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Immigration as a Social and Structural Determinant of Health

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Abstract

This chapter describes how immigration status affects patients and influences care in the emergency department (ED). There are 11.3 million undocumented immigrants within the US, and many more with limited legal status, who are vulnerable to political, legal, and structural factors predisposing them to poor health outcomes. Many of these factors are beyond the control of the emergency provider, but there are ways to mitigate the structural vulnerability of this population by optimizing their care in the ED. Important steps include educating providers regarding health risks, care gaps, and patient experience; creating a system of immigration-informed care that employs sensitive and stabilizing care while in the ED; and integration of the clinical encounter with community resources (legal, case management, accompaniment) to support patients outside the ED.

Keywords

  • Immigration
  • Undocumented immigrant
  • Barriers to care
  • Structural competency
  • Immigration informed care

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References

  1. U.S. Census Bureau. (2012). 2009-2011 American Community Survey 3-year Public Use Microdata Samples [SAS Data file]. Retrieved from https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t.

  2. Child Trends. 2019. Immigrant children – child trends. [online] Available at: https://www.childtrends.org/indicators/immigrant-children [Accessed 2 May 2019].

  3. The Henry J. Kaiser Family Foundation. 2019. Health Coverage of Immigrants. [online] Available at: https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/ [Accessed 2 May 2019].

  4. Ommundsen R, Van der Veer K, Larsen KS, Eilertsen DE. Framing unauthorized immigrants: the effects of labels on evaluations. Psychol Rep. 2014;114(2):461–78.

    Google Scholar 

  5. Jie Zong J. Naturalization Trends in the United States. [online] migrationpolicy.org. 2019. Available at: https://www.migrationpolicy.org/article/naturalization-trends-united-states [Accessed 2 May 2019].

  6. Morey BN, Gee GC, Muennig P, Hatzenbuehler ML. Community-level prejudice and mortality among immigrant groups. Soc Sci Med. 2018;199:56–66.

    Google Scholar 

  7. Dhs.gov. 2019. Annual flow report. [online] Available at: https://www.dhs.gov/sites/default/files/publications/Refugees_Asylees_2017.pdf [Accessed 2 May 2019].

  8. Pimienti M, Polkey C. Snapshot of US immigration 2019. March 29, 2019; Available from: https://www.ncsl.org/research/immigration/snapshot-of-u-s-immigration-2017.aspx.

  9. Baker B, Rytina N. Estimates of the unauthorized immigrant population residing in the United States: January 2012: Office of Immigration Statistics; 2012.

    Google Scholar 

  10. Fazel-Zarandi MM, Feinstein JS, Kaplan EH. The number of undocumented immigrants in the United States: estimates based on demographic modeling with data from 1990 to 2016. PLoS One. 2018;13(9):e0201193.

    CrossRef  Google Scholar 

  11. Rosenblum M, Ruiz Soto AG. An analysis of unauthorized immigrants in the United States by country and region of birth. Washington, DC: Migration Policy Institute; 2015.

    Google Scholar 

  12. Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33.

    CrossRef  Google Scholar 

  13. Castaneda H, Holmes SM, Madrigal DS, Young ME, Beyeler N, Quesada J. Immigration as a social determinant of health. Annu Rev Public Health. 2015;36:375–92.

    Google Scholar 

  14. Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med. 2017;92(3):299–307.

    Google Scholar 

  15. Cone J, Bosch-Bonacasa M. Invisible war: Central America’s forgotten humanitarian crisis. Brown J World Aff. 2017;24:225.

    Google Scholar 

  16. Miller T. Empire of Borders: The Expansion of the US Border Around the World. United Kingdom: Verso Books. 2019.

    Google Scholar 

  17. Wallace SP, Torres J, Sadegh-Nobari T, Pourat N, Brown ER. Undocumented immigrants and health care reform: UCLA Center for Health Policy Research; 2013. p. 26. http://healthpolicy.ucla.edu/publications/Documents/PDF/undocumentedreport-aug2013.pdf.

  18. Pourat N, Wallace SP, Hadler MW, Ponce N. Assessing health care services used by California’s undocumented immigrant population in 2010. Health Aff (Millwood). 2014;33(5):840–7.

