immigrant_health by liaoxiuli3

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									      Immigrant Health


       Steven P. Wallace, Ph.D.
UCLA School of Public Health & UCLA Center for
          Health Policy Research

      http://swallace.bol.ucla.edu
                  Outline
 Who are immigrants?
 What is their health status & risks?
 What determinants of health vary for
  them?
 What are community health strategies?
 What are their health systems issues?
1. Demographics of immigration
     Country of origin of immigrants, all
                ages, 2006
          30.0
                            29.5
                                                                         26.2
                                        United States
          20.0
Percent




                                                           15.0                      15.8

          10.0                            7.5
                                                                                                      5.9

              0.0
                           Mexico    Central America    Rest of Latin    Asia    Europe/Canada    Rest of world
                                                         America

                             43.7
                    40.0                                                  32.8
                                          California
                    30.0
          Percent




                    20.0
                                            8.7                                        8.7
                    10.0                                      3.2                                      2.8
                     0.0
                            Mexico    Central America    Rest of Latin    Asia    Europe/Canada    Rest of world
                                                          America


              Source: U.S. Census Bureau, 2006 Current Population Survey
Changing immigrant sources
1890 – 14.6% born
abroad, mostly W & N
Europe
1930 – 11.5% born
abroad, most
common Italy,
Poland, Russia…


                       Ellis Island, 1902
      Immigration Reform
1965 Added Western
hemisphere quota
1965 Added family
reunification
1980 Refugee act
1986 IRCA – amnesty
for undocumented,
employer sanctions
                      San Ysidro border crossing
     Country of origin of immigrants, all
                ages, 2006
          30.0
                            29.5
                                                                         26.2
                                        United States
          20.0
Percent




                                                           15.0                      15.8

          10.0                            7.5
                                                                                                      5.9

              0.0
                           Mexico    Central America    Rest of Latin    Asia    Europe/Canada    Rest of world
                                                         America

                             43.7
                    40.0                                                  32.8
                                          California
                    30.0
          Percent




                    20.0
                                            8.7                                        8.7
                    10.0                                      3.2                                      2.8
                     0.0
                            Mexico    Central America    Rest of Latin    Asia    Europe/Canada    Rest of world
                                                          America


              Source: U.S. Census Bureau, 2006 Current Population Survey
Population of all Mexican Americans &
 only Mexican immigrants in the U.S.
millions of persons




                                                                                       28.0 28.3
                                                                        25.4 26.4 26.9
                                                         22.8
                                               21.1 22.0
                      17.6 18.5 18.7 19.4 20.4



                            7.0   6.9   7.3   7.4   7.4    8.1    8.5    9.9 10.2 10.7 11.0 11.2
                      6.5

                      1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

                                  Mexican immigrants only        Mexican Americans, all

               Source: U.S. Census Bureau, Current Population Survey 1994-2006
                     Mexican-born and Mexican-American Population and
                      Percentage of Total Population in California, 2005


                                           Population                                         Proportion of total
                    12                                                      35.0%
                                                10.8                                                       30.0%
                                                                            30.0%
                    10

                                                                            25.0%
  Million persons




                    8




                                                               Percentage
                                     6.1                                    20.0%                17.0%
                    6
                           4.7                                                       13.0%
                                                                            15.0%

                    4
                                                                            10.0%

                    2
                                                                            5.0%

                    0
                                                                            0.0%
                         Mexican   Mexican-     Both
                                                                                    Mexican    Mexican-    Both
                                   American
                                                                                               American




Source: Estimates based on U. S. Census Bureau, Current Population Survey (CPS), March 2005.
 Exhibit 3: States with more than
100,000 Mexican immigrants, 2006
    1.    California     4.4 million
    2.    Texas          2.2 million
    3.    Arizona          713,000
    4.    Illinois         526,000
    5.    Florida          317,000
    6.    Georgia          316,000
    7.    North Carolina   273,000
    8.    Colorado         268,000
    9.    New York         209,000
    10.   Nevada           198,000
    11.   New Jersey       130,000     Source: U.S. Census Bureau,
    12.   Oregon           122,000     2006 Current Population
                                       Survey
    13.   New Mexico       118,000
    14.   Washington       116,000
     Age distribution of Mexican
   immigrants and others, U.S. 2006
                   1.2                  7.3                   4.1
                                                                                14.2
                  21.8                                        19.3

                                                              12.0
                                        59.6                                    41.8
                  36.3                                        10.7
percent




                                                                                11.8
                  21.0                                        53.9              9.0
                                        22.7
                  19.7                                                          23.2
                                        6.8

