At the Border: Q&A with Ana Martinez-Donate, Public Health Researcher

The world is changing. More than 70 million people – 2.3 million more than in 2017 – are currently displaced as a result of conflict, violence, and other factors, according to a United Nations report published earlier this month. In 2017, the greatest number of new asylum applications were received here in the United States – 254,300 from 166 countries and territories.

“We have to come to terms with forced displacement as a result of war, because it is becoming an entrenched norm in the 21st century,” Adrian Edwards, spokesperson for the UN’s refugee agency, told The Telegraph. “This reflects the very conflicted state of the world and 70.8 million people are paying the price.”

But what price are migrants paying? Ana Martinez-Donate, PhD, an associate professor of community health and prevention in the Dornsife School of Public Health, and her colleagues have been on the case, publishing extensively on health disparities experienced by migrants from Mexico.

The latest study, published last year in the Journal of Health Care for the Poor and Underserved, delved into access to health care among migrants and immigrants from Mexico. Among other findings, the researchers found that 84 percent of Mexican immigrants and migrants had health insurance before they crossed into the United States, but that number plummeted to 25-50 percent once they migrated to the United States. Migrants varied on health care access depending on what stage they were in — migrants at communities of destination in the U.S., migrants returning via deportation, and migrants who were back in Mexico after having migrated to the U.S.

Now Martinez-Donate’s team embarks on two additional studies to build on this work. The first is a two-year grant from the National Institute on Minority Health and Health Disparities that aims to advance our understanding of the extent and determinants of substance abuse, violence, HIV/AIDS, and mental health among Latino immigrants in Philadelphia. Studies show these conditions disproportionately impact Latinos and suggests that these factors tend to influence each other. Through in-depth interviews and a community survey, the group will identify targeted steps and resources to address these disparities.

The second, a five-year, $3.1 million grant from the National Institute of Child Health and Human Development, will fund an observatory of health to monitor the health of Mexican immigrants crossing the United States/Mexico border (into the U.S. or returning to Mexico). The team will survey migrants to assess health status and their access to health care.

Martinez-Donate shares with the Drexel News blog some of her team’s achievements and important next steps in understanding and improving health care for migrants:

Your research on the health of migrants has led to free prevention clinics opening in five deportation stations at the border with Mexico (with support from the Mexican Secretariat of Health). Now that you’re expanding this work into other border cities, what do you hope this will achieve?

I hope this new phase will help us to get a better understanding of the health status of Mexican migrants at different stages of the migration experience. That is, before migrating, during their journey to the United States, and after their stay in this country. I also expect the data will shed light on factors that influence their health, as well as barriers this population faces to access health services at these different points of the migration continuum. With this information in hand, I hope one day policy makers and health professionals will be able to allocate resources and develop programs to address health issues and barriers experienced by migrants in communities of origin, destination, and transit.

This is difficult community-based research. Please describe the work your team is doing on location near the border and why it’s especially critically important right now.

As for our previous and current projects, for this new study we will work closely with our experienced Mexican colleagues on the Northern border of Mexico. Under the supervision of co-investigator Dr. Gudelia Rangel, from the Mexico section of the Border Health Commission, our trained field staff will conduct surveys of Mexican migrants at key transit points in Tijuana, Nogales, and Nuevo Laredo. These points include bus stations, airports, and deportation facilities through which northbound and southbound migrants travel on their way to the U.S. or back to Mexico. The timing of this study is particularly important considering this administration’s crackdown on immigration, and increased use of anti-immigration rhetoric. At the same time, some communities of origin and transit are experiencing a worsening in violence and poverty levels (the so-called “push factors” that lead to migration). The conditions in these communities are likely to have negative impacts on the health of these transnational populations, including a reduction in access to health services throughout the different migration phases.

Tens of millions of people are migrating worldwide – how can communities in Philadelphia and across the United States care for the health of these individuals and families?

We all can contribute to create a more welcoming and supportive environment, in which both immigrant and native populations can thrive. Starting with developing an understanding of the conditions that push migrants to leave their communities of origin, the perils many experience in their journey to the U.S., and the hardship that many immigrant families endure here in the U.S., we need to put ourselves in their shoes, and wonder what would we do if we faced a similar situation. It is important to understand we are all human and very similar in what we seek out in life: safety and better economic and educational opportunities for ourselves and our families.

Second, we all can help by acknowledging the economic and cultural contributions of immigrants throughout the history of the U.S., which have made this country the global leader it is today. This is a nation of immigrants and anything we do to improve immigrant health will result in the betterment of our nation as a whole.

Third, I believe it is very important to become more familiar with the culture and language of our main immigrant communities and develop cultural sensibility and humility to relate to them in a respectful manner.

Fourth, to provide better care, we need to learn more about the health issues that affect these populations and immigration-specific factors that impact their health, and then we need to develop and apply culturally appropriate, evidence-based responses to address those needs.

Finally, all of us can contribute by demanding and supporting more humane immigration policies and policies that increase access to health care for all, regardless of immigration status.

What is the biggest misconception that some of the general public may have about the population you’re researching?

One common misconception is that Latino immigrants represent a “drain” on health care and social services systems in the U.S. Our research and plenty of previous studies actually show that Latino immigrants are generally healthier and utilize health and social services at lower rates compared to natives. Even when they are entitled to certain programs, many individuals in immigrant families do not use them for fear that it could have negative consequences for them or other family members. Another misunderstanding is that concerning criminal activity among immigrants. Again, data show that foreign-born individuals are less likely to engage in criminal behavior, compared to natives.

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