    Google Scholar 

  19. Nandi A, Galea S, Lopez G, Nandi V, Strongarone S, Ompad DC. Access to and use of health services among undocumented Mexican immigrants in a US urban area. Am J Public Health. 2008;98(11):2011–20.

    Google Scholar 

  20. Wallace S, Tones J, Sadegh-Nobari T, Pourat N, Brown R. Undocumented Immigrants and Health Care Reform. UCLA: Center for Health Policy Research. Retrieved from https://escholarship.org/uc/item/8sv4w4m4. 2013.

  21. Linton JM, Ameenuddin N, Falusi O. Pediatricians awakened: addressing family immigration status as a critical and intersectional social determinant of health. Am J Bioeth. 2019;19(4):69–72.

    CrossRef  Google Scholar 

  22. Callaghan T, Washburn DJ, Nimmons K, Duchicela D, Gurram A, Burdine. Immigrant health access in Texas: policy, rhetoric, and fear in the Trump era. BMC Health Serv Res. 2019;19(1):342.

    Google Scholar 

  23. Cohen MS, Schpero WL. Household immigration status had differential impact on medicaid enrollment in expansion and nonexpansion states. Health Aff (Millwood). 2018;37(3):394–402.

    CrossRef  Google Scholar 

  24. Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy. 2015;8:175–83.

    Google Scholar 

  25. Flynn MA, Eggerth DE, Jacobson CJ Jr. Undocumented status as a social determinant of occupational safety and health: the workers’ perspective. Am J Ind Med. 2015;58(11):1127–37.

    CrossRef  Google Scholar 

  26. Vargas Bustamante A, Fang H, Garza J, Carter-Pokras O, Wallace SP, Rizzo JA, et al. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. J Immigr Minor Health. 2012;14(1):146–55.

    Google Scholar 

  27. Khullar D, Chokshi DA. Immigrant health, value-based care, and emergency medicaid reform. JAMA. 2019;321(10):928–9.

    CrossRef  Google Scholar 

  28. Saadi A, McKee M. Hospitals as places of sanctuary. BMJ. 2018;361:k2178.

    CrossRef  Google Scholar 

  29. Maldonado CZ, Rodriguez RM, Torres JR, Flores YS, Lovato LM. Fear of discovery among Latino immigrants presenting to the emergency department. Acad Emerg Med. 2013;20(2):155–61.

    Google Scholar 

  30. Rodriguez RM, Torres JR, Sun J, Alter H, Ornelas C, Cruz M, et al. Declared impact of the US President’s statements and campaign statements on Latino populations’ perceptions of safety and emergency care access. PLoS One. 2019;14(10):e0222837.

    Google Scholar 

  31. Kim G, Molina US, Saadi A. Should immigration status information be included in a patient’s health record? AMA J Ethics. 2019;21(1):E8–16.

    CrossRef  Google Scholar 

  32. Saadi A, Cheffers ML, Taira B, Trotzky-Sirr R, Parmar P, Samra S, et al. Building immigration-informed, cross-sector coalitions: findings from the Los Angeles County Health Equity for Immigrants Summit. Health Equity. 2019;3(1):431–5.

    Google Scholar 

  33. Macias-Konstantopoulos W. Human trafficking: the role of medicine in interrupting the cycle of abuse and violence. Ann Intern Med. 2016;165(8):582–8.

    CrossRef  Google Scholar 

  34. Shandro J, Chisolm-Straker M, Duber HC, Findlay SL, Munoz J, Schmitz G, et al. Human trafficking: a guide to identification and approach for the emergency physician. Ann Emerg Med. 2016;68(4):501–508.e1.

    Google Scholar 

  35. Samra S, Taira BR, Pinheiro E, Trotzky-Sirr R, Schneberk T. Undocumented patients in the emergency department: challenges and opportunities. West J Emerg Med. 2019;20(5):791–8.

    Google Scholar 

  36. Ngai KM, Grudzen CR, Lee R, Tong VY, Richardson LD, Fernandez A. The association between limited English proficiency and unplanned emergency department revisit within 72 hours. Ann Emerg Med. 2016;68(2):213–21.

    Google Scholar 

  37. Taira BR. Improving communication with patients with limited English proficiency. JAMA Intern Med. 2018;178(5):605–6.

    CrossRef  Google Scholar 

  38. Becerra BJ, Arias D, Becerra MB. Low health literacy among immigrant Hispanics. J Racial Ethn Health Disparities. 2017;4(3):480–3.