               Recent                Long stay          U.S. born            U.S. born
              Mexican                Mexican             Mexican             nonLatino
             immigrants             immigrants          Americans              whites
                         age 0-17   18-24     25-34   35-64    65 and over

          Source: U.S. Census Bureau, 2006 Current Population Survey
Contribution of Mexicans and Mexican-Americans to Population
  Growth in California ages 15 to 44 and 0 to 15, 1990-2000


               140    119.7
               120
  % Increase




               100
                80                     60.1
                60
                                                                                                62.8
                40
                20                                                            8.7
                 0
                     Mexican       Mexican-                               Mexican           Mexican-
                                   American                                                 American


                      Increase in group ages 15-44                  Increase in group ages 0-15



 Source: Estimates based on U. S. Census Bureau, 15-percent sample 1970, 5-percent sample 1980, 5-percent sample
         1990 and 5-percent sample 2000.
  Exhibit 8: Labor force participation
      of men ages 18-64, 2006
                                             United States
Percent




                    93.9                    91.1                                            84.8
                                                                  82.7




          Recent Mexican immigrants   Long stay Mexican     U.S. born Mexican    U.S. born nonLatino whites
                                         immigrants            Americans




                                                   California
Percent




                    91.8                    90.9                                          84.5
                                                                 80.8




          Recent Mexican immigrants   Long stay Mexican    U.S. born Mexican    U.S. born nonLatino whites
                                         immigrants           Americans

          Source: U.S. Census Bureau, 2006 Current Population Survey
     Why immigrant health?
           context
Employed in segmented labor market
– Especially manual & service occupations
– Low incomes, benefits, difficult work
Live in segregated housing
– Low income housing with more structural and
  other problems
– Concentrated in low performing schools
– Experience similar shortages of public space
  & other public services
        Mexican immigrants = 20% of the male CA
       labor force, but account for many workers in:
Cement and Concrete workers                                       (n=13,000)                                          100.0
Packaging machine operators                                       (n=13,000)                                   89.8 %
           Agriculture Workers                                  (n=105,000)                                 84.7
                    Dishwashers                             (n=25,000)                                    81.2
         Metal/Plastic workers                            (n=11,000)                               75.0
                         Roofers                        (n=27,000)                                 74.5
                      Gardeners                      (n=125,000)                            66.8
                           Cooks                    (n=108,000)                          63.6
   Sewing Machine Operators                         (n=18,000)                           62.7
Drywall/Ceiling Tile Installers                    (n=34,000)                        60.1
         Construction Laborer                     (n=142,000)                       58.4

                                    0        10    20      30          40      50   60      70       80          90    100
                                        Mexican immigrants as (number) percent of all workers in occupation

    Source: U.S. Census Bureau, 2006 Current Population Survey.
           “Carwasheros”
Difficult work
Largely
undocumented
Often paid less than
minimum wage
No benefits,
insurance
Living wage could
easily be passed on
in price
                       Photo: LA Times March 27, 2008
      Why immigrant health?
        Individual factors
Knowledge – prior experience with health
and healing systems
Culture – beliefs and values related to
health and healing
Beliefs, rumors – about immigration status
and risks
2. Immigrant health status & Risks
         Life expectancy @ birth
NLwhite women                                                                    80.3
                                                                                79.9
  NLwhite men                                                        75.6
                                                                    74.8
  black women                                                                     81.0
                                                                   74.6
    black men                                                         75.6
                                              67.5
   API women                                                                                85.0
                                                                                              86
       API men                                                                    80.7
                                                                               78.9
 Latino women                                                                              84.1
                                                                                      82
    Latino men                                                                 79.0
                                                                     75.2
                                                   U.S. born              Immigrant

     Source: Singh & Hiatt, International Journal of Epidemiology, 2006
  Relative Rates, Immigrant v. Native
            (adjusted for age, sex, income, region, etc)

   1.12
                                                                            Native rate=1
              0.86                                                  0.89
                                         0.79             0.83
                               0.73                            0.64
0.61     0.61                                       0.68                        0.59      0.59
                        0.59
                                    0.48                                               0.48
                                                                              0.38




  diabetes                 heart disease              hypertension               asthma

        Latino       African Americans               Asian       nonHispanic whites
       Source: Singh & Hiatt, International Journal of Epidemiology, 2006
   Immigrant Birth Outcomes Better

     11.9%
          10.5%
                                               US born mother          Immigrant mother
                                     7.9%
                                                                    7.14*
                                                 6.4%
                                                                               5.12*




