As we move into an uncertain future, we need to look at what our bodies tell us
In my WhatsApp group chat, one of my friends is so evangelical about vitamin D that she’ll pop up like clockwork, on the stroke of winter solstice, to remind us to take our supplements. It’s a kind of public service for me and my friends – darker skins with more melanin allow less UVB to enter the skin (because melanin protects against skin UVB sun damage), so less UVB absorption means less vitamin D is produced each minute. Basically, black and brown people living in countries with less sunshine and long dark nights need to top up. These messages are a kind of community PSA, left up to us to pick up the slack. Despite the peer knowledge about darker skins, I’ve never seen an initiative letting communities of colour know to take supplements daily.
Whenever I think about how GPs might better serve immigrant communities, I think of whether a doctor could ever have got in between my grandmother’s addiction to Cadbury’s Dairy Milks after reaching the UK, trying chocolate for the first time sometime in the 70s, and getting hooked. It’s a cute story about my grandma’s idiosyncrasies, but it makes the point about just how external factors like diet can be impacted by migration. It’s an obvious, and widespread example: people migrating from places where diet are rich in oil-based fats, fresh vegetables, pulses, and raw ingredients, are affected by moving to western countries where people eat an abundance of highly processed, sugary things. My grandma is now diabetic, in line with the stats that show that South Asians are six times more likely to develop Type 2 diabetes than their white British counterparts.
I tell this story to Dr. Mesfin Teklu Tessema, Senior Director of the health unit at IRC (International Rescue Committee, an organisation that looks at humanitarian crises, including the movement of refugees), and he breaks some of it down. “Migration certainly has an effect on our biology,” he tells me over the phone. “Rapid diet change, increased consumption of high fat, sugar or highly processed food, can lead to obesity, which has implications for long term care and a risk of hypertension”.
It’s true too, that African, East Asian and South Asian populations have disproportionate levels of lactose intolerance (in some East Asian communities, more than 90 per cent of local populations are affected). And while it’s unclear whether the populations who can better tolerate dairy can do so because their bodies adapted to the consumption of dairy, a 2015 Cornell study concluded that ethnic groups with ancestors from climates supporting the production of dairy cattle, like Europe, can digest milk better than those with ancestors from places that did not have the right conditions for dairy cattle. These places include Asia and Africa.
So, migration changes the food you eat, which changes your body. We know that even in a globalised world this is the case, and that diet is still hugely dependant on climate and politics of trade. Migration has a physical effect on the body, one that must be explored in order to consider our survival in a future world, where climate change will render us all migrants at some point. We need to look at what our bodies tell us as we move into the future – that processed sugars affect our long term health, and that vulnerable communities suffer dire consequences when the state fails to inform them of specific health concerns like vitamin D deficiency, to cite just these two examples. (There are many more.)
“There’s been a lot of research that shows a clear link between heart disease in migrant populations as a result of experiencing discrimination” – Guppi Bola
Guppi Bola is the the interim director at Medact, a charity that aims to end health inequality. Bola’s area of study focuses on migrant populations that move from a “dominant brown country to a dominant white country” and the experience that “discrimination and racism has on the body”.
The point she makes is that it is not just conflict refugees who have escaped sites of horror that internalise trauma. Many migrants, who travel for work or a ‘better life’, do too. “There’s been a lot of research from the US and Canada that shows a clear link between heart disease and circularity disease in migrant populations as a result of experiencing discrimination,” she explains. “And that has been brought up by a rising cortisol output, which is the response your body gives to stress. That can have an impact on things like kidney function and increase of obesity over time”.
The link between racism and poor health is beginning to be explored and researched beyond anecdotal ideas of things we might assume are a natural result of discrimination (such as a loss of sleep or anxiety). There are many fascinating case studies to explore, but one that always strikes me is this one by NPR in 2017. The Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, asked members of different ethnic and racial groups about their experiences with discrimination, including bad service at restaurants, and “small indignities that showed uncourteous treatment”. It found a link between these experiences and rapid development of coronary heart disease. It also found that pregnant women who reported high levels of discrimination gave birth to babies with lower birth weights.
It’s a sobering thought that confirms things you may have already suspected. But what if this goes beyond even this, and acute trauma could actually live beyond your present self?
Epigenetics explores this idea by pushing our understanding of genetics (that DNA is not affected DNA by life experience) much further, posing that the effects of stress and trauma can be passed down genetically. A precedent case in 2001 by Rachel Yehuda, a psychologist at the Mount Sinai School of Medicine in New York, studied the effects of stress on a group of women who were inside or near the World Trade Center and were pregnant at the time. She found that babies born from mothers with PTSD had low levels of cortisol, and exhibited higher distress responses than their peers.
