Dearborn's Arabs Facing a Health Care Crisis, Part 2

For centuries, immigrants have come to this country to pursue the American Dream–not fall victim to American diseases.

But the latter is becoming a reality for incoming waves of Arab immigrants to Dearborn, as the growing population continues to battle a number of potentially fatal diseases brought about by the transition to an American lifestyle.

This socioeconomic and cultural shift has led to alarmingly high rates of heart disease among Dearborn’s Arab population, experts say, adding that increased health education and preventive care are essential to reverse the trend.

“When immigrants first come to Dearborn, they are much healthier than (they are) five years later,” said Dr. Adnan Hammad, health director at .

The prevalence of heart disease among local Arabs is partly due to a high cholesterol rate that is roughly double the national average, according to a 2009 ACCESS survey. The study, which examined Arabs in the Detroit Tri-County Area, also found an above average frequency of high blood pressure.

Meanwhile, a 2010 report from the Michigan Department of Community Health estimated that between 18 and 33 percent of Dearborn’s Arab population is diabetic. The general population’s rate is around 8 percent, according to the American Diabetes Association.

Cultural Transition Begets Disease

Ismael Ahmed, an associate provost at and former ACCESS executive director, said Arabs’ cardiovascular problems stem largely from the transition between Middle Eastern and American diets. The former is grain-based and heavy in fruits and vegetables, while the latter includes much more meat and fats.

As many incoming Arab immigrants lack knowledge of the healthy eating habits often taught in American public schools, the diet change takes its toll, Ahmed said.

“All of the sudden, you can buy all the meat you want,” said Ahmed, who formerly directed the Michigan Department of Human Services. “Food is status, sometimes. If you can eat steak every night, that’s a good thing.”

The fact that many Dearborn Arabs are low income also plays a role, as they have less access to and fewer dollars for healthy foods, Ahmed said.

“Fresh vegetables cost more than McDonald’s,” he added.

Experts cite the diet change–and the resulting high rate of obesity–as one of the leading factors contributing to Arabs’ cardiovascular disorders. But it’s not the only factor.

Physical Activity, Tobacco Use Play Roles

Hammad, who heads ACCESS’ Community Health & Research Center, added that Arabs’ adaptation to new living and working environments also influences cardiovascular health.

Whereas many Arabs worked physically intensive jobs before immigrating to the United States, they often settle into non-physical, low-income employment after arriving, Hammad said. And the drop-off in physical activity extends further, as many Arabs are unaccustomed to the Western emphasis on exercise.

The 2009 ACCESS study found local Arabs generally exercise less than their non-Arab counterparts.

Adding to these cardiovascular stress factors is the Arab community’s tobacco use. The MDCH found the rate of tobacco use among them is more than double that of non-Arabs.

These issues are not uncommon for immigrant communities, Hammad said.

“Their sedentary lifestyle is changing, their diet is shifting, less exercise and more stress factors,” he added. “It’s very stressful to be an immigrant ...

"Acculturative stress is a disorder.”

Lack of Health Care Burdensome

Complicating the problem even further is the health care crisis among Dearborn’s Arabs. More than 31 percent of local Arabs have no health insurance, according to the 2009 ACCESS study. That’s nearly double the national average.

Dearborn Arabs’ lack of health insurance not only negates the help of preventative care for cardiovascular problems, but also poses a more alarming problem, Hammad said.

“Almost half of (Arab immigrants) who have diabetes don’t know they have diabetes,” he added.

But better healthcare is only half of the solution, said Dr. Mouhanad Hammami, president of the National Arab American Medical Association. Equally important is increased outreach and education on healthy lifestyles within an American environment.

ACCESS Focuses on Outreach

ACCESS and other community organizations have already begun incorporating diet and health education classes into their regular programming. While such initiatives are a start toward healthier living, they need to take center stage in the classroom, Hammami said.

“Education in school in how to live healthy, how to eat healthy and how to exercise more…in addition to awareness of diseases such as cancer and cardiovascular diseases…would be beneficial in the long run,” Hammami said.

Heart disease may be the leading cause of death in the United States, but it’s not something Dearborn’s Arab immigrants expected in abundance when they set out to realize the American Dream.

While there has been improvement in the prevention, care and education surrounding heart disease and related disorders in Dearborn, there is still work to be done. ACCESS and other community organizations have tried to address these problems through primary care and education initiatives. But even more action–from government, health care providers and the education system–needs to be taken to properly handle the Arab community’s health needs, Hammad said.

“They are being addressed, but it is not something that has been done,” Hammad said. “We are not in the past tense.”