Dr. Farzanna Haffizulla, who is from Trinidad and Tobago, has always felt her Caribbean community is left out of health guidelines and policy-making, swallowed by larger racial and ethnic groups like white, Black and Latino.
For example, healthy eating signs in the U.S. often use apples but ignore tropical fruits like papayas or guavas. Nutritional advice also doesn’t address whether Jamaican patties are OK to eat frequently, or in what quantity.
Haffizulla says the lack of education has meant that eight out of 10 deaths in Caribbean communities are linked to a noncommunicable disease like diabetes, high blood pressure and other cardiovascular conditions.
“These disparities were sort of hidden and we became invisible because a lot of the race and ethnicity categories never truly outline with full transparency our multi-racial and multi-ethnic backgrounds,” said Haffizulla, chair of the Department of Internal Medicine at the Patel College of Osteopathic Medicine of Nova Southeastern University.
But the coronavirus pandemic, which has disproportionately affected communities of color, makes strong public health messaging targeted to Caribbean Americans all the more urgent, Haffizulla said.
This month, which also marks Caribbean American Heritage Month, Haffizulla presented the results of focus groups she led with her NSU colleagues before the pandemic. Her research, which included a study of 38 people from five Caribbean countries who have been living in South Florida for at least five years, has turned into an ambitious healthy eating outreach campaign tailored to Caribbean immigrants.
The Caribbean Diaspora Healthy Nutrition Outreach Project links a lack of culturally relevant messages to the diaspora’s disproportionate rates of illnesses like diabetes, heart disease and cancer. Funded by an NSU Quality of Life Grant, the project aims to develop menus and educational material that promote health and wellness in Caribbean communities, rather than representing native Caribbean foods across the board as generally unhealthy.
The study, published in February 2020, included immigrants from the top countries represented in Broward County — Haiti, Jamaica, Dominican Republic, Cuba and Trinidad and Tobago.
“Consistently, there’s just been a deficit ... of information on us, us Caribbean people,” Haffizulla said during a presentation in Davie to Broward County officials and other community members earlier this month.
Guidelines on Caribbean foods
In the early months of the COVID-19 pandemic, Haffizulla noticed some of the same patterns she often documented in her research on underlying conditions in Caribbean-American communities: Large immigrant groups were consistently left out of COVID data. Federal guidelines didn’t apply to multi-generational households. Not enough Black and brown people were included in large-scale medical studies.
“Many of the recommendations that were given out there did not take into account what was happening in our communities of color,” said Haffizulla.
The racial and ethnic disparities that emerged during the pandemic, which she documented in an article last summer in the International Journal of Environmental Research and Public Health, illustrated what Haffizulla already suspected: The Caribbean diaspora in the U.S., nearly 80% of which lives in the tri-county area in South Florida, is not understood well enough by health authorities and researchers to develop materials that address health disparities.
The Caribbean Diaspora Healthy Nutrition Outreach Project helped develop a national three-tier format similar to a traffic light — green for “Go,” yellow for “Slow,” and red for “Whoa” — into a model that explains what foods that are familiar to Caribbean Americans should be consumed more frequently than others. In the green category, for example, are foods like beans, roti and papaya smoothies with no added sugar or condensed milk. There’s curried goat in the “Slow” category. Guava pastries are in the “Whoa” category.
“Given the large number of Caribbean-born residents, Caribbean heritage families in South Florida, and those not accounted for in the census data, there is a strong need to provide culturally appropriate nutrition and healthy food options,” Haffizulla’s team wrote in the study, adding that previous research suggests that both African and Caribbean diasporas have higher rates of diabetes, despite lower obesity rates when compared to U.S.-born Blacks.
In the focus groups, participants talked about what cultural themes they liked about healthy nutrition materials and which ones they didn’t. For example, when it came to preferred forms of exercise, Haffizulla’s team noticed that swimming was not common among Afro-Caribbean women and that walking was favored across all groups. They liked seeing kitchen and household items they’re familiar with, like wooden spoons and dominoes.
And while eggs are used often in Caribbean cuisine, some research participants said they believed eggs weren’t healthy, a common misrepresentation of their nutritional value.
Strokes, heart disease more prevalent in Caribbean community
Haffizulla believes there’s a real and painful cost in underrepresenting particular ethnic groups in national nutritional education efforts. Her own mother, a nurse, died of complications from diabetes, Haffizulla said.
“This is a crisis. There are deathly effects if we don’t grab hold of this, take control of this and turn it around,” said Haffizulla. “We’ve had strokes and heart disease and every disease, you name it, has hit our family in one way or another. I see it in my patients; I see it in our community members; and it breaks my heart to know that it can be prevented.”
While the focus groups were conducted only in English, all of the material developed from the project is translated into Spanish and Haitian Creole. So far, the Caribbean Diaspora Healthy Nutrition Outreach Project has created partnerships with the Broward County Department of Health and Baptist Health South Florida, among others.
Last week, Haffizulla hosted the first CDHNOP Wellness Webinar with Antiguan reggae artist Causion, who was himself diagnosed with colon cancer last year.
Commissioner Melissa Dunn of the City of Lauderhill said she believes the project is particularly important to her district, which includes one of the ZIP Codes targeted in the study for the number of Caribbean-born immigrants.
“When you look at the community in the city of Lauderhill, all but two Census tracts suffer severely from a lot of these diseases that’s impacted a lot by our nutrition,” Dunn said during the presentation at NSU. “It’s very relevant to me but it’s relevant as well to my city.”
While the sampling in the study was relatively small, and was made up mostly of women, Haffizulla and her team at NSU are aiming to expand the program and get funding for more research that can help create evidence-based policies addressing health inequities.
“I think of Carnival bringing us all together. No matter who you are, you are equalized with Carnival,” said Haffizulla. “As a community, we have to come together, as strong as we can and help each other out.”