Derechos de Inmigrantes: The Impact of Federal Policies on Immigrant Health

Transcription

1 Derechos de Inmigrantes: The Impact of Federal Policies on Immigrant Health Tracy Jungwirth, MA Program Mangaer NMAETC, University of New Mexico Project ECHO

2 Undocumented Immigrants In general, there are three broad categories of immigrants: voluntary migrants, refugees and asylum seekers, and undocumented immigrants. Undocumented immigrants: (1) legally entered the nation state or territory but remained in the country after their visa/permit expired; (2) received a negative decision on their refugee/asylee application but remained in the country; (3) experienced changes in their socioeconomic position and could not renew residence permit but remained in the country; (4) used fraudulent documentation to enter the country or territory; or (5) unlawfully entered the country or territory, including those who were smuggled.

3 Undocumented Immigrants in the U.S. The International Organization for Migration (IOM) estimated that 25.5 to 32.1 million people which represent 10% 15% of the world's total 214 million international immigrants are undocumented immigrants. There were 11.2 million undocumented immigrants in the U.S. in 2012, a total that was unchanged from 2009, and making up 3.5% of the nation s population.

4 Mexicans make up about half of all undocumented immigrants (52%), though their numbers have been declining in recent years. Six states alone account for 60% of undocumented immigrants California, Texas, Florida, New York, New Jersey and Illinois. Seven states in which the undocumented immigrant population increased: Florida, Idaho, Maryland, Nebraska, New Jersey, Pennsylvania and Virginia.

5 Access to Health Services Some countries only provided health care to undocumented immigrants in detention centers. Other countries have explicit laws and policies in which undocumented immigrants are entitled only to emergency care Perceived fear of deportation and harassment from authorities correlated to lack of access to a wide range of health services. Clear association between immigration policies and access to HIV services and care coordination services for HIV positive undocumented immigrants, including LGBT individuals. Participants not only felt threatened by antiimmigration policies and felt that they prevented them from accessing HIV services but also felt that the lack of health care accessibility and bureaucratic requirements served as barriers to HIV care.

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9 Health Insurance Low income immigrants are much more likely to lack health insurance than similarly poor nativeborn citizens Immigrants have less access to health care services and are less likely to see a doctor or even visit an emergency room States have discretion on how residents access Medicaid Access under any immigration reform is controversial and likely to take

10 HIV and AIDS along the U.S.-Mexico Border Prevalence difficult to assess accurately due to different methodologies in surveillance reporting and transience of the population. Border region is unique and cannot be extrapolated accurately from national statistics. University of Oklahoma Center for Applied Research, HIV AIDS Along the US Mexico Border

11 Immigration Nearly 195 million passenger crossings in vehicles & 49 million pedestrian crossings annually at 25 ports of entry into the U.S. Border region has higher incidence of infectious diseases compared to rest of U.S. Border demographics may favor vulnerability to HIV and other STIs. University of Oklahoma Center for Applied Research, HIV AIDS Along the US Mexico Border

12 Immigration As of 2005, 11 million Mexican immigrants living in the U.S. Approximately 66% are located in the 4 border states. 70% are years of age. 59% have no health coverage. People of Mexican origin represent 29.5% of all immigrants in the U.S. Conasida 2008: Manual para la prevención del VIH/SIDA en migrantes Mexicanos a Estados Unidos.

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15 Migratory patterns In order to plan care, it is important to know where a person is returning to: Western Mexican states (>50%) Border states, plus Baja California Sur and Sinaloa (20%) Central Mexican states (20%) South-southeastern states (10%) Conasida 2008: Manual para la prevención del VIH/SIDA en migrantes Mexicanos a Estados Unidos.

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17 Condom use in heterosexual migrant men Last sexual intercourse with a nonregular/non-commercial sex partner = 50.9% Last commercial sex = 64.8% Last 12 months all sexual partners = 2.1% From: Update on HIV/AIDS in Mexico, June, 2007, Dr. Jorge Saavedra, General Director, National HIV/AIDS Program (Centro Nacional para Prevención y Control del VIH/SIDA CENSIDA). Source cited in original slide: Second Generation HIV Surveillance (Mexico, 2001)

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19 Discussion Expand laws that actively grant undocumented immigrants with rights beyond the more exclusionary federal standard, such as driver s licenses, access to higher education, and access to health care. Buffer the impact of federal laws that restrict undocumented immigrants rights or access to resources via state and local involvement in enforcement, such as limiting the use of E Verify or limiting cooperation with the Priority Enforcement Program Strengthen laws that are not explicitly immigrationrelated, but that create a legal or social environment that is more inclusive and beneficial to undocumented immigrants, such as strong labor and employment protections and higher education affordability.

20 Discussion Explicitly include undocumented immigrants in policies that apply broadly to the population, but in which legal status limits the level or type of benefits available, such as through the SNAP funding formula and workers compensation statutes. Policies specific to health issues (e.g., end of life care) and labor issues (e.g., preventing wage theft or occupational injury, etc). Administrative and implementation policies at the state and local levels that promote immigrant integration, such as free ESL classes, legal assis tance in seeking deferred action or other options for obtaining lawful status, and professional licenses without regard to immigration status. Policies that create a climate of acceptance of all immigrants and that would reduce immigrants fear and avoidance of public authorities.

21 Discussion I.Interventions are needed to increase immigrants understanding of their rights and eligibility to use health services. II.Public health agencies must appear credible in the advice they render and trustworthy in their practices. Winning and maintaining the trust of those at risk of disease are preconditions for effective public health programs. III.Public health authorities must rely on expert knowledge derived from the sciences of public health to better serve the evolving needs of their communities.