Global health often requires its practitioners to travel far and wide, to sleepy rural villages in
Haiti, to teeming urban slums in Brazil, to expansive grasslands in Africa. But global health is also in the United States, in California, in the apartment complex across the street. This is partly because now, more than ever before, people are on the move.
International migration has increased dramatically in the last few decades. In the 1950s, roughly 50 million people worldwide had migrated from their countries of origin to live and work in other places. By 2008, that number had grown to 200 million. This diaspora brings increased challenges to the field of public health, including the spread of infectious disease, barriers to health care and insurance for immigrants, and an exchange of health problems between countries. Health Initiative of the Americas (HIA) was founded in 2001 under the auspices of the UC Office of the President to address, from a binational perspective, the health care issues that immigrants from Mexico face in the United States. The initiative has since expanded to work with seven other countries: Guatamala, El Salvador, Honduras, Nicaragua, Colombia, Ecuador, and Peru. Today, as a center at the UC Berkeley School of Public Health, HIA continues to lead the way in this field as emigration from these areas increases.
“Health Initiative of the Americas is a driving force behind our school’s ability to address one of the major issues of the twenty-first century— the rapid pace of global change fueled in large part by the migration of populations,” says Dean Stephen M. Shortell.
There are many reasons why more people are traveling and seeking new places to live, but most move for economic opportunity. Xóchitl Castañeda, director of HIA, believes low-income immigrants face a lot of risks on a daily basis. She says, “They come here seeking the American Dream. But for many, the American Dream can become an American Nightmare.”
Castañeda points out that some immigrants have an easier transition— she herself came to the United States from Mexico to pursue a graduate degree, then worked at UCSF and came to UC Berkeley to found and run HIA. Rather, she is mainly referring to low-income and underserved populations: “The farm workers who are in the streets offering their hands to work, their legs to carry, their backs to transport,” she says.
And, yes, undocumented immigrants are a large part of that population. Many Americans would prefer to ignore the existence of undocumented immigrants in this country. Others, when they do acknowledge this population, accuse them of being a drain on society’s resources and feel strongly they should return to their own countries. Rosario Alberro, associate director of HIA, believes undocumented immigrants are not motivated by a desire to stay in the country.
“No matter how successful undocumented immigrants are in the United States,” Alberro says, “None of them want to stay here for long. I’m pretty sure that if I say all of them want to go back, I’m not mistaken.”
Dispelling myths about migration
The toll of migration can be high—separation from family and isolation in a foreign culture. And, says Castañeda, “it’s worse for undocumented immigrants because they are excluded from a lot of the social benefits of this society, even though they are often paying taxes. So they end up subsidizing the welfare, including health issues, of the main society. But they are completely excluded.”
As for the idea that the United States would be better off if there were no undocumented immigrants in the country? “There is a big lie there,” Castañeda responds forcefully. “Because this country would not be able to subsist one day without Mexicans and without Latinos.”
The majority of people who move to the United States from Mexico are seeking employment, higher incomes, and a better life for themselves and their families. Synergistically, the United States has an aging population and needs able workers to contribute to its economy. While the baby boomers in the United States are thinking hard about retirement, the population of Mexico is relatively young, and the average age of immigrants from Mexico is 30 years.
In addition to often being at the peak of their working years, Mexican immigrants end up concentrated in certain industries that may be unattractive to other workers. HIA recently released a report about the concentration of Mexicans in agriculture, a $30 billion industry that feeds the country. In California, 8 out of 10 farm workers are from Mexico.
“Many immigrants end up living in isolated areas, mainly rural areas where there is agriculture,” says Castañeda. “Those communities do not necessarily have a lot of social factors like sewage, electricity, schools, and diversions. Also navigating a fragmented system like the health care system—it’s very difficult. Imagine you come from another country with another kind of health care system without really knowing the language or the culture here; you feel very intimidated. So they can not seek services in an efficient manner.”
Health Initiative of the Americas helps immigrants navigate the health care system, and is also working to refute common misperceptions surrounding migration. Says Alberro, “A great deal of the American society, I think, is misinformed regarding the typical Latino migrants in the United States and the contributions they make. We’re trying to get rid of the myths and provide accurate information based on our research.”