       Preterm birth                 Low birthweight                 Infant deaths*
                                                                     * Per 1000 live births
Source – CDC, MMWR, December 6, 2002 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5148a3.htm
        Immigrant paradox:
          High risk factors
Low income
Low education
Poor working
conditions
Overcrowded housing
        Immigrant paradox:
        BUT good outcomes
Mortality
Chronic conditions
like heart disease
(except diabetes)
Birth outcomes
3. Determinants of Health
            Mexican Immigrants have lowest levels of education


100%             5.4               5.2
                                                    12.8
 90%             7.8              10.1                                                  19.1
                                                                      30.0                             35.6
 80%
 70%            33.7                                29.2
                                  32.4                                                  27.2
 60%
                                                                      27.1                             18.6
 50%
 40%
                                                    44.0
 30%                                                                                    45.9           31.4
                53.1              52.2                                38.5
 20%
 10%                                                14.0                                               14.4
                                                                       4.4               7.8
   0%
          Recent Mexican Longer-stayed            Mexican          U.S.-Born       U.S.-Born Non- Immigrants from
            immigrants     Mexican                American          Whites             Whites      a country other
                          immigrants                                                                 than Mexico



                        Less than 10 grade      10 - 12 grade    Technical     Professional

Source: SSA, Inmigrantes Mexicanos y Centroamericanos en Estados Unidos, 2006
Adults 25 years and older, U.S., http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196
                                      Mexican immigrants have high levels of poverty

                                      28.4
                                                                    United States
                 30.0

                                                       19.6                                         19.6
Porcentage




                 20.0
                                                                        14.8
                                                                                                                      12.1
                 10.0                                                                 8.1


                          0.0
                                 Recent Mexican    Longer-stayed       Mexican-    U.S.-Born    U.S.-born Non- Immigrants from
                                   Immigrants         Mexican         Americans     Whites          whites      a country other
                                                    immigrants                                                   than Mexico

                                                                     California
                          30.0
                                       24.9
             Porcentage




                          20.0                          18.5
                                                                                                     13.8
                                                                         11.5
                                                                                                                       9.6
                          10.0                                                        7.7


                           0.0
                                  Recent Mexican    Longer-stayed       Mexican-    U.S.-Born   U.S.-born Non-   Immigrants from
                                    Immigrants         Mexican         Americans     Whites         whites        a country other
                                                     immigrants                                                    than Mexico
Source: SSA, Inmigrantes Mexicanos y Centroamericanos en Estados Unidos, 2006
Adults 18 years and over living in poverty, U.S. And CA, 2005
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196
  Immigrant paradox: Why?
Selection effects = health/social capital
– Health? (Rural Mexican women, Rubalcava, AJPH,
  2008)

– Education (found in all countries, exc. Puerto
  Rico; Feliciano,Demography, 2005)
– Social Networks?
– Other human capital?
  Immigrant paradox: Why?
Selection effects
Return migration (salmon effect)
– 1/3 of Mexican immigrants return w/i 10 years
– Mortality is lower for Mexicans (who can
  return) than Cubans (who can not)
– Can this explain birth outcomes??
  Immigrant paradox: Why?
Selection effects
Return migration (salmon effect)
Health behaviors (culture)
– Lower rates of smoking, healthier diets
– Stronger social networks
    Direct effects – helping out, share info, etc
    Indirect effects – buffer stress
– Erodes w/acculturation
    Acculturative stress
    Changing behaviors
  Immigrant paradox: Why?
Selection effects
Return migration (salmon effect)
Health behaviors (culture)
Community effects (context)
– Immigrants communities have an independent
  protective effect
– Assimilation reduces (vs. acculturation)
n.s.=married, educ, income, immigrant, English interview, neighborhood poor
4. Community health strategies
Sustain healthy
behaviors
Improve medical
infrastructure
Improve social &
environmental context
of health




                 Photo: http://www.flickr.com/photos/roscoland/962051804/
        Healthy Behaviors
Promote good nutrition: in schools, stores,
food stamps
Facilitate physical activities: via sports,
parks school yards
Disseminate information via promotoras
Sustain social networks via public space
Improve medical infrastructure
Sustain/expand community clinics, school
based clinics
Increase bilingual, bicultural workforce
Better connect workers to workers
compensation system
Expand preventive & elder care,
screenings & treatment
  Improve context for health
Improve housing, building enforcement
Improve workplace health & safety,
CalOSHA, living wage and other
enforcement
Improve air quality in immigrant
communities
Summary, immigrant paradox
Better health outcomes despite many risk
factors
Some health advantage due to selection,
other to health behaviors, other to social &
community conditions
To maintain health capital, community
health strategies are important
5. Medical Care Issues
             Mexican immigrants have the lowest levels
             of health insurance of all in CA in poverty
     100%


