Research

Immigrants and the American Healthcare System

 

 If you are an immigrant searching for a boost in your health care, do not come to the United States.  In the modern world, although America expresses itself to be the land of equal opportunity for all, there is very minimal equality that exists in the realm of health care.  As a well-off, white individual, it surely is easy to take a trip to the hospital if you feel a little under the weather. Or perhaps the sickness is so miniscule, you decide to pay your primary care doctor a visit instead.  Or perhaps what you have contracted is self-treatable, and all you need is a short pharmacy visit to purchase the essential medications. The choice is there – because the money, the education, and the status are there as well.  As a hispanic immigrant who just came to the United States in 2015, what status do you have? What wealth have you accumulated and what education have you received? The answer is simply nothing. An immigrant in America who doesn’t even speak the English language is a nobody, and why should a nobody receive the same form of health care as an affluent white person who has been an American citizen their entire life?  In more recent years, this idea has pushed the United States to balance health care and make it equally available to all, and while the gap between immigrants and non-immigrants is not as prevalent as it was in the past, it still impacts millions of families in modern America.  

America is a nation full of diversity; however, it does maintain its own practices and culture that contrast sharply with those of other countries.  Thus, when foreigners come into contact with such differences, it is the equivalent of a ballet dancer joining a football team – simply alien. Between 2007 and 2008, civil war plagued Somalia, causing millions of Somalian citizens to travel to the United States in search of better lives.  This is, of course, the primary purpose for which immigrants all around the world come to the United States: to live in a land where they can safely practice their own culture. While America advocates for this to occur so as to promote diversity, there are gray areas in which foreign culture and so-called American culture clash, and the medical field is perhaps the most evident example.  Researchers studying the mass Somalian immigration to the states have “…found that Somali women’s health beliefs related closely to situational factors and contrasted sharply with the biological model that drives Western medicine. These discordant health beliefs resulted in divergent expectations regarding treatment and healthcare interactions. Experiencing unmet expectations, Somali women and their healthcare providers reported multiple frustrations which often diminished perceived quality of health care” (Pavlish et al. 2010).  If an individual was brought up for the first twenty years of their life learning that practicing a certain religion is the way to go and all other religions are bad, then it is highly unlikely that the individual would convert to another faith in the future.  It is simply human nature to live our lives with the principles we have become accustomed to from a young age. Therefore, it is no surprise that Somalian immigrants during the discussed time period, disagreed heavily with the American healthcare system. All their lives, the Somalian people were medically treated under a more holistic and situational approach, and all of a sudden they encounter the American way of simply prescribing medication and providing injections.  This clash in culture is a problem of its own, but it also creates several other dilemmas. The principles stated in the American Constitution states that all American citizens, whether immigrants or not, have a right to equal healthcare and clearly, this couldn’t be further from the truth. The Somalian people are accustomed to being treated a certain way, and by no means did they receive this treatment upon coming to the United States. The purpose of their migration was to take advantage of the principles that our country promises, and instead what they found upon arriving was a complete disregard of their practice of medical care.  Now, of course, it is difficult for doctors to be knowledgeable about every single culture in the world and how they practice their medicine, perhaps even impossible. Nevertheless, the United States should not be making promises it cannot keep, and by advocating an influx of diversity and simultaneously not providing a home or a place for such cultures, it is doing exactly this.       

A poem written by Wang Ping in 1957, states “We carry diplomas: medicine, engineer, nurse, education, math, poetry, even if they mean nothing to the other shore” (Ping 10-11).  The name of the poem is “Things We Carry on the Sea”, and its primary purpose is to tell the story of the immigrant. At no point in the poem is the United States mentioned.  At no point in the poem is the focus solely medicine. The primary idea of the literary work, as evident from the aforementioned quote, is to emphasize the fact that immigrants have a culture so ingrained in them that they will follow it intensely regardless of where they end up.  Perhaps their ideals “mean nothing to the other shore”, but this will not stop them from practicing their form of education or believing in their own religions. This will not stop them from practicing math or poetry the way they are used to doing. This will not stop them from practicing medicine the way they have always known.  This concept of the maintenance of culture is what causes a clash between immigrants and the United States. Immigrants are encouraged to practice their traditions here in the states, and yet there is no place for them to do so. This is the exact situation that Somalian women dealt with upon coming to the United States. America gives immigrants false hope; America cannot provide what it promises to provide.  When it comes to healthcare, the U.S. is set on one mindset and that one mindset alone, and a deviation from such a practice is automatically deemed wrong and perhaps even primitive. Thus is the struggle of the immigrant in the United States, the so-called land of equal opportunity.  

