Immigrant%20Health

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Immigrant Health

• Steven P. Wallace, Ph.D.
• UCLA School of Public Health UCLA Center for
  Health Policy Research
• http//swallace.bol.ucla.edu

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Outline

• Who are immigrants?
• What is their health status risks?
• What determinants of health vary for them?
• What are community health strategies?
• What are their health systems issues?

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1. Demographics of immigration
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Country of origin of immigrants, all ages, 2006
United States
California
Source U.S. Census Bureau, 2006 Current
Population Survey
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Changing immigrant sources

• 1890 14.6 born abroad, mostly W N Europe
• 1930 11.5 born abroad, most common Italy,
  Poland, Russia

Ellis Island, 1902
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Immigration Reform

• 1965 Added Western hemisphere quota
• 1965 Added family reunification
• 1980 Refugee act
• 1986 IRCA amnesty for undocumented, employer
  sanctions

San Ysidro border crossing
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Country of origin of immigrants, all ages, 2006
United States
California
Source U.S. Census Bureau, 2006 Current
Population Survey
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Population of all Mexican Americans only
Mexican immigrants in the U.S.
Source U.S. Census Bureau, Current Population
Survey 1994-2006
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Mexican-born and Mexican-American Population and
Percentage of Total Population in California, 2005
Proportion of total
Population
Source Estimates based on U. S. Census Bureau,
Current Population Survey (CPS), March 2005.
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Exhibit 3 States with more than 100,000 Mexican
immigrants, 2006

1. California 4.4 million
2. Texas 2.2 million
3. Arizona 713,000
4. Illinois 526,000
5. Florida 317,000
6. Georgia 316,000
7. North Carolina 273,000
8. Colorado 268,000
9. New York 209,000
10. Nevada 198,000
11. New Jersey 130,000
12. Oregon 122,000
13. New Mexico 118,000
14. Washington 116,000

Source U.S. Census Bureau, 2006 Current
Population Survey
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Age distribution of Mexican immigrants and
others, U.S. 2006
Source U.S. Census Bureau, 2006 Current
Population Survey
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Contribution of Mexicans and Mexican-Americans to
Population Growth in California ages 15 to 44 and
0 to 15, 1990-2000
Source Estimates based on U. S. Census Bureau,
15-percent sample 1970, 5-percent sample 1980,
5-percent sample 1990 and 5-percent sample 2000.
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Exhibit 8 Labor force participation of men ages
18-64, 2006
United States
California
Source U.S. Census Bureau, 2006 Current
Population Survey
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Why immigrant health?context

• Employed in segmented labor market
• Especially manual service occupations
• Low incomes, benefits, difficult work
• Live in segregated housing
• Low income housing with more structural and other
  problems
• Concentrated in low performing schools
• Experience similar shortages of public space
  other public services

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Mexican immigrants 20 of the male CA labor
force, but account for many workers in

Source U.S. Census Bureau, 2006 Current
Population Survey.
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Carwasheros

• Difficult work
• Largely undocumented
• Often paid less than minimum wage
• No benefits, insurance
• Living wage could easily be passed on in price

Photo LA Times March 27, 2008
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Why immigrant health?Individual factors

• Knowledge prior experience with health and
  healing systems
• Culture beliefs and values related to health
  and healing
• Beliefs, rumors about immigration status and
  risks

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2. Immigrant health status Risks
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Life expectancy _at_ birth
Source Singh Hiatt, International Journal of
Epidemiology, 2006
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Relative Rates, Immigrant v. Native (adjusted
for age, sex, income, region, etc)
Native rate1
Source Singh Hiatt, International Journal of
Epidemiology, 2006
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Immigrant Birth Outcomes Better
Per 1000 live births
Source CDC, MMWR, December 6, 2002
http//www.cdc.gov/mmwr/preview/mmwrhtml/mm5148a3.
htm
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Immigrant paradoxHigh risk factors

• Low income
• Low education
• Poor working conditions
• Overcrowded housing

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Immigrant paradoxBUT good outcomes

• Mortality
• Chronic conditions like heart disease (except
  diabetes)
• Birth outcomes

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Determinants of Health
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Mexican Immigrants have lowest levels of education
Source SSA, Inmigrantes Mexicanos y
Centroamericanos en Estados Unidos, 2006 Adults
25 years and older, U.S., http//www.healthpolicy.
ucla.edu/pubs/publication.asp?pubID196
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Mexican immigrants have high levels of poverty
United States
California
Source SSA, Inmigrantes Mexicanos y
Centroamericanos en Estados Unidos, 2006 Adults
18 years and over living in poverty, U.S. And CA,
2005 http//www.healthpolicy.ucla.edu/pubs/publica
tion.asp?pubID196
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Immigrant paradox Why?