    CrossRef  Google Scholar 

  39. Shommu NS, Ahmed S, Rumana N, Barron GR, McBrien KA, Turin TC. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: a systematic scoping review. Int J Equity Health. 2016;15:6.

    Google Scholar 

  40. Saadi A, Ahmed S, Katz MH. Making a case for sanctuary hospitals. JAMA. 2017;318(21):2079–80.

    CrossRef  Google Scholar 

  41. New York City Health and Hospitals Corporation. Seek care without fear. 2018. https://www.nychealthandhospitals.org/immigrant/.

  42. Tobin Tyler E. Medical-legal partnership in primary care: moving upstream in the clinic. Am J Lifestyle Med. 2019;13(3):282–91.

    CrossRef  Google Scholar 

  43. Martinez O, Wu E, Sandfort T, Dodge B, Carballo-Dieguez A, Pinto R, et al. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health. 2015;17(3):947–70.

    Google Scholar 

  44. Kelley AT, Tipirneni R. Care for undocumented immigrants – rethinking state flexibility in medicaid waivers. N Engl J Med. 2018;378(18):1661–3.

    Google Scholar 

  45. Cervantes L, Tuot D, Raghavan R, Linas S, Zoucha J, Sweeney L, et al. Association of emergency-only vs standard hemodialysis with mortality and health care use among undocumented immigrants with end-stage renal disease. JAMA Intern Med. 2018;178(2):188–95.

    Google Scholar 

  46. Krieger N, Huynh M, Li W, Waterman PD, Van Wye G. Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 August 2017. J Epidemiol Community Health. 2018;72(12):1147–52.

    Google Scholar 

  47. Hacker K, Chu J, Arsenault L, Marlin RP. Provider’s perspectives on the impact of Immigration and Customs Enforcement (ICE) activity on immigrant health. J Health Care Poor Underserved. 2012;23(2):651–65.

    Google Scholar 

  48. McLeigh JD. How do Immigration and Customs Enforcement (ICE) practices affect the mental health of children? Am J Orthopsychiatry. 2010;80(1):96–100.

    CrossRef  Google Scholar 

  49. Hacker K, Chu J, Leung C, Marra R, Pirie A, Brahimi M, et al. The impact of immigration and customs enforcement on immigrant health: perceptions of immigrants in Everett, Massachusetts, USA. Soc Sci Med. 2011;73(4):586–94.

    Google Scholar 

  50. Vargas ED, Sanchez GR, Juarez M. Fear by association: perceptions of anti-immigrant policy and health outcomes. J Health Polit Policy Law. 2017;42(3):459–83.

    CrossRef  Google Scholar 

  51. Lopez WD, Kruger DJ, Delva J, Llanes M, Ledón C, Waller A, et al. Health implications of an immigration raid: findings from a Latino community in the midwestern United States. J Immigr Minor Health. 2017;19(3):702–8.

    Google Scholar 

  52. Fenton JJ, Catalano R, Hargreaves WA. Effect of Proposition 187 on mental health service use in California: a case study. Health Aff (Millwood). 1996;15(1):182–90.

    CAS  CrossRef  Google Scholar 

  53. Berk ML, Schur CL. The effect of fear on access to care among undocumented Latino immigrants. J Immigr Health. 2001;3(3):151–6.

    Google Scholar 

  54. Torche F, Sirois C. Restrictive immigration law and birth outcomes of immigrant women. Am J Epidemiol. 2019;188(1):24–33.

    CrossRef  Google Scholar 

  55. Toomey RB, Umaña-Taylor AJ, Williams DR, Harvey-Mendoza E, Jahromi LB, Updegraff KA. Impact of Arizona’s SB 1070 immigration law on utilization of health care and public assistance among Mexican-origin adolescent mothers and their mother figures. Am J Public Health. 2014;104(Suppl 1):S28–34.

    Google Scholar 

  56. Beniflah JD, Little WK, Simon HK, Sturm J. Effects of immigration enforcement legislation on Hispanic pediatric patient visits to the pediatric emergency department. Clin Pediatr (Phila). 2013;52(12):1122–6.

    Google Scholar 

  57. Rodríguez MA, Bustamante AV, Ang. A. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med 2016. 2009;24(Suppl 3):508–13.

