Dealing with Disparities in Food Acquisition Among Refugees (DDFAR)

In the United States, resettled refugees arrive in designated resettlement cities where they can in theory start a new life with support systems in place. Although refugee resettlement agencies are the main point of contact upon arrival, agencies are mandated to work with refugees for 90 days. Traditionally, local governments have not had purposeful contact with resettled refugee populations, yet the policies they enact and built environments they shape impact the lives and health of resettled refugees in myriad ways. As resettled refugees adjust to new ways of life, local governments can support plans and policies that reinforce healthy lifestyles. Multiple studies show that, among resettled refugee populations, acculturation of diet leads to increased risk of chronic disease. Furthermore, resettled refugee populations may be especially susceptible to experiencing cultural and economic inequities that ultimately contribute to food disparities, possibly leading to detrimental health outcomes. We explore the extent to which local governments in major U.S. resettlement cities consider the needs of resettled refugee populations in planning, particularly in regard to how planning influences food security, nutrition, and food-related and health concerns. Using a mixed-methods approach, we first conduct a review of the comprehensive plans of 10 cities that resettled the most refugees between 2012 and 2016 to determine if and how local governments are planning for resettled refugee populations. With an in-depth case study of the city of Buffalo, we explore the nuances of the findings from the review of comprehensive plans. For this deep-dive case study, interviews and a focus group were conducted with refugees from Burma to gain an understanding of how local governments and civil society groups plan for new American populations, particularly in terms of their food and health. Results carry implications as to how local governments can better serve resettled refugee populations through comprehensive planning.

Background: Over the past decade, refugees from Burma have been the largest single refugee group resettled to the US. There is concern that food insecurity and dietary acculturation will increase morbidity and mortality from chronic disease in this population. The purpose of this study was to explore opportunities for promoting healthy eating in refugees from Burma. Method: We conducted 28 semi-structured interviews and 1 focus group with 33 refugees from Burma living in Buffalo (5 ethnicities, 85% female, aged 28-72). We examined beliefs about the relationship between food and health and participants’ dietary habits. Interviews were conducted in in Karen, Burmese or English and were simultaneously transcribed and translated. We used a structured codebook and thematic analysis to analyze the transcripts. Results: Participants’ perception of the relationship between food and health was both similar and divergent from that of Western healthcare. Most, but not all participants perceived an important relationship between diet and health and discussed the value of eating vegetables and limiting sugar and fat. However, they did not attribute heart disease risk to diet, and risks associated with white rice and high salt foods were not discussed. Cost of vegetables, dental problems, and growing preference for processed American foods were barriers to heating a healthy diet. Discussion: Given conceptualizations of sugar and fat as unhealthy, health education about processed and convenience foods may be well-received. Community gardens and economic development may have downstream effects on promoting healthy eating and chronic disease prevention in this population.

The United States has resettled an average of 62,000 refugees per year over the past decade, one-quarter of whom originate from Burma. Although refugees from Burma sometimes migrate from places lacking food-related resources, their resettlement in the United States, where processed foods are abundant, may have unanticipated negative dietary and health consequences. Studies suggest that refugees decrease their intake of fruits and vegetables after they have resided in the United States for a certain length of time, which constitutes an Americanization of diet. With little preparation for navigating Western-oriented food environments, resettled refugees from Burma may be especially susceptible to cultural and economic inequities that ultimately worsen food-related disparities.

We explore the experiences of refugees from Burma in navigating food environments in the United States, and explore the extent to which local governments are supporting or hindering their access to culturally preferred, nutritious foods. This paper presents a qualitative case study of Buffalo, New York, based on open-ended interviews with refugees originating from Burma, local government officials, and representatives from civil-society groups. The results suggest that resettlement cities may create food inequities for refugees from Burma, but that civic and social networks help refugees to adapt to their new food environments. Local government efforts are lagging in planning for and with refugee communities. We conclude with suggestions for how local governments and researchers can promote food equity for resettled residents.