Associate Professor and Chair, Department of Communication, University at Albany, State University of New York; Faculty Affiliate, ISSP, uOttawa
Professor, Department of Psychology; Dean, College of Arts and Sciences, University at Albany, State University of New York
Clinical Associate Professor and Executive Director, Center for Women in Government & Civil Society, Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York
On Thursday, January 28, at 12:00 PM, the ISSP hosted Food for Thought: Uncovering Health Disparities among Immigrant Communities during the COVID-19 Pandemic. This blog is an adaptation of the lead author’s remarks.
According to the 2019 American Community Survey, there are 44.9 million foreign-born people in the United States—roughly 13.7 percent of the total population. Of this foreign-born cohort, 44 percent are Hispanic or Latino, 27 percent are Asian, 17% are white, 10% are Black; 51.6 percent are naturalized citizens, and 48.4% are non-citizens. There is also an estimated 10.5 million unauthorized immigrants. It is a huge and growing slice of the United States.
COVID-19 has inflicted disproportionate harms on these communities, from poorer health and education outcomes to higher unemployment. What are the structural causes for health disparities in these communities? Over the past several months, we have undertaken a series of interdisciplinary projects focused on COVID-19 and its effects on immigrant populations, and especially population groups with Limited English Proficiency (LEP). In this blog, we will discuss recent findings on some of the structural barriers that are driving these health disparities in the United States, and approaches to addressing them.
Language can be an enormous barrier. Non-English-speaking populations tend to be of working age, yet participate in the labour force at a lower rate than English-proficient counterparts. They also tend to lack access to health insurance, public assistance, and linguistically and culturally appropriate services. Limited English proficiency puts them in a vulnerable position, particularly when it comes to accessing health care. For undocumented immigrants, there is also a fear of being deported and separated from families. So this population opt to be invisible and live in the shadows which further compounds health disparities. They tend to rely on emergency rooms for their urgent care which in turn exacerbates costs.
The literature shows that poor communication in health care can impede access to preventive care and lead to poor health care experiences and treatment outcomes for immigrant populations. Oftentimes, medical ethics can be compromised, arising from a lack of understanding and access to culturally and linguistically appropriate services. These groups are also less likely to be able to provide informed consent and therefore are more likely to undergo costly and unnecessary diagnostic tests. Often, these groups are also mis-diagnosed, as well. We have seen cases of malpractice, negligence, legal liability, and lower overall patient satisfaction. All of these factors eventually lead to higher health care costs.
So what to do to address the situation?
Evidence-based interventions can help us mitigate, manage, and prevent these minority health disparities. The literature shows that the use of health navigators, community health workers, trained interpreters, and home visiting programs can all be effective. In the United States, this would include culturally and linguistically competent and trained community health workers who are able to deliver information and culturally appropriate services to clients. Achieving this goal necessitates working with them and their families in their native language on health prevention, education, insurance, and enrollment and treatment plans.
Trust is a crucial piece of engaging and mobilizing LEP patients. Trusted cultural workers must proactively reach out to and serve immigrants where they live. The pandemic has revealed a lack of trust in public health systems among immigrant communities. Community partnerships and cross-sector collaborations have successfully improved health outcomes and are in fact mutually beneficial, allowing all partners to advance their mission more effectively. One successful example is the Australian Changing Cultures Project, which used partnerships between health, education, and resettlement sectors to integrate language literacy, mental health services, and basic education into workforce development initiatives. Community partnerships can also involve organizations that focus on faith, senior members of a cultural community, and revered members or leaders who possess the trust of community members. Processes that engage those community representatives would favor and hasten behaviors that would lead to greater utilization of services and completion of effective intervention programs.
For organizations working on this outreach, proactive policies and programs can help as well. For example, human resource policies can diversify staff to reflect the communities they are serving and allocate more resources to trained interpreters who are proficient in different languages and medical terminology. Governments can also be more proactive. Is attention being paid to proactive outreach to immigrant populations? Are issues of diversity, equity, and inclusion and language assistance being incorporated into strategic plans? Are there proper structures for social programs, collaborative governance, public consultation and recruitment and diversification of the public workforce? Moreover, we know that individuals may also posses challenges identified as disabilities or impairments (e.g., deafness) that adds an additional concern when mapping out health related policies and protocols.
There is significant overlap between core aspects of the immigrant experience and social determinants of health. The immigration process itself can be a social determinant of health, in addition to economic instability and a lack of access to housing, employment opportunities, food, financial services, education, and culturally and linguistically competent services. COVID-19 has demonstrated just how interconnected these determinants are, and has made the search for evidence-based solutions more urgent than ever.