Global Mph Barriers Immigrants Women

762 views

Published on

Published in: Health & Medicine, Spiritual
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
762
On SlideShare
0
From Embeds
0
Number of Embeds
35
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Global Mph Barriers Immigrants Women

    1. 1. Sapna Pandya, MPH Director of Programs South Asian Health Initiative Center for Immigrant Health Barriers to Health Care for Immigrant Women
    2. 2. Brainstorm <ul><li>What are generalizations? </li></ul><ul><li>What are stereotypes? </li></ul><ul><li>What is cultural competence? </li></ul><ul><li>Why & How do we do this? </li></ul>
    3. 3. Generalization: A Definition <ul><li>A statement or judgment made based on common trends or occurrences that may be seen in several individuals and then those presumptions are applied to the entire group.   </li></ul><ul><li>It is a beginning point, where the individual making the generalization actually goes out in search of the answer.   </li></ul><ul><li>Generalizations may apply to some of the individuals within a certain group, but not to all. </li></ul>
    4. 4. Stereotyping: A Definition <ul><li>The process by which people use social categories (e.g. race, sex) in acquiring, processing, and recalling information about others. </li></ul>
    5. 5. CULTUR (e) AL COMPETENCE <ul><li>What does it mean? </li></ul><ul><li>Why does it matter? </li></ul><ul><li>How do we become culturally competent ? </li></ul>
    6. 6. What is culture? <ul><li>The learned and shared patterns of information that a group uses to generate meaning among its members. </li></ul><ul><li>Macro cultures: </li></ul><ul><li>national, ethnic or racial groups </li></ul><ul><li>Micro cultures: </li></ul><ul><li>sexual orientation, disability, religion, gender , age … what else ?? </li></ul>
    7. 7. Can “culture” influence care provision? <ul><ul><li>Appropriate Greetings / Salutations </li></ul></ul><ul><ul><li>Formality in salutations, placement of individuals (esp. b/c of gender) </li></ul></ul><ul><ul><li>Sexual minorities </li></ul></ul><ul><ul><li>Superstitions: Numbers & Colors </li></ul></ul><ul><ul><li>In Mandarin, words for “10” and “4” sound like word for “death” </li></ul></ul><ul><ul><li>What does RED mean to you? </li></ul></ul><ul><ul><li>Who are the ‘bearers of cultural practices’? </li></ul></ul><ul><ul><li>Importance of Family </li></ul></ul><ul><ul><li>who makes the decisions? </li></ul></ul><ul><ul><li>who is interpreting and what should they/do they know? </li></ul></ul><ul><ul><li>Attitudes towards medical professionals </li></ul></ul><ul><ul><li>In many cultures, doctors are revered </li></ul></ul>
    8. 8. Broader social barriers <ul><li>“ Model minority myth” </li></ul><ul><ul><li>low-income segment </li></ul></ul><ul><ul><li>overlooked… even within community </li></ul></ul><ul><li>Assimilation pressures </li></ul><ul><li>History of patriarchy and </li></ul><ul><li>heteronormativity </li></ul><ul><li>Inferiority complex </li></ul><ul><li>Family pressures of </li></ul><ul><li>marriage, work, sponsorship, </li></ul><ul><li>residence, financial </li></ul><ul><li>obligation, etc. </li></ul><ul><li>Diversity within community: </li></ul><ul><li>immigration patterns  class), dietary practices, </li></ul><ul><li>linguistic, religious, etc. </li></ul><ul><li>Immigrant women twice as likely male counterparts to be widowed, divorced, or separated </li></ul>
    9. 9. Specific barriers to health <ul><li>Lack of health insurance </li></ul><ul><li>Socio-economic barriers, including financial dependence  isolation </li></ul><ul><li>Citizenship concerns </li></ul><ul><li>Language barriers </li></ul><ul><li>Transportation </li></ul><ul><li>Effects of 9/11 (e.g. Coney Island Avenue) </li></ul><ul><li>Lack of information  underutilization of existing services </li></ul><ul><li>Embarrassment about self/body; self-esteem </li></ul><ul><li>Social stigma relating to disease & certain prevention </li></ul><ul><li>Difficulty with adherence </li></ul><ul><li>Accepting & understanding risk </li></ul>