• Selection effects health/social capital
• Health? (Rural Mexican women, Rubalcava, AJPH,
  2008)
• Education (found in all countries, exc. Puerto
  Rico Feliciano,Demography, 2005)
• Social Networks?
• Other human capital?

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Immigrant paradox Why?

• Selection effects
• Return migration (salmon effect)
• 1/3 of Mexican immigrants return w/i 10 years
• Mortality is lower for Mexicans (who can return)
  than Cubans (who can not)
• Can this explain birth outcomes??

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Immigrant paradox Why?

• Selection effects
• Return migration (salmon effect)
• Health behaviors (culture)
• Lower rates of smoking, healthier diets
• Stronger social networks
• Direct effects helping out, share info, etc
• Indirect effects buffer stress
• Erodes w/acculturation
• Acculturative stress
• Changing behaviors

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Immigrant paradox Why?

• Selection effects
• Return migration (salmon effect)
• Health behaviors (culture)
• Community effects (context)
• Immigrants communities have an independent
  protective effect
• Assimilation reduces (vs. acculturation)

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n.s.married, educ, income, immigrant, English
interview, neighborhood poor
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4. Community health strategies

• Sustain healthy behaviors
• Improve medical infrastructure
• Improve social environmental context of health

Photo http//www.flickr.com/photos/roscoland/9620
51804/
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Healthy Behaviors

• Promote good nutrition in schools, stores, food
  stamps
• Facilitate physical activities via sports, parks
  school yards
• Disseminate information via promotoras
• Sustain social networks via public space

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Improve medical infrastructure

• Sustain/expand community clinics, school based
  clinics
• Increase bilingual, bicultural workforce
• Better connect workers to workers compensation
  system
• Expand preventive elder care, screenings
  treatment

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Improve context for health

• Improve housing, building enforcement
• Improve workplace health safety, CalOSHA,
  living wage and other enforcement
• Improve air quality in immigrant communities

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Summary, immigrant paradox

• Better health outcomes despite many risk factors
• Some health advantage due to selection, other to
  health behaviors, other to social community
  conditions
• To maintain health capital, community health
  strategies are important

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5. Medical Care Issues
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Mexican immigrants have the lowest levels of
health insurance of all in CA in poverty
Source SSA, Inmigrantes Mexicanos y
Centroamericanos en Estados Unidos, 2006 Adults
18 years and older who live in poverty, U.S.,
http//www.healthpolicy.ucla.edu/pubs/publication.
asp?pubID196
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Mexican immigrants lack connection to health
care facilities
Source California Health Interview Survey,
2003 Adults 18 or older, California
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Mexican immigrants have the highest levels of no
medical visits in the past two years
Source- CONAPO, Migración México-Estados Unidos,
Temas de salud. 2005. Adults 18 years or older,
U.S. http//www.healthpolicy.ucla.edu/pubs/public
ation.asp?pubID154
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Mexican immigrants have the lowest levels of
emergency room visits
Fuente- CONAPO, Migración México-Estados Unidos,
Temas de salud. 2005. Adults 18 and over
U.S. http//www.healthpolicy.ucla.edu/pubs/publica
tion.asp?pubID154
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Mexican immigrants have the highest use of health
or dental services in Mexico
Source - 2001 California Health Interview
Survey Adults 18 years or over, California
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Adults age 18 and over with no doctor visit past
year
Source California Health Interview Survey, 2003
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Adults age 18 and over with no dental visit in
past year
Source California Health Interview Survey, 2003
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Adults age 65 and over with no influenza
immunization past year
Source California Health Interview Survey, 2003
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Adults age 50 and over who have never had a
colorectal exam
Source California Health Interview Survey, 2003
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Women age 18-64 with no pap smear past three years
Source California Health Interview Survey, 2003
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Summary, health care

• Mexican and Central American immigrants are an
  important part of Californias population
• They face substantial access to care barriers
• It is possible to provide adequate access to care
  to these populations

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Conclusion

• Immigrants are here to stay
• They face a number of special health, health
  behavior, and access to health care issues
• It is critical to address those issues to
  maintain a health California