2.  Immigration in the United States
HEALTHCARE
Immigration is one of the factors involved in the
debate of reform:
IMMIGRATION AND
 Are we the people too crowded to respond
generously to non-citizens?
 Today we want to take the debate into our
classroom for discussion with this critical
debate question:
SHOULD HEALTHCARE BE DENIED or PROVIDED
FOR THE NON-CITIZEN RESIDENTS OF THE U.S.?

3. PRO CON
 Our national identity of generosity to  The reality of radical inequality of
those less fortunate; human kindness healthcare costs and access for U.S.
, national philosophy “Give me your citizens---basic healthcare is not even a
tired, your poor” right of citizenship
 Prevention of public health issues and  The recent economic crisis has strained
costs of disease from lack of taxpayers who are contributing the
immunizations and safe, healthy most to support healthcare costs
housing for thousands of residents who through high taxes and health
are not eligible in some states insurance premiums
 Retail tax income from  Lack of income tax and business taxes
healthy, motivated employees to support health services directly for
 Increased healthy labor pool as illegal residents
essential for some businesses to thrive  Flood the country with immigrants
 To deny healthcare to immigrants needing healthcare
displays racism and classism  The national debt and obligation to
 Structural Violence through bringing protect those already here
immigrants in to work the fields and  A breech in national security
work in nursing, but denying help to
others

4. •To learn about immigration laws and healthcare cost
•To better understand how social, political and structural systems
affect healthcare systems
•To learn how to engage in both sides of a debate and discover
evidence for your own nursing practice
•To develop a true sense of holistic care
•To address your own thoughts and feelings about
racism, classism, structural violence, nationalism and silence and
how these pertain to your role as a nurse

5. 5 Critical
Concepts: Take out a
sheet of
paper.
Write
Nationalism Classism
which side
of the
debate at
this point
you would
Structural support.
Silence
Violence Do these 5
critical
concepts
Racism contribute
to your
decision?

6. Most legal immigration is classified into
six immigration categories:
 • Immediate Relatives
 • Family-Based
 • Employment-Based
 • Refugees
 • Asylees
 • Lottery Admissions

7. Illegal Aliens:
An individual who is not a U.S. citizen or U.S.
national and resides in the U. S. without legal
status
Lawful Permanent Resident (LPR):
An immigrant who has been granted
approval to reside and work in the U. S.
without restrictions

8. Estimated at ~ 11 Million
about 27 % increase in past decade
Of all unauthorized immigrants
living in the
United States in 2010,
39 % entered in 2000
or later, and 62 %
were from Mexico.

9. Immigrant (Lawful
Permanent Resident) ~ 12
Million with immediate
family members also
eligible, ¾ are eligible for
naturalization process. The
process toward citizenship is
variable and may be
lengthy.
These families work
legally, have a “green card”
and if well-employed may
hold work-related health
insurance benefits.
Regardless of employment
they are eligible for public
health and educational
services.
Lawful Immigration Annual Quotas
include 226,000 family-based, 140,000
employment-based, 90,000 refugee, and
10,000 special status for a total expected
lawful immigration of about
1 million per year

10. The article we read by Holmes points out the
disparities between race, class and social position
in provision of healthcare. Facts that stand out:
• Latino children have twice the death and
hospitalization rates from pedestrian injury than
do white children in the U.S.
• Latino adults have lower rates of preventive
medicine screening.
• Latino immigrants face medical deportation on
a daily basis by clinicians and healthcare
workers who deem them as unworthy of
assistance. (Holmes, 2006).

11. Formal Letter of
Complaint
 Connections between
Dear Sir: public health policies and
the development of long-
Due to the difficult circumstances
we find ourselves in this foreign
country, we look to you asking for
help in this case. We are enclosing a
copy of the severe law that the
railroad line has imposed on us
lasting representations of
Mexicans who work on the track,
which we do not see as a just thing,
but only offensive and humiliating.
Mexicans as disease
When we crossed the border into this
country, the health inspector carriers are demonstrated
by the response to a 1916
inspected us. If the railroad line
needs or wants to take such
precautions it is not necessary that
typhus outbreak in Los
they treat us in this manner. For this,
they would need health inspectors
who assisted every individual with
medical care and give us 2 rooms to
live, one to sleep in and one to cook
in, and also to pay a fair wage to
Angeles County.
obtain a change of clothes and a
bar of soap. This wage they set is not
enough for the nourishment of one
 The disease spread from
person. Health comes from this and
these precautions are the basis for person to person, spurring
the creation of local
achieving sanitation. Health we
have. What we need is liberty and
the opportunity to achieve it. We
policies derived from the
need a bathroom in each section of
camp and that the toilets that are
now next to the sleeping quarters be
moved. Many times their bad smell
has prevented us from even eating
our simple meal. Furthermore, we
premise that all Mexicans
can disclose many other details
which compromise our good health
and personal hygiene With no
spread disease
further ado, we remain yours,
graciously and devotedly, your (Molina, 2011).
 Medical deportations
attentive and faithful servants. We
thank you in advance for what you
may be able to do for us.
Felipe Vaiz,José Martinez, Felipe
Martinez, Adolfo Robles, were not uncommon.
Alejandro Gómez, Alberto
Esquivel.[12]

12. • Labor migration is a significant phenomenon
throughout the world, from the most vulnerable illegals
through the most educated STEM professionals
(Farmer, 2005; http://www.nam.org/Issues/Employment-and-
Labor/Workforce.aspx, 2011)
• Mexico’s minimum wage is a little over $4.00
per day. (Minimumwage.com/international)
• Agribusiness and manufacturing have long used
immigrant labor to reduce costs and increase
cooperation of employees when U.S. workers were
not willing to tolerate minimum wage for hard labor
without health insurance or other benefits.
• U. S. businesses have legally relocated a portion of
these jobs in other countries through NAFTA
(Farmer, 2005, Loewen, 2007 ).
• Some jobs have been taken to the other countries
through NAFTA (http://www.nam.org/Issues/Employment-and-
Labor/Workforce.aspx ).

