Approximately three percent of Africa’s population have migrated internationally, many to Europe, North America and Australia. One health issue immigrants from Africa face is a stark decrease in the amount of vitamin D they get.
Much of Africa sits very close to the equator, getting intense year-round sun exposure, intense enough to stimulate vitamin D production in dark-skinned Africans. Because of this intense year-round sun exposure, Africans evolved to have dark skin to protect their bodies to a certain extent. Their skin color evolved in the African environment likely to strike a balance between fulfilling their vitamin D needs and protecting themselves from over-exposure. We have blogged on this topic before.
When Africans emigrate away from Africa, suddenly their skin type no longer fits their environment. Their skin is designed to handle much more sun exposure, much more intense and frequent UV rays. The result is their skin-type overprotecting their skin and not allowing it to produce enough vitamin D. This is why the majority of immigrants and people of African descent are vitamin D deficient.
Recently, researchers in Australia wanted to get a sense of how aware immigrants were of vitamin D deficiency, if they knew they were at risk and what would entice them to actually correct their deficiency.
The team of researchers led by Alana Pirrone recruited thirty women, all immigrants living in Melbourne, Australia, and from the Horn countries Somalia, Eritrea, Oromo. All had moved to Australia within the past 10 years.
They divided the women into five focus groups and asked each group a series of open-ended questions to gage their understanding of sunlight, vitamin D, vitamin D deficiency and similar topics. The sessions took 40 minutes and the researchers specifically sought to:
- explore individual perceptions, experience and understandings of vitamin D deficiency among African migrant women.
- identify the most useful sources of information about vitamin D deficiency among this population.
- document the barriers and enablers to addressing vitamin D deficiency.
Here’s what they found:
- When asked about the risk factors for vitamin D deficiency, most women understood that lack of sunlight, dark skin and heavy clothing all contributed to increased risk of vitamin D deficiency.
- Asked what happens when you become deficient in vitamin D, the women had much less awareness. A common response to this question is that you become forgetful.
- Many were familiar that they were likely deficient in vitamin D (or knew they were deficient), but they hadn’t done anything about it. They were familiar that supplementation was an option, though none of them supplemented.
- Some understood quite clearly that their skin was very dark to protect themselves from the sun, and in consequence, they needed more sun exposure than most to be able to make adequate vitamin D.
- Paradoxically, most believed that sun exposure in Australia was more dangerous than sun exposure in Africa, despite some earlier noting that their skin was dark because of the abundant sun in Africa. They noted that skin cancer and cancer in general wasn’t an issue in Africa, but expressed concern in getting skin cancer due to the more “dangerous” Australian sun.
- The women mentioned that when weighing the two options, risking skin cancer or becoming deficient in vitamin D, they felt it was safer to have vitamin D deficiency than risk getting skin cancer.
- Lastly, when the women were asked what would help them take action to raise their vitamin D levels from deficient to sufficient, they unanimously agreed that they’d like to see more peers provide information on vitamin D and would like to see more peers take actions themselves, ie actively seek sun exposure and supplement.
The authors conclude,
“This study has demonstrated the significant need for health promotion strategies in Melbourne, Australia, to combat vitamin D deficiency in dark skinned and veiled women. It is well established that simply providing knowledge and information about a particular health issue is not enough to result in sustained behavior and lifestyle change.”
Further they recommend,
“Public health and health promotion campaigns should encompass peer education as an effective approach in addressing vitamin D deficiency.”
What stood out to me is the need for more clear and thorough sun exposure messages. The women report that skin cancer isn’t much of a concern at all in Africa, yet through some time spent in Australia, have a new found concern of getting skin cancer. This in spite that their skin type is well adapted to receive even the most intense of Australian rays. While the authors didn’t say, their new concern is likely due to public health messages/campaigns warning about the dangers of sun exposure, a type of campaign that doesn’t exist in Africa.
Furthermore, the women report that vitamin D deficiency is probably okay compared to getting more sun exposure and increasing their risks of skin cancer. This belief, coupled with their prior nonexistent concern of skin cancer, tells us sun avoidance messages are still speaking much louder than moderate sun exposure messages. This battle between the messages is particularly misguiding for dark-skinned immigrants living away from their natural equatorial environment. At the very least, it should be the responsibility of those behind sun avoidance campaigns to be clear that their messages lack relevance to darker skin types.
Lastly, we echo the authors’ conclusions and recommendations. A big part in overcoming epidemic vitamin D deficiency is peer-to-peer communication. Members, what are your thoughts? And how do you encourage your peers to take action to ensure vitamin D sufficiency?
Pirrone A, Capetola T, Riggs E, Renzaho A. Vitamin D deficiency awareness among African migrant women residing in high rise public housing in Melbourne, Australia, qualitative study. Asia Pac J Clin Nutr 2013.