“I never complain, because I understand I am a guest in this country, but in Syria we had a lot more parks and a garden. I would walk every day” – Sammiyah Khan
Delanjathan Devakumar cites two other cases. “The best studies would be the Dutch Winter Famine, and the Chinese Famine, which show epigenetic consequences” he says, referring to the World War II Dutch famine in 1945, where over 20,000 people died of starvation after the Nazis blocked food supplies. It was later found that the children they gave birth to showed famine-related illnesses, like higher levels of triglycerides and LDL cholesterol, diabetes and schizophrenia. While in 2016, research showed that there was an increased risk of hyperglycaemia for those whose parents had been exposed to the Chinese famine in mid-20th Century China.
This is all useful to consider because, while these cases do not look at migration specifically, they confirm that trauma has long-lasting consequences. When you remember, in a UK context, that hate crimes have increased 40 per cent in the last year, or the impact on conflict refugees living in Calais camps for instance, you may begin to wonder just how future generations will feel our current political moment in their bodies.
In the context of a future world, it seems obvious that a zero-tolerance approach to race-related discrimination is literally crucial for our survival. Our bodies physically change from exposure to lasting racism, discrimination and inequality. Policy should work to reducing race-related stressors to maintain the healthy continuation of the human race. Right now, there is opportunity for us to shift political frameworks, and understand that by demonising difference in the present, we are taking the worse practices into the future, limiting our chances to survive.
While these cases can feel like they live in the abstract, I took some of these thoughts to Sammiyah Khan, a new Birmingham resident who has been living in the UK for two years after leaving Aleppo owing to political conflict. Sitting in her living room, drinking hot, sweet milky tea and ginger snaps, we discuss these ideas of a changing world, and while she agreed she ate fresher food back home and laughed at my point about increased sugar (“I had a big desire for sweet in Syria too!”) she flagged something else.
“I was shocked by the lack of a garden” she says. “I never complain, because I understand I am a guest in this country, but in Syria we had a lot more parks and a garden. I would walk every day. I was more active because of the space. Here, I do not go out much because of the cold, and I am careful because you hear about a lot of racists.”
The changing climate, social housing infrastructure and political rhetoric all feeds into Sammiyah reducing her activity to daily walks in green spaces to none at all. She is just one case, but the idea that social housing and its paltry offerings of green spaces in inner cities and its link to poor mental health is hardly a new conceit. Trends like forest bathing make this point in a lifestyle context; and just this week, researchers from Sheffield University urged GPs to prescribe time in nature to improve patients’ mental health.
When I used the phrase ‘current failings’ to experts in the discussion of this piece, there was one thing that every medical expert, researcher and activist mentioned when discussing this piece, calling it “the biggest structural issue humanity will face”: vaccination.
Vaccination will play a huge part in ‘health wealth’ moving forward, and it is crucial to discuss, because it impacts the life chances of migrants at a disproportionate rate of those static in countries. Those who move around may miss vaccinations; those who are conflict refugees may spend time in camps where there are no immunisations offered, and those entering countries with resource may be put off by the challenges of access to GPs, or misinformation spread by anti-vaxxers.
“The thrill of exploring a new world hinges on how we explore ourselves”
Dr Robert Allridge, a public health doctor and associate professor at University College London discusses the problem and a possible solution in the context of migration. “I think there’s a market failure in drug and vaccine developments” he tells me over the phone. “Right now, we are in a place where we have organisations like the Bill and Melinda Gates Foundation who are developing access for vaccinations, for things like measles, mumps and rubella which could be saving millions of children’s lives”. So, in the future, should we be looking to private investors to bridge the gap between who does and doesn’t survive? “I think there is a role for innovative funding and collaborations between government and private sector organisations to create vaccines” says Allridge. “Like neglected tropical diseases that don’t generate huge amounts of cash for drug companies. I think we should provide incentives for drug companies to do that”.
Vaccination continues to be a (contentious) minefield, but this idea is a relatively simple one, which related to access. If we began investing now, could we level the playing field and ensure an abundance of vaccines over the next 50 years? It’s a sensible question to be asking.
In order for this to happen, we may need to change the narrative about just who has the power when it comes to accessing healthcare. In a UK context, activists are already challenging political border regimes infringing on our bodies and activist groups like Patients Not Passports and Docs Not Cops, are pushing back against the UK government, who are charging migrants upfront to use the NHS, and denying care when they cannot prove their eligibility or pay. Perhaps it will be this kind of activism that will we become increasingly reliant on.
We know that migration is part of our past, present and future. It has always been part of the human condition – that we move to places to better survive, that the voice of our most basic instincts instruct us to find safety. We are a world in flux, and climate change is a driver. We must learn lessons about the future from our present bodies. The thrill of exploring a new world hinges on how we explore ourselves. Thinking about diet, trauma, political narratives, access to healthcare, urban planning, alternative therapies, how to fund vaccinations, and lifting barriers to care will be crucial to our survival as a warming planet makes migrants of us all. Humanity must rise to the challenge.