13.  What is the regulatory meaning and
description of immigration in the U.S?
 What is the historical healthcare
experience of immigrants, both legal
and illegal, in the U.S.?
 What is the best role of the nursing
profession in serving the immigrant
population?

15. Inequalities in
Global Market:
 The nursing shortage of the 2000’s caused hospitals to
recruit foreign nurses as a means to provide fill the
gap in trained professional nurses
 Hospitals employed companies to go to developing
countries and seek out nurses to come to the US by
offering them wages that sounded great but were
actually much less than American born nurses were
making.
 Foreign nurses are recruited from poor developing
countries depleting their healthcare labor force

16.  Low-income, English-speaking countries that
engage in high levels of bilateral trade
experience greater losses of nurses to the U.K.
and the US.
 Poor countries seeking economic growth
through international trade expose themselves
to the emigration of skilled labor. This tendency
is currently exacerbated by nursing shortages
in developed countries (Ross, Polsky &
Sochalsky, 2005).
 Countries that provide most nurses are highly
populated poorer nations (Ross et al, 2005).

17.  Overcoming language barriers
 Dealing with discrimination
 Adopting U.S. nursing practices
 Adjusting to U.S. social customs
 Becoming accustomed to U.S. culture
 Reconciling work ethics. (Lin, 2009)

18.  Is it ethical to entice nurses from poorer
countries to come to developed
countries to practice nursing?
 What produces the most tension in the
debate of issues of immigration ?

19. Why do immigrants fail to seek
health services on a regular basis?
1. Social Barriers
› a. lack of social support
› b. limited English proficiency
› c. immigration status
› d. fear
2. Health Care Delivery Barriers
› a. financial cost
› b. lack of child care
› c. lack of transportation
› d. lack of time

20. › Immigrants use the language of silence to
express themselves.
› Parin Dossa (2003) tells us that silence does
not rule out speech. She tells us that much
can be "said" through the silent gaps
between words.
› In her Migratory Tale of Social Suffering and
Witnessing, Dossa shows how Zahra uses the
silent language of the body (her symptoms)
to tell her story.
› Witnessing makes it necessary for us to listen
to the language of silence.
› Many immigrants keep silent in hopes of
staying "invisible" and not stirring up any
questions, especially if they are illegal.

21. Audre Lorde (1980) says that "silence and invisibility go
hand in hand with powerlessness.“
In research about postpartum depression (PPD) in Hispanic women, it was found
that most of them will not admit to or acknowledge the fact that they are
experiencing any form of depression. Hispanic women feel ashamed and that
depression should be kept silent. There are many women that simply won't say
anything.
 Many female immigrants keep silent out of fear. Fear of
authority, deportation, or in many cases their husbands (depending on their
culture.)
 A PERSONAL STORY:
I had a patient one night on postpartum from Saudi Arabia. I was
told in report that she spoke no English. She had delivered her
baby earlier in the evening and her husband, who did speak
English and interprets for her, had left for the night. I went into
her room to get her vital signs and do her assessment. This was
before we started using the language lines or had material
printed in other languages. I wasn't sure how I would
communicate with her. When I entered her room, I spoke to her
and told her my name. She just looked at me. Then she said, in
very plain English, "Your hair is so pretty." I said, "Oh. I didn't think
you could speak English." She said, "Oh, yes. I speak English." She
could speak and understand English very well. Her husband did
not know that and we did not tell him.
Her secret was safe with us.

22.  Nursing encompasses an art, a humanistic
orientation, a feeling for the value of the
individual, and an intuitive sense of ethics, and of
the appropriateness of action taken. ~ Myrtle
Aydelotte
 We have to ask ourselves whether medicine is to
remain a humanitarian and respected profession
or a new but depersonalized science in the service
of prolonging life rather than diminishing human
suffering ~ Elisabeth Kubler-Ross

23. Callister, L.C., Beckstrand, R.L., & Corbett, C., (2011). Postpartum Depression and
Help-Seeking Behaviors in Immigrant Hispanic Women. Journal of
Obstetric, Gynecologic & Neonatal Nursing, 40(4), 440-449.
Dossa, P. (2003). The Body Remembers, A Migratory Tale of Social Suffering and
Witnessing. International Journal of Mental Health, 32(3), 50-73.
Farmer, P. ( 2005). Pathologies of power: Health, human rights, and the new war
on the poor. Berkley, CA: The University of California Press.
Holmes, S. (2006). An ethnographic study of the social context of migrant health
in the United States. PLOS Medicine (3) 10. p 1776-1793.
Lin, L. (2009). A synthesis of the literature on Asian nurses' work experiences in the
United States. Research & Theory for Nursing Practice, 23(3) p 230-45.
Loewen, J.( 2007). Lies my teacher told me. New York, NY: The New Press.
Lorde, A. (1980). The Transformation of Silence into Language and Action. J.
Pinkvoss & S. Brawn (Eds.), The Cancer Journals (pp. 16-22). San Francisco:
aunt lute books.
Molina, N. (2011). Borders, laborers, and racialized medicalization: Mexican
immigration and US public health practices in the 20th century. American
Journal of Public Health. 101(6).
National Manufacturer’s Association ( 2011). Retrieved from
http://www.nam.org/Issues/Employment-and-Labor/Workforce.aspx
Ross, S., Polsky, D. & Sochalsky, J. (2005). Nursing shortages and international
nurse migration. International Nursing Review. 52(4) 253-62