Running head: MIGRANT AND IMMIGRANT PATIENTS

Vulnerable Populations: Migrant and Immigrant Patients Amy Lewis Ferris State University

IMMIGRANT PATIENTS Migrant and Immigrant Patients Across the United States, the number of immigrant people is continuing to increase, and with this increase, there are significant problems associated with this group of people related to their access and use of health care. In 2010, 13% of the United States population was foreign born and had immigrated to this country (Lubetkin, Zabor, Brennessel, Kemeny & Hay, 2013). Of these foreign born people, 82% overall admitted to speaking their native language at home. Many areas of vulnerability have been identified in the immigrant population including legal status of the person, socioeconomic background, educational background, age of the immigrant person, as well as their ability to speak and understand the English language (Derose, Escarce & Lurie, 2007). While I have some experience dealing with the Latino population in the Grand Rapids area, through my volunteer work with La Clinica Santa Maria, as well as a Spanish speaking high school named Adelante, I have not been challenged to consider the other immigrant

populations in the United States or here in Michigan. I have personally seen some of the barriers that the Latinos population experiences while attempting to receive and understand healthcare, and see that this can be a significance hindrance in the achievement and maintenance of health. Having participated in six short-term medical mission trips to Honduras, I have seen firsthand the health care needs that are unique to Latino populations. I have a special interest in the Spanish speaking population here in Grand Rapids and note that where I work, there is a lack of employees that are able to comfortably communicate with this population. While I have taken several years of Spanish classes, I have yet to take a class that is based on health care Spanish. There are many studies that have been done on the disparities in health status and healthcare access in older immigrants, especially the two largest groups of immigrants, which are

IMMIGRANT PATIENTS Latinos and Asians. These are classified as two of the groups who have been identified as both vulnerable and underserved (Kim et al., 2011). Older immigrants tend to be more vulnerable

than the younger generation of immigrants within their same cultural group as they often are less educated and have less English proficiency (Lubetkin, Zabor, Brennessel, Kemeny & Hay, 2013). English proficiency among immigrants has a significant determination on the ability to overcome some of the barriers within the health care system (Kim et al., 2011). Facing these barriers while interacting with the English-speaking world is evidenced in the fact that those with limited English proficiency tend to have fewer physician visits, receive less preventative care such as breast and cervical cancer screening, and tend not to seek care in a consistent service setting. Additionally, those with limited English proficiency have a difficult time getting health information or advice over the telephone (Lubetkin, Zabor, Brennessel, Kemeny & Hay, 2014). Currently, there are 40 states that do not require their Medicaid system to cover interpreter services, making it difficult for the non-English speaking person to obtain and understand their medical care (Yun, Fuentes-Afflick, Curry, Krumholz & Desai, 2013). The lower socioeconomic status of older immigrants, who also tend to have less proficient English skills than the younger immigrants do, have more health disparities in health status and healthcare access (Kim et al., 2011). This older population tends to be less educated, especially within the Latino group, compared to the older Asian immigrants, which makes the Latino population fall into a group of vulnerable adults whose health outcomes are worse than those of their Asian peers. The older Latinos report more chronic health problems such as hypertension, diabetes and obesity, have higher disability rates, and rate their health as poorer

IMMIGRANT PATIENTS than the older Asian immigrant population does (Nguyen & Reardon, 2013). These disparities could be due to the lower reported economic and educational level in this population. The position of vulnerability that older immigrants are in with respect to health care includes problems understanding doctors and nurses, as well as difficulty reading the written information, which is provided at the doctors offices (Nguyen & Reardon, 2013). The information on prescription bottles is also a barrier when the immigrant patient has limited English proficiency, and this can be an area of vulnerability in this population. The older immigrant population has a generally lower socioeconomic level as well as a lower educational level, and this has an influence on the access to healthcare resources and makes them even more vulnerable (Sohn & Harada, 2004). While the educational level between the older Latino and Asian immigrant population can be quite diverse, this needs to be taken into account when planning care for these patients. After doing research on immigrant patients, I realized that I had seen the health care disparities among the immigrant population in a very narrow way. I thought that the largest barrier was the language barrier, but learned that even greater is the educational and socioeconomic level of the immigrant. With more public awareness of these issues, the policies regarding care of the vulnerable immigrant population could be strengthened and more sensitive to their needs. Also, the length of time they had been in the United States had a large impact on

their health and access to care, as well as their immigration status and demographics. I think it is difficult for anyone who is not in the immigrants position to fully understand the barriers that they face while trying to access healthcare in this country. For me to think that learning to speak Spanish more proficiently is the answer to enable me to provide more culturally sensitive care is

IMMIGRANT PATIENTS not realistic, I would really need to understand more of the immigrant persons cultures and struggles that they have in this country.

IMMIGRANT PATIENTS References

Derose, K., Escarce, J. & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health Affairs, 31(6), 1258-1268. doi: 10.1377hlthaff.26.5.1258 Kim, G., Worley, C. B., Allen, R. S., Vinson, L., Crowther, M. R., Parmelee, P., & Chiriboga, D. A. (2011). Vulnerability of older Latino and Asian immigrants with limited English proficiency. Journal of American Geriatrics, 59(7), 1246-1251. doi:10.1111/j.15325415.2100.03483.x Lubetkin, E., Zabor, E., Brennessel, D., Kemeny, M. M., & Hay, J. (2014). Beyond demographics: Differences in patient activation across new immigrant, diverse language subgroups. Journal Of Community Health, 39(1), 40-49. doi:10.1007/s10900-013-9738-1 Nguyen, D., & Reardon, L. J. (2013). The role of race and English proficiency on the health of older immigrants. Social Work In Health Care, 52(6), 599-617. doi:10.1080/00981389.2013.772554 Yun, K., Fuentes-Afflick, E., Curry, L. A., Krumholz, H. M., & Desai, M. M. (2013). Parental immigration status is associated with childrens health care utilization: Findings from the 2003 New Immigrant Survey of US Legal Permanent Residents. Maternal & Child Health Journal, 17(10), 1913-1921. doi:10.1007/s10995-012-1217-2