ID Policy & Immigrant Policy As Health Equity Policy

Transcription

1 ID Policy & Immigrant Policy As Health Equity Policy Alana M.W. LeBrón, Ph.D., M.S. Departments of Population Health & Disease Prevention & Chicano/Latino Studies University of California, Irvine Presented to: UC Center Sacramento July 25, 2018

2 PRESENTATION OVERVIEW Theoretical Frameworks Othering Health inequities Restrictive Immigrant & ID Policies Health Implications Recommendations: Policy & Practice 2

3 SOCIAL STRATIFICATION PROCESS Racial and ethnic meanings are constructed & reconstructed Creating & reinforcing inequalities Othering: Difference between groups Defining boundaries between groups Devalue other group(s) Inequitable access to resources Sources: Schwalbe, 2000, Massey, 2009, Omi & Winant

4 EQUALITY VS. EQUITY 4 Image Source: Interaction Institute for Social Change

5 INEQUITIES The term inequity has a moral and ethical dimension. It refers to differences which are unnecessary and avoidable but, in addition, are also considered unfair and unjust. So, in order to describe a certain situation as inequitable, the cause has to be examined and judged to be unfair in the context of what is going on in the rest of society. Margaret Whitehead (p. 219) 5 Source: Whitehead, M. (1991). The concepts and principles of equity and health. Health Promotion International, 6(3),

6 IMMIGRANT POLICING OF LATINAS/OS Number of deportations from > 20 th century Majority (96%) of deportations from the US are of Latin American Immigrants Belief that police primarily target Latinos & that Latinos absorb the brunt of federal and state level restrictive immigration policies 61% of Latinos know someone who is undocumented 36% of Latinos know someone who has been detained by immigration officials or deported Immigration politics structures decision to use health care & public services Sources: TRAC, 2014; Park 2015; Barreto & Segura, 2010; Manzano 2011; Latino Decisions, 2015; Toomey et al. 2014; Donelson 2015; Beniflah et al. 2013; Pew Hispanic Center 2007; Goldsmith

7 STATE ID POLICIES, Source: Park H. Which States Make Life Easier or Harder for Illegal Immigrants. New York Times

8 HEALTH IN CONTEXT LeBrón

9 RACIALIZING MARKERS AS SYMBOLS OF IMMIGRATION OR LEGAL STATUS Socially constructed symbols that social agents manipulated in unequal interactions in assessing immigration status and access to resources The threat we live with everyday the first thing is, your shade of skin. Cause if you look Mexican that s when [the police] go after you, and then if you don t speak English, well that s worse. Angela Source: LeBrón et al. 2018a 9

10 QUESTIONED IMMIGRATION STATUS EXPERIENCED ACROSS GENERATIONS They assume that I am not from here. So they treat you like what makes you feel like you should not have WIC like you re not a citizen or whatever. I had to explain to them that I am from here and that actually technically it s not for me, it s for the baby, which was born here. Alice Source: LeBrón et al. 2018a 10

11 ID POLICY = IMMIGRANT POLICY Why is it important to have a license? Because a lot of people don t want to drive because they are afraid that the police might stop them and they ll get asked for their license. If they don t have a license they ll call immigration, if you have a license, then there is no reason for them to call immigration. Liliana, 1.5 Generation Mexican American woman Source: LeBrón et al. 2018a; LeBrón et al. 2018b 11

12 CLIPPING OUR WINGS They are clipping our wings. You made an error just because you are sitting behind a wheel driving without a license. They are always going to judge you whether you make a mistake or not. Because the police can stop you and say you went through the stop [sign], they are going to give you a ticket for not stopping. - Lilly Source: LeBrón et al. 2018a 12

13 Immigration agencies & officials Police Immigration Policies Citizenship opportunities; pathways to citizenship 100-mile rule Immigration enforcement policies Law Enforcement Policies Racial profiling Secure Communities program DYNAMIC SYSTEMS OF RACISM Women Social networks Secretary of State Government- Issued ID Policies REAL ID Act (2005) 2007 MI Attorney General s Decision Racial profiling Employers Social welfare institutions Employment Policies Social Welfare Policies E-Verify Deficit Reduction Act (2005) Patient Protection & Affordable Care Act (2010) LeBrón AMW, Schulz AJ, Gamboa C, Reyes A, Viruell-Fuentes EA, Israel BA. (2018a) They Are 13

14 ID POLICY = HEALTH POLICY I got close to see what they were giving out, and it was water. And the first thing they asked me for was my license. Resident of Flint, MI Policies are compounded by exclusionary interpretation Source: Lee EYH. How the Flint Water Crisis is Impacting Undocumented Immigrants. ThinkProgress. Published