Research on both sides of the border
Members of HIA can speak with authority when it comes to facts about immigration, because the center is on the forefront of research in the field of mobile populations and health. The initiative has provided more than $3 million in funds to binational teams that include researchers from both the United States and the countries of origin. Says Castañeda, “In order to understand mobile populations, you can not just have the perspective of the receiving country. You also need to understand why people leave and what happens to the families they left behind.”
On September 7, HIA launched the first center on migration and health in the western hemisphere, in collaboration with UC Davis. The Migration and Health Research Center (MAHRC) will conduct and sponsor multidisciplinary research to discover new information about migrant health. The findings will be translated into policy and other recommendations to reduce acute and chronic illness and injuries among migrant populations. MAHRC will also train students and support faculty in addressing critical issues in this field.
“The UC system is leading one of the most needed research movements in the world today,” says Castañeda, who is the associate director of the new center. “And our two campuses are uniting in response to global needs.”
Working together with other campuses and other countries is smart from the standpoint of sharing resources. “Especially in the state of California, resources are so scarce,” says Alberro. “So now we have the backup of the countries of origin, who can no longer say, ‘Okay you left my country, you are no longer my responsibility.’ No, you do have a responsibility. We can share responsibility.”
Out of this binational research, HIA produces a range of publications, each very well tailored to its target audience. A one-page fact sheet with easy-to-read bullet points highlighting findings about the mental health of Latinos also contains policy recommendations for hospitals. A large, friendly bilingual guide contains straightforward yet detailed information about public and private programs that can provide health care services for low-income individuals in California. A report, Migration, Health & Work: The Facts behind the Myths, provides an in-depth look at the realities behind the common misperception that immigrants come to the United States primarily to seek health services.
The report, a collaboration with the UCLA Center for Health and Policy Research, concluded that not only do immigrants make less intensive use of health care services in the United States, they often put their health at risk to perform jobs needed in our economy. It recommends that “if Latino immigrant workers are expected to keep contributing in the U.S. labor force, they must be provided the means to care for the health and social needs of their families.”
A strategy for insuring undocumented immigrants
Language in HR 3200, a major health care reform bill currently in Congress, specifically excludes undocumented immigrants from health care services such as government subsidies for insurance or access to any proposed public insurance plan. And in his speech to a joint session of Congress, President Barack Obama explicitly stated that the national health care proposal would not apply to undocumented immigrants.
“They have so much invested in moving the reform forward,” Castañeda reasons, “that it would kill it to put that in. But I think because this is a population that is really in need, something needs to happen at the local level.”
From a statistical standpoint, the need is obvious. There are an estimated 12 million undocumented immigrants in the United States and nearly 70 percent of them are uninsured. In addition, more than half of the 10 million documented Mexican immigrants in the United States also lack health insurance. The problem is amplified in California, where 43 percent of all Mexican immigrants to the United States reside.
To meet this need, HIA has proposed a strategy for binational health insurance in California, which would involve a partnership between private insurers in the United States and public providers in Mexico. Because many immigrants travel back and forth between the two countries, it makes sense to collaborate on coverage. In addition, many Mexicans who are employed in California have dependent family members in Mexico and spend out-of-pocket on health care for their families.
HIA’s goal in this arena is to set up a pilot project between California and Mexico, which could then serve as a model for other states. The Mexican government has shown a willingness to participate in this reform. And Castañeda feels that even though the federal government is not currently addressing health care for undocumented immigrants, that it can still proceed at a local and state level.
“Once you enact big reform, you’re going to apply it, and you’re going to apply it locally,” she says. “In this country, the states are part of the federation but not necessarily dependent on the federation to act. Someone has to lead the way.”
History has shown that the United States as a whole benefits when those who come here from other places are allowed to thrive. “We need to remind ourselves that we are a nation of immigrants,” says Shortell. “It is our responsibility to ensure that the new wave of immigrants to our country—and in this global world to other countries as well—have the community, educational, and health-building resources to live meaningful, productive lives as those before them have largely enjoyed.”