The culture clash between immigrants and the United States is a major influencing factor in the gap that exists in the American healthcare system, but so too is the concept of socioeconomic status.  Socioeconomic status encompasses all that an American citizen owns or is privy to, whether that be work-related opportunities, educational opportunities, etc. There is also an aspect of socioeconomic status that delves into the idea of acceptance.  Hispanic immigrants are usually studied through the lens of socioeconomic status simply because they occupy the position of the largest ethnic group of immigrants in America. Indeed by studying Hispanic immigrants through such a lens, it can be clearly seen how much of a gap truly exists in the American healthcare system.  Fairly modern research indicates that “Latinos have the highest uninsurance rates among racial/ethnic groups living in the United States. But there has been surprisingly little discussion of the importance of immigration status, although one-third of U.S. Hispanics and two-thirds of U.S. Asians are foreign-born. Immigrants are a large and growing segment of American society and are disproportionately low-income and uninsured” (Ku and Matani 2001).  The effect of socioeconomic status is quite simple: you are a nobody in the country, you do not receive the same opportunities as someone who isn’t a nobody. The United States may offer work positions to Latin immigrants, knowing that they aren’t informed well enough about the investments they should make or the amount of money they should really be making. The United States offers educational opportunities to Latin immigrants, knowing that many of them will not be able to afford such opportunities.  The United States claims that Latin immigrants, so long as they are American citizens, have a right to equal healthcare, knowing well that the poor education levels and the poor work that these people receive, do not allow this to be true. Most Latin immigrants in the country cannot even speak the English language because of their lack of education. It is because of this that society often takes advantage of them, and that includes professionals in the medical field. My own grandmother was taken advantage of for her inability to speak English and her low socioeconomic status.  A doctor once prescribed her medication for a heart condition that she never had in the first place. For years she took the medication and it wasn’t until surgery was recommended that our family sought out a second opinion, only to find out she had been perfectly healthy all along. Many Latin immigrants across the country are taken advantage of in this fashion, and thus they are provided with such a downgraded form of healthcare as compared to that of American-born citizens. Simply put, “Educational attainment, type of occupation, and earnings directly and indirectly influence immigrants’ access to health care resources. Overall, immigrants are less likely than U.S.-born populations to have graduated from high school and are more likely to work in service occupations and live in poverty” (Derose et al. 2007).  Statistics indicate how one’s status in the United States essentially shapes their entire life: what education they receive, what work they are allowed to undertake, and most importantly, what form of health care they receive. 

The magnificent United States of America is by no means the place it claims to be, although this is not to say that one day it cannot be.  America may not be the so-called land of equal opportunity, but valiant efforts have been made to decrease the gap between immigrants and American-born citizens in the healthcare system.  The most influential of such efforts was perhaps the Affordable Care Act of 2010, which essentially made healthcare extremely cheap to counter the low economic status of most immigrants in the country.  Research indicates that “…the ACA [Affordable Care Act] has closed the coverage gap that previously existed between U.S. citizens and non-citizen immigrants. We find that naturalized citizens, non-citizens with more than 5 years of U.S. residency, and non-citizens with 5 years or less of U.S. residency reduced their probability of being uninsured by 5.81, 9.13, and 8.23%, respectively, in the first 3 years of the ACA. Improvements in other measures of access and utilization were also observed” (Bustamente et al 2019).  In addition to this, several companies and/or organizations have been created to allow for proper communication to occur between physicians and their non english-speaking patients.  In her Ted Talk, Rebecca Onie discusses Health Leads, an organization designed to enable physicians to ask their patients what they need to be healthy, such as electricity to refrigerate medication.  Such programs and policies have provided immigrants in more modern times with a weapon – a primitive version at best, but a weapon nonetheless. Ernesto Rocha disccuses in his Ted Talk how life for him as an undocumented Mexican individual in the states was difficult, until he came to the realization that he is not dfined by his status.  The institutions that are arising in the present day have certainly promoted this very idea, and this indicates that there is possibly a better future for immigrants in the United States. Even with these positive advancements; however, there are still so many issues relating back to socioeconomic status and the level of awareness and/or education that immigrants have.  There is no point in having programs for immigrants if they have no idea how to access them. There is no point in decreasing the price of healthcare if immigrants aren’t aware of it.  Aside from socioeconomic status, there are still major issues relating back to cultural disparities.  If America is truly the melting pot it claims to be, then as a nation, we should be more accepting of the culture that immigrants bring and more knowledgeable about the healthcare they practice.  It will undeniably take a lot of time, money, and effort to fix the American healthcare system, but putting in the work will be necessary if we are to truly assume the title of “the land of equal opportunity.”

 

Work Cited

Pavlish, Carol Lynn, et al. “Somali Immigrant Women and the American Health Care System: Discordant Beliefs, Divergent Expectations, and Silent Worries.” Social Science & Medicine, Pergamon, 29 Apr. 2010, www.sciencedirect.com/science/article/pii/S0277953610003199. 

Derose, Kathryn Pitkin, et al. “Immigrants And Health Care: Sources Of Vulnerability.” Health Affairs,  www.healthaffairs.org/doi/full/10.1377/hlthaff.26.5.1258.

Ku, Leighton, et al. “Left Out: Immigrants’ Access To Health Care And Insurance.” Health Affairs, www.healthaffairs.org/doi/full/10.1377/hlthaff.20.1.247.

Bustamante, Arturo Vargas, et al. “Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act.” Journal of Immigrant and Minority Health, U.S. National Library of Medicine, Apr. 2019, www.ncbi.nlm.nih.gov/pubmed/29633069.

“Things We Carry on the Sea by Wang Ping – Poems | Academy of American Poets.” Poets.org, Academy of American Poets, poets.org/poem/things-we-carry-sea.  

Onie, Rebecca, director. TED. TED, www.ted.com/talks/rebecca_onie_what_americans_agree_on_when_it_comes_to_health/transcript?language=en#t-140933. 

Rocha, Ernesto, director. TED. TED,

https://www.youtube.com/watch?v=iQ7juMMw3DQ