2. HEALTHCARE
SHOULD HEALTHCARE BE
IMMIGRATION
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 healthy,  Lack of income tax and business taxes
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 Which of
these 5
critical
Racism concepts
contribute
to your
decision?

6. Legal Immigration: Lawful Illegal Immigration:
Permanent Resident  An individual who is not
(LPR) a U.S. citizen or U.S.
 Immediate Relatives national and resides in
the U. S. without legal
 Family-Based
status
 Employment-Based
 As defined by
 Refugees Government
 Student Visa Regulation: Illegal
Aliens

7. Estimated at ~ 11 Million
About 27 % increase in past decade
Of all unauthorized immigrants
living in the U. S. in 2010
39 % entered in 2000
or later, and 62 %
were from Mexico.

8. Immigrant Lawful
Permanent Resident
~ 12 Million with immediate
family members also eligible
The process toward citizenship
is variable and may be lengthy
and expensive.
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.
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 ~1 million
per year

9.  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)

10.  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 ).

11. The belief that races have
distinctive cultural characteristics
determined by hereditary factors
and that this endows some races
with an intrinsic superiority over
others.
Racism. (n.d.). Collins English Dictionary - Complete &
Unabridged 10th Edition. Retrieved November 29, 2011,
from : http://dictionary.reference.com/browse/racism

12. Barbee (1993), described three types of racism, based upon the
works of Jones, (1972).
 Individual Racism emphasizes discriminatory acts directed
towards individuals because of visible biological characteristics.
 Cultural Racism involves individual and institutional expression of
the superiority of one’s cultural heritage over that of others.
 Institutional Racism the intentional or unintentional manipulation or
toleration of institutional policies that unfairly restrict the
opportunities of particular groups.

13. o ~10 million migrant farm laborers in the U.S.
Extremely poor health status of migrant workers is often the result
of structural racism and anti-immigrant practices.
o Migrant worker job assignments often made based upon
perceived biological/racial attributes and differences (e.g. height).
o Clinicians and migrant workers rarely question the racism practices
because they are considered natural and NOT social – societal
normalizing
o Only 5% of migrant farm workers have health insurance (84%, U.S.
citizens with health insurance)
Holmes, S. (2006). An ethnographic study of the social context of
migrant health in the united states. Plos Medicine, 3 (10), 1776-
1793.

15. 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).

16.  Connections between public health
policies and the development of long-
lasting representations of Mexicans as
disease carriers are demonstrated by the
response to a 1916 typhus outbreak in
Los Angeles County.
 The disease spread from person to
person, spurring the creation of local
policies derived from the premise that all
Mexicans spread disease (Molina, 2011).
 Medical deportations were not
uncommon.

17. Formal Letter of Complaint :
Dear Sir:
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 Mexicans who work on the track, which we do not see
as a just thing, but only offensive and humiliating. When we crossed the border into this
country, the health inspector inspected us. If the railroad line needs or wants to take
such precautions it is not necessary that 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 obtain a change of clothes and a bar of soap. This wage they set is not enough for
the nourishment of one person. Health comes from this and these precautions are the
basis for achieving sanitation. Health we have. What we need is liberty and the
opportunity to achieve it. We 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 can
disclose many other details which compromise our good health and personal hygiene
With no further ado, we remain yours, graciously and devotedly, your 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,
Alejandro Gómez, Alberto Esquivel.[12]

18. 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

19.  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).

20.  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)

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

22. › 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.

23.  Audre Lorde (1980) says that "silence and invisibility go
hand in hand with powerlessness.“
Many immigrants keep silent in hopes of staying "invisible"
and not stirring up any questions, especially if they are illegal.
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

24.  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 ?
 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?

25.  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

26. Barbee, E. (1993). Racism, gender, class, and health. Medical Anthropology Quarterly, 7 (4), 346-362.
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
Racism. (n.d.). Collins English Dictionary - Complete & Unabridged
10th Edition. Retrieved November 29, 2011, from http://dictionary.reference.com/browse/racism
Ross, S., Polsky, D. & Sochalsky, J. (2005). Nursing shortages and international nurse migration.
International Nursing Review. 52(4) 253-62