                                                                           30.9             33.8
       80%                                                                                                     43.0
                                                        45.3
                                      57.3

       60%           77.3
                                                                                            21.2
                                                                           35.0
                                                        17.6                                                   24.3
       40%
                                      14.2


       20%                                                                                  45.0
                     9.3                                37.0               34.1                                32.7
                                      28.5
                     13.4
        0%
                 Recent Mexican    Longer-stayed   Mexican American   U.S.-Born Whites   U.S.-Born Non-   Immigrants from a
                   immigrants        Mexican                                                 Whites       country other than
                                    immigrants                                                                 Mexico



                        Public         Private or both                No health insurance
Source: SSA, Inmigrantes Mexicanos y Centroamericanos en Estados Unidos, 2006
Adults 18 years and older who live in poverty, U.S., http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196
        Mexican immigrants lack connection to
                 health care facilities


                   20.9%                     14.7%                      9.2%
   42.4%

   14.5%           46.2%                     66.3%                     79.4%

   39.6%           31.1%
                                             14.7%                      9.0%
Recent Mexican    Longer-stay          Mexican American U.S.-Born Whites
 Immigrants        Mexican
                  immigrants

         Doctor's office or health center              Clinic         None

                   Source: California Health Interview Survey, 2003
                   Adults 18 or older, California
   Mexican immigrants have the highest levels of
      no medical visits in the past two years

                37.4%

                            22.0%
                                                     16.0%
                                                                              7.3%


Recent Mexican            Longer-stay                Mexican              U.S.-Born Whites
  immigrants               Mexican                  Americans
                          Immigrants
 Source- CONAPO, Migración México-Estados Unidos, Temas de salud. 2005.
 Adults 18 years or older, U.S.
 http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=154
    Mexican immigrants have the lowest levels of
              emergency room visits

                                                     16.7%
                                                                              15.5%
                            11.9%

    7.1%




Recent Mexican           Longer-stayed              Mexican-              U.S.-Born Whites
 Immigrants                Mexican                  Americans
                          immigrants
 Fuente- CONAPO, Migración México-Estados Unidos, Temas de salud. 2005.
 Adults 18 and over U.S.
 http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=154
Mexican immigrants have the highest use of health or
            dental services in Mexico



                           12.9%                            Low income   Other
      10.6%                     10.5%
  8.1%
                                                     5.3%

                                                            0.9%    0.7% 0.2%

 Recent Mexican             Longer-stayed            Mexican-      U.S.-Born Whites
  Immigrants                  Mexican                Americans
                             immigrants
  Source - 2001 California Health Interview Survey
  Adults 18 years or over, California
Adults age 18 and over with no
     doctor visit past year
    38.2%
                               26.0%
                                                     19.9%
                                                                 14.3%



  Recent                   Long-stay                Mexican-    U.S. Born
 Mexican                   migrants                 Americans    whites
 migrants                 (10+ years)
 Source: California Health Interview Survey, 2003
Adults age 18 and over with no
   dental visit in past year
   62.4%
                              46.1%
                                                    34.3%
                                                                26.8%




 Recent                   Long-stay                Mexican-    U.S. Born
Mexican                   migrants                 Americans    whites
migrants                 (10+ years)
Source: California Health Interview Survey, 2003
 Adults age 65 and over with no
influenza immunization past year
                                            28.8%
        25.5%                                           25.0%




   All Mexican                          Mexican-    U.S. Born whites
    migrants                            Americans
 Source: California Health Interview Survey, 2003
Adults age 50 and over who have
  never had a colorectal exam
         67.1%
                                             54.3%
                                                         42.2%




    All Mexican                          Mexican-    U.S. Born whites
     migrants                            Americans
  Source: California Health Interview Survey, 2003
Women age 18-64 with no pap
  smear past three years
                                                    16.2%
  13.1%                      12.0%                              11.2%




  Recent                  Long-stay                Mexican-    U.S. Born
 migrants                 migrants                 Americans    whites
(<10 years)              (10+ years)
Source: California Health Interview Survey, 2003
     Summary, health care
Mexican and Central American immigrants
are an important part of California’s
population
They face substantial access to care
barriers
It is possible to provide adequate access
to care to these populations
                Conclusion
Immigrants are “here
to stay”
They face a number
of special health,
health behavior, and
access to health care
issues
It is critical to address
those issues to
maintain a health
California

								
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