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Hidden Disparities: Poor Access to Care in Transient Immigrant Groups from Mexico

photo of couple with a doctor

January 8, 2018

For hundreds of thousands of people from Mexico who cross the border into the United States hoping for a better a life, the trip may last just a handful of days—perhaps a month. Yet, new research shows, the negative health effects of these brief or repeated sojourns may last a lifetime.

The findings were revealed in a new study led by Ana Martinez-Donate, PhD, from the Department of Community Health and Prevention at Drexel’s Dornsife School of Public Health. Her work shows that a rarely studied group of Mexican migrants—those who travel between the two countries repeatedly—often lose access to health care when they leave their native country.

The study, published in the Journal of Health Care for the Poor and Underserved in December 2017, also suggests that the Hispanic paradox—the idea that immigrants from Hispanic countries are often healthier than non-Hispanic, white Americans, even though they may experience poverty or face other challenges in the U.S.—overlooks the difficulties this group experiences when attempting to access health care.

“Once migrants enter the U.S., they encounter legal, financial, and institutional barriers that can make it hard to get the health care they need,” said Martinez-Donate. “At the same time, they may also lose health insurance or access to the health care they had in Mexico, making it more difficult for them to get medical care if they eventually return.”

These migrants face complex scenarios in both countries. “Aspects of the health care systems on both sides of the border, such as employer-based health care and minimum-stay requirements for health insurance, make it difficult for mobile populations,” said Félice Lé-Scherban, PhD, assistant professor in the Dornsife School of Public Health, who served as a co-author on the study.

While many in this population have significant health care needs, maintaining permanent residence in either country to qualify for health insurance, along with more stable care, can be extremely difficult. Many survive on seasonal labor, following opportunities not only from country to country, but also from state to state, before returning to Mexico briefly to care for family. Others may forgo needed care out of fear of deportation after visiting medical facilities.

The research team’s exploration of the health needs of the population are ongoing, but “traditionally, we have seen higher rates of occupational injuries, obesity, and self-reported markers of chronic disease, such as diabetes, hypertension, and hypercholesterolemia, along with depression and stress and at-risk drinking,” said Martinez-Donate.

Because they are not a part of medical care systems on either side of the border, the unmet health care needs and high rates of health care disparities in this group are often missed by researchers investigating the health of immigrant populations.

“Most research has been able to study stationary samples of Latino immigrants. That is, individuals who are established in the U.S. or have returned to Mexico, who end up being included in national or statewide surveys conducted in these countries,” said Martinez-Donate. “The characteristics of these immigrants may differ from the less established or more mobile segment of the Mexican immigrant population.”

To capture data about the unique factors effecting this group Martinez-Donate, Lê-Scherban, and their team recruited a study sample of 1550 northbound and southbound migrants traveling through the U.S.-Mexico border. For the study, they collaborated with a national and international group of researchers, including the Mexico section of the U.S. Mexico Border Health Commission.

“This study is the first of series of three about this population,” said Martinez-Donate. “Our next study will take a closer look at the health problems in this group.”

The researchers advise policymakers to take note of the new findings about this population as immigrant access to health care will likely decrease as anti-immigration legislation in the U. S. increases.

“We need policymakers to take actions to respond to the health care needs of this population who play a key role in so many industries in the U.S., including the agriculture, construction, and hospitality sectors. Mexican immigrants contribute significantly to the economy of the U.S. and increase the affordability of many products and services for the average American,” Lê-Scherban and Martinez-Donate said.

Possible options for increasing access to care for this immigrant group include the development of a portable health insurance program, expanding eligibility criteria to allow migrants, regardless of immigration status and length of residence, to qualify for the Affordable Care Act, or whatever takes its place, and facilitating enrollment in Seguro Popular a Mexican insurance program for the unemployed for migrants who return to Mexico.