    Google Scholar 

  58. The Lancet. US public charge rule: pushing the door closed. Lancet. 2019 Jun 1;393(10187):2176. https://doi.org/10.1016/S0140-6736(19)31233-4. PMID: 31162066.

  59. Services, U.S.C.a.I. Public charge rule. 2020; Available from: https://www.uscis.gov/greencard/public-charge.

  60. Zallman L, Finnegan KE, Himmelstein DU, Touw S, Woolhandler S. Implications of changing public charge immigration rules for children who need medical care. JAMA Pediatr. 2019;173:e191744.

    Google Scholar 

  61. Bleich SN, Fleischhacker S. Hunger or deportation: implications of the Trump Administration’s Proposed Public Charge Rule. J Nutr Educ Behav. 2019;51(4):505–9.

    CrossRef  Google Scholar 

  62. Perreira KM, Yoshikawa H, Oberlander J. A new threat to immigrants’ health – the public-charge rule. N Engl J Med. 2018;379(10):901–3.

    Google Scholar 

  63. Cleary SD, Snead R, Dietz-Chavez D, Rivera I, Edberg MC. Immigrant trauma and mental Health outcomes among Latino Youth. J Immigr Minor Health. 2018;20(5):1053–9.

    Google Scholar 

  64. Steel JL, Dunlavy AC, Harding CE, Theorell T. The psychological consequences of pre-emigration trauma and post-migration stress in refugees and immigrants from Africa. J Immigr Minor Health. 2017;19(3):523–32.

    Google Scholar 

  65. Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA. 2003;290(5):627–34.

    Google Scholar 

  66. Perreira KM, Pedroza JM. Policies of exclusion: implications for the health of immigrants and their children. Annu Rev Public Health. 2019;40:147–66.

    CrossRef  Google Scholar 

  67. Berlinger N, Zacharias RL. Resources for teaching and learning about immigrant health care in health professions education. AMA J Ethics. 2019;21(1):E50–7.

    CrossRef  Google Scholar 

  68. Acosta DA, Aguilar-Gaxiola S. Academic health centers and care of undocumented immigrants in the United States: servant leaders or uncourageous followers? Acad Med. 2014;89(4):540–3.

    CrossRef  Google Scholar 

  69. Moreno G, Rodríguez MA, Lopez GA, Bholat MA, Dowling PT. Eight years of building community partnerships and trust: the UCLA family medicine community-based participatory research experience. Acad Med. 2009;84(10):1426–33.

    Google Scholar 

  70. Casale CR, Clancy CM. Commentary: not about us without us. Acad Med. 2009;84(10):1333–5.

    CrossRef  Google Scholar 

  71. Polk S, DeCamp LR, Guerrero Vázquez M, Kline K, Andrade A, Cook B, et al. Centro SOL: a community-academic partnership to care for undocumented immigrants in an emerging Latino area. Acad Med. 2019;94(4):538–43.

    Google Scholar 

  72. Losonczy LI, Hsieh D, Wang M, Hahn C, Trivedi T, Rodriguez M, et al. The Highland Health Advocates: a preliminary evaluation of a novel programme addressing the social needs of emergency department patients. Emerg Med J. 2017;34(9):599–605.

    Google Scholar 

  73. Katz MH, Brigham TM. Transforming a traditional safety net into a coordinated care system: lessons from healthy San Francisco. Health Aff (Millwood). 2011;30(2):237–45.

    CrossRef  Google Scholar 

  74. Regenstein M, Trott J, Williamson A, Theiss J. Addressing social determinants of Health through medical-legal partnerships. Health Aff (Millwood). 2018;37(3):378–85.

    Google Scholar 

  75. Bernhardt LJ, Lin S, Swegman C, Sellke R, Vu A, Solomon BS, et al. The Refugee Health Partnership: a longitudinal experiential medical student curriculum in refugee/asylee health. Acad Med. 2019;94(4):544–9.

    Google Scholar 

  76. Eisenstein L. To fight burnout, organize. N Engl J Med. 2018;379(6):509–11.

    CrossRef  Google Scholar 

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Schneberk, T., Samra, S. (2021). Immigration as a Social and Structural Determinant of Health. In: Alter, H.J., Dalawari, P., Doran, K.M., Raven, M.C. (eds) Social Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-65672-0_3

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