For the inaugural Sections Edition, we asked some of our section members to share their policy insights on a topic of increasing relevance—border and migrant health—and to comment on how medical anthropology can help. Here are their responses.
In the Rio Grande Valley, along the Texas/Mexico border, people are frequently caught between two worlds when it comes to their health care. In the county in which I research, one in ten persons is undocumented, and the proportion of mixed-status families is one of the highest in the country. While social ties and proximity to Mexico once allowed people living in this dynamic region to access a range of health care options, they now experience extreme restrictions in mobility, making it difficult to access care. For medical anthropologists working in immigrant communities, two pressing policy issues demand our attention. First, under the Affordable Care Act, juridico-legal categories of immigration status matter just as much as means-tested ones. As a result, an estimated 11.2 million undocumented immigrants still face explicit exclusion from obtaining affordable health insurance. In addition, the 2.3 million mixed-status families in the US experience indirect effects. Children, including US citizens, are directly impacted by the “illegality” of family members; they experience reduced overall household resources and access benefits such as Medicaid and SCHIP at a lower rate, despite their eligibility. Second, medical anthropologists are called upon to expose how intensified immigration enforcement under the new presidential administration will impact community well-being and further dampen access to health care. Tighter enforcement policies are associated with a “chilling effect,” provoking fear and eroding trust between immigrant communities and healthcare providers. (University of South Florida)
The current policy outlook in the US does not bode well for migrant health. We know that migration can be prompted by health concerns—people emigrate to seek care and treatment or to seek better economic opportunities to pay for care or treatment for themselves or family members. Migration can also be a means for escaping violence, especially for children and minors. Reports from family detention centers, which continue to operate at capacity on the US-Mexico border, indicate that mothers with children, whole families, and unaccompanied minors continue to flee Central America. Detention centers can also be harmful to migrant health, with overcrowding, unsanitary conditions, inadequate or unsafe food, and undiagnosed or untreated medical problems.
The changing legal landscape in which migrants and refugees find it increasingly difficult to secure stable and permanent safe havens is causing chaos and uncertainty and has resulted in people being returned to places where they have credible fear of harm. The “unshackling” of customs and border patrol agents in the US has led to increased aggressiveness in detentions and deportations. Advocates report that immigrants are avoiding federal forms of assistance such as food vouchers and may be skipping court dates for domestic violence cases out of fear of deportation. All of these can increase health risks for migrants and their families. The longer-term consequences may be harder to anticipate but evidence shows that prolonged exposure to stress, discrimination, and undiagnosed or untreated trauma may heighten the likelihood of chronic diseases. Anthropologists must continue our long-standing tradition of cultural critique, revealing and criticizing the biases and misconceptions that undergird so many of the anti-immigrant views shaping public policy. (Lehman College)
My research has long focused on understanding how health policy and governance impact immigrants’ health and well-being, and how immigrants, particularly those from Haiti and Latin America, experience poor health outcomes and limited access to care more broadly. Findings from my current work on Maryland’s Eastern Shore suggest that increasingly restrictive health and immigration policies and highly racialized anti-immigrant local contexts have created disproportionate barriers for immigrants in accessing basic public resources such as health coverage and care. These factors also marginalize frontline providers who work with immigrant populations as health professional norms and ethics are often difficult to navigate in light of restrictive health care policies.
Improving immigrants’ access to social services and their overall well-being is critical as the social and health landscapes for immigrants becomes more uncertain. State and local governments, nongovernmental institutions, and key stakeholders must come together to address chronic and new challenges related to immigrant health. Policy initiatives to combat social exclusion and to ensure health care benefits for all such as additional funding for safety net services, access to public housing, health care and social security benefits, and employment support services will have long-term positive impacts on entire communities, native and immigrant alike. (University of Maryland)
For additional information on current SMA initiatives, including special interest groups working on issues related to border and migrant health, please visit our website, or consider becoming a member to stay apprised of section activities.
Cite as: Carney, Megan A. 2017. “Improving Policy to Address Migrant Health.” Anthropology News website, August 4, 2017. doi: 10.1111/AN.540