15 RESTRICTIVE ID POLICIES SHAPE ACCESS TO HEALTH-PROMOTING RESOURCES Housing (e.g., viewing housing, applying for housing) Health care & pharmaceutical (e.g., health care provider, regulated medications) Financial (getting a bank account, cashing a check, applying for a loan) Political enfranchisement (e.g., voting) Identification or governmental records (e.g., birth certificate) Goods & services (purchasing with debit/credit card, check) Age-restricted goods (e.g., alcohol) Community (e.g., applying for a library card, nutritional assistance through food banks) Caregiving (e.g., picking up children from school) Remaining in US (e.g., identifying self to police) Source: LeBrón AMW, Lopez WD, Cowan K, Novak NL, Temrowski O, Ibarra-Frayre M, Delva J. (2017) Restrictive ID Policies: Implications for Health Equity. Journal of Immigrant and Minority Health. DOI: /s

16 CAUTIOUS CITIZENSHIP Emergent type of citizenship practice Hypersensitive to citizenship gradients Incentives to avoid citizenship scrutiny, even for citizens Cautious participation 16 Source: Pedraza, Cruz Nichols, LeBrón, 2017

17 POPULATION-BASED SURVEY EXPERIMENT With all of the attention to: "Health insurance" "Immigration issues" Ex ante: Immigration issues primes negative considerations 17

18 OUTCOME VARIABLE Making a health care appointment When you are thinking about making an appointment to see a doctor or nurse or going to a clinic for health care, with all of the attention to [experimental condition], are you more likely to use health care services, less likely, or has it not made a difference? 18

19 CAUTIOUS CITIZENSHIP MECHANISMS Know someone who is undocumented Know someone who has been deported Do you happen to know somebody who may be an undocumented immigrant? Do you personally know someone who has faced deportation? State immigration policy context Thinking about the immigrant population in your state, would you describe [state] policies as favorable or unfavorable towards immigrants? 19

20 LIKELIHOOD OF MAKING AN APPOINTMENT TO SEE A HEALTH CARE PROVIDER Source: LeBrón, Cruz Nichols & Pedraza (In Preparation) 20

21 LIKELIHOOD OF MAKING AN APPOINTMENT TO SEE A HEALTH CARE PROVIDER KNOW SOMEONE WHO IS UNDOCUMENTED Source: LeBrón, Cruz Nichols & Pedraza (In Preparation) 21

22 LIKELIHOOD OF MAKING AN APPOINTMENT TO SEE A HEALTH CARE PROVIDER KNOW SOMEONE WHO HAS BEEN DEPORTED Source: LeBrón, Cruz Nichols & Pedraza (In Preparation) 22

23 LIKELIHOOD OF MAKING AN APPOINTMENT TO SEE A HEALTH CARE PROVIDER PERCEIVED STATE IMMIGRATION POLICY CONTEXT Source: LeBrón, Cruz Nichols & Pedraza (In Preparation) 23

24 PREDICTED PROBABILITY OF IMMIGRANT POLICING ON TRUST IN THE GOVERNMENT AS A SOURCE OF HEALTH INFORMATION 24 Source: Cruz Nichols, LeBrón & Pedraza 2018a

25 HEALTH IMPLICATIONS Cardiovascular risk Deportation-related worry Restricted access to health-promoting resources Adverse birth outcomes Immigration raids Poor mental health outcomes County-level deportations Adverse self-rated health Immigration raids Concern about racialized policing Sources: LeBrón et al., 2018c; Torres et al., 2018: Novak, Martinez & Geronimus 2017; Cruz Nichols, LeBrón & Pedraza 2018b; Lopez et al

26 DISCUSSION Immigration Policy + ID Policy = Health Policy Discretion of institutional actors Cautious citizenship Latinos are actively assessing and are vigilant towards risk of direct encounters with the complex, multifaceted, and growing immigrant policing infrastructure Immigration politics is read as threat & provokes an aversive response Implications for population health policy: Immigrant politics creates inequities Threat impacts governance, as seen through use of health care and public services Cautious citizenship in

27 BUILDING HEALTH EQUITY Value & uplift community knowledge Address social & physical conditions that undermine health Coalition building social justice movements Support local efforts to support inclusive contexts Strengthen trust towards public health institutions Organizational capacity Institutions reflect communities served Develop practices that ensure not seen as collaborating with immigrant policing mechanisms LeBrón

28 THANK YOU Alana M.W. LeBrón, PhD, MS With Thanks to: Healthy Environments Partnership Washtenaw ID Project Amy Schulz Cindy Gamboa Angela Reyes Barbara Israel Edna Viruell-Fuentes Graciela Mentz James House Keta Cowan William D. Lopez Nicole Novak Jorge Delva Vanessa Cruz Nichols Francisco Pedraza UM National Center for Institutional Diversity UM CRECH Robert Wood Johnson Foundation 28

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