans in the United States. Social Science
& Medicine. 2007; 65, 1524-1535.
5. Carter-Pokras O, Zambrana RE, Yankelvich G, Estrada M, CastilloSalgado C, Ortega AN. Health status of Mexican-origin persons: Do proxy
measures of acculturation advance our understanding of health
disparities? Journal of Immigrant and Minority Health 2008 (In Press).
Discussion Questions:
1. The video focuses on the “Latino Paradox,” stating that despite higher
rates of poverty and lack of insurance, and lower use of health services,
Latino immigrants to the United States tend to have lower mortality and
morbidity rates than non-Hispanic whites. What explanations does the
video offer for this paradox?
2. The video looks at stronger family and community ties as the most likely
reason behind good health in recent immigrants to the United States as
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compared to long-time U.S. residents. What are your thoughts about this
explanation? Are there other explanations?
3. What is it about stronger family and community ties that keep us healthy?
Why might social isolation accelerate the rate of aging?
4. The video states that the longer people stay in their country of origin
before immigrating, the less likely they are to have psychological disorders
such as depression and anxiety in the U.S. What about the U.S. could
cause such outcomes?
5. How does hopefulness for the future play into health outcomes for Latino
immigrants and their children?
6. What does the video mean when it says the “Mythology of the American
Dream”? What factors prevent poor immigrants from working their way
out of poverty?
7. The video says that the good health of Latino immigrants comes with an
expiration date. Why is it that negative social and health outcomes start to
appear in the Latino community after only 5 years of residence in the U.S.,
and are especially noticeable just one generation after immigration to the
U.S.?
8. How is Kennett Square, Pennsylvania working to form a more cohesive
community? What social and health-related benefits will community
members get out of such a set-up?
9. What is needed to make sure that immigrants to the U.S. stay healthy?
How does this translate to people who are already living in the U.S.?
10. As a health professional student, these problems may seem very ‘big
picture’ and overwhelming. After watching this video, what do you think
you can do as a health professional student, and future health
professional to address these issues?
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