According to the Census Bureau, as of the second quarter of 2015, there are over 42 million immigrants (documented and undocumented) in the United States. This same time last year, the immigrant population rose by 1.7 million people. That is almost equivalent to Nebraska’s entire state population. Immigrants now make up a whopping 13 percent of the American population (Zeigler, Camarota)! This is the largest percentage in over one hundred years. In the early 90’s most immigrants came from Latin America or Europe, now most originate from Asia or Africa (Plummer, 2013). Immigration to the United States for many people derives from various reasons such as work, education, security, or freedom, but all have one common theme, which is a concept of “opportunity” (Plummer, 2013). The question is, does this include adequate access to healthcare? Is there a gap?
Immigrants to the U.S. tend to enjoy better health than their U.S.-born counterparts, known as the “healthy immigrant effect.” This is because healthier people are more likely to migrate to another country and thus have better health behaviors, at least immediately following migration (Esther Prins, Shannon Monnat, 2015).One reason that could make this possible is because changing countries is a lot more than just changing zip codes. Someone who is looking to move to the U.S. possibly has access to finances to enable them to do so, which means this person had a form of income, which means they most likely worked, and this person must be healthy enough to work. It is important to note that immigrants also come to the United States as refugees escaping hardships from their home country. It is interesting to think how they fit into that “healthy immigrant effect”. It may have to do with the fact that their diet and lifestyle stresses have changed since coming from their home country’s situation. Coming to the U.S. maybe gives them a chance to gain better health in terms of access and quality.
Nevertheless, the key phrase previously stated is, “at least immediately following migration”. So what issues arise after spending time in the U.S.?
Is the land of opportunity maybe the land of misunderstanding? The immigrant population is more than often referred to as a “vulnerable” population, which is a population with increased risks of poor physical, psychological, and social health outcomes. Inadequate healthcare is in general mostly due to a lack of socioeconomic and societal resources (Esther Prins, Shannon Monnat, 2015). Many foreign-born people in the U.S. come here with prior knowledge of what is good health and what are adequate healthy life styles (Esther Prins, Shannon Monnat, 2015). The most common issue for immigrants spending time in the U.S. is that they assimilate and acculturate to the American lifestyle. In addition, inequitable access to healthcare and insurance, poor healthcare quality, segregation, environmental hazards, cultural disagreement, lack of familiarity with the U.S. healthcare system, and limited English proficiency are all issues that may also diminish immigrants’ ability to convert literacy and health proficiencies into health rewards (Esther Prins, Shannon Monnat, 2015).
Immigrants are less likely than U.S.-born populations to have graduated from high school and are more likely to have lower literacy scores, work in service occupations, and live in poverty (Debrose, Escarce, Lurie, 2007). Even with the exception of Asian and African immigrants whose percentage of high school graduates equals that of percentages for U.S.-born populations (87 percent), the problem still pervades as the percentage drops much lower (38 percent) among immigrants from Mexico and Central American populations. The socioeconomic hierarchy is a very strong determinant for overall health outcome. Being able to get an education, the type of occupation one can qualify for, and the earnings they receive for that occupation all directly and indirectly influence immigrants’ access to healthcare resources. This phenomenon, along with the legal status of a person, undoubtedly contributes to the major determinants of immigrants’ access to social services and jobs with benefits that lead to opportunities of better overall healthcare (Debrose, Escarce, Lurie, 2007).
With the political climate as it is now, legal status can exacerbate community concerns regarding the effects of immigration on community resources. A common theme in newspaper articles and opinion pieces nowadays is that immigrants, especially the undocumented, overburden the safety net and take away from “deserving” families, even though research suggests that immigrants in general, and the undocumented in particular, use relatively few healthcare resources ( Debrose, Escarce, Lurie, 2007). Being part of a stigmatized group can make immigrants reluctant to seek care because of concerns about poor treatment ( Debrose, Escarce, Lurie, 2007). This is an important point because it takes into account the physical sort of barriers and the psychological barriers that make proper healthcare access difficult. There should be proper avenues of assistance that have the resources to be able to address both. Everyone wants to feel comfortable and wanted wherever they are living.
Immigrants consistently show lower rates of health insurance coverage than U.S.-born populations, although there are differences among immigrants based on immigration status, time in the United States, and country of origin. Forty-five percent of non-citizen immigrants living in the United States lack health insurance, whereas non-coverage for naturalized citizens is approximately 15 to 20 percent of the U.S.-born population. These insurance disparities extend to immigrants’ children. U.S.-born children with noncitizen or naturalized parents also have lower rates of health insurance than U.S.-born children with U.S.-born parents. The disparities are manifest in other measures of access as well, such as not having a regular source of care, not having a physician or dental visit in the past year, or having fewer visits, even after adjusting for health insurance and health status (Debrose, Escarce, Lurie, 2007). This can lead to poor health during childhood years and eventual poor health status during adulthood.
Going back to health literacy and education: English proficiency can be a multifaceted issue. While this is not an issue for immigrant groups where English is the national or first language of their home country, adults with limited English proficiency and their children are found to be much less likely to have insurance and a usual source of care than those who only speak English. Limited English proficiency can also affect patient safety, increasing the probability of an adverse medication reaction resulting from problems in understanding instructions (Debrose, Escarce, Lurie, 2007). Language barriers should not block correct health education and instruction, considering lives could be at stake. Not only improper use of medications can be dangerous, but also addictions can be formed. If low SES is involved, mental health and depression may follow. Each day, 44 people in the United States die from overdose of prescription painkillers alone (CDC, 2015).
A complete and encompassing healthcare plan is a dream that many hold on to, including myself. In the meantime, some better policies put in place will suffice. For example, policy that would expand access to health insurance to community clinics and other care venues, which can be effective in maintaining coverage among immigrant children and their families. Increasing funding and awareness to community health centers can aid in helping current staff to become more culturally aware and competent in order to understand the differences in cultures from which the people they serve come. A good example is something as simple as dietary restrictions. Simply telling someone what he or she can and cannot eat without knowing certain cultural traditions probably will not yield the desired results. Instead, a chart or list of various substitutes for different ingredients as a quick handout can be beneficial. Lastly, issues related to English proficiency are an important source of vulnerability among immigrants, so there would likely be a benefit from broader implementation and enforcement of the national CLAS standards and the expansion of Medicaid benefits to cover interpreter services in the forty states that do not do so already (Debrose, Escarce, Lurie, 2007).
I am a first generation Nigerian American and I know a version of the immigrant story. My father originally came to the United States in the 80’s in pursuit of an undergraduate and graduate education, eventually going back to Nigeria with dreams of becoming successful. He married my mother and when things didn’t work out in the job market, they both came back to the U.S. in the 90’s where my father got work and my mother got in to college. Now a fledgling family, my father went through the struggles required to create better “opportunities” for his new family. He and my mother may be examples of the exceptions. So here’s food for thought. As we know, many cultures are patriarchal societies where men have more societal power and support their entire families with pride. When these men try to search for better opportunities in America, “help” may not exactly be what they want. They may just want to be presented with opportunities like everyone else has and all the commercials and movies show. So, better policies in which immigrant families are presented with healthcare options earlier on may be the way to improve the general health of the population.
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