    10. 10. Health of South Asian women <ul><li>Anemia (thalassemia) </li></ul><ul><li>Low birth weight infants </li></ul><ul><li>Malignant tumors (breast) </li></ul><ul><li>Mental health </li></ul><ul><li>PCOS </li></ul><ul><li>Intimate partner violence (37% Boston) </li></ul><ul><li>Diabetes </li></ul><ul><li>Heart disease (3x that of white women) </li></ul><ul><li>Limited English Proficiency </li></ul><ul><li>Financial dependence </li></ul>
    11. 11. WHY? <ul><li>Feeling you’re not at risk  no early intervention </li></ul><ul><ul><ul><li>1/3rd haven’t had pap, mammogram </li></ul></ul></ul><ul><li>Nutrition  low fruit, simple carbs, high fat </li></ul><ul><li>Isolation, role in family,  lack of information </li></ul><ul><li>Financial issues (incl. financial dependence)  disempowerment </li></ul><ul><li>Literacy & language barriers (written & spoken) </li></ul>
    12. 12. WHY? (cont.) <ul><li>Uninsured rates </li></ul><ul><li>Embarrassment </li></ul><ul><li>Higher rates of insulin resistance </li></ul><ul><li>Saving face  not addressing IPV, sexuality, etc. </li></ul><ul><li>Language </li></ul><ul><li>Citizenship </li></ul>
    13. 13. Understanding Religion & Faith to Care Effectively for Patients <ul><li>Dietary laws of different faiths/people </li></ul><ul><ul><li>vegetarianism, Kosher, Halal, hot/cold foods (e.g. during </li></ul></ul><ul><ul><li>child birth) </li></ul></ul><ul><li>Clothing & modesty </li></ul><ul><ul><li>Hijab, burqa </li></ul></ul><ul><li>Death & Dying </li></ul><ul><ul><li>Cremation, ritual washings, burial </li></ul></ul><ul><li>Fatalism </li></ul><ul><ul><li>Use of chemotherapy, medicine </li></ul></ul><ul><li>Observance of holidays may influence care </li></ul><ul><ul><li>Ramadan, Sabbath </li></ul></ul>
    14. 14. Hijab vs. Niqab
    15. 15. Communicating ‘Mental Health’ <ul><li>Supernatural factors e.g. black magic, el mal ojo/nazar/ain al hasoot </li></ul><ul><li>Spitting/blessing </li></ul><ul><li>Silence </li></ul><ul><li>Lack of vocabulary to talk about mental illness in local language </li></ul><ul><li>Dearth of immigrant populations participating in research on mental health disorders </li></ul>
    16. 16. LGBT Community <ul><li>Not everyone uses terms “gay” and “lesbian”, etc. </li></ul><ul><li>Relatively more ‘closeting’ among LBT women </li></ul><ul><li>Feeling of being discriminated against in medical settings </li></ul><ul><ul><ul><li>- Visiting rights: “Who are you to him/her?” </li></ul></ul></ul><ul><ul><ul><li>Medical coverage for one’s partner </li></ul></ul></ul><ul><ul><ul><li>Being considered for appropriate screenings </li></ul></ul></ul><ul><li>“ Medical power of attorney”/health care proxy </li></ul><ul><li>Need advocates & safe space within hospital setting </li></ul>
    17. 17. Transgender Overview <ul><li>'Umbrella' Term for a Diverse Community </li></ul><ul><ul><li>Broad array of gender identities (e.g., transsexuals, cross-dressers and 'drag queens‘) </li></ul></ul><ul><ul><li>Both male-to-female (MTF) and female-to-male (FTM) </li></ul></ul><ul><ul><li>Openly transgendered or not </li></ul></ul><ul><ul><li>Consistently presenting in one gender or not </li></ul></ul><ul><ul><li>Interested in hormone replacement therapy (HRT) and/or sex reassignment surgery (SRS) or neither (many undergo no medical intervention at all) </li></ul></ul><ul><ul><li>Of every sexual orientation (lesbian, gay, bisexual and heterosexual) </li></ul></ul><ul><ul><li>From every demographic background (race, ethnicity, class, age, occupation, etc.) </li></ul></ul>Developed for SVH by NY Assoc. for Gender Rights Advocacy (NYAGRA) and the Transgender Legal Defense & Education Fund (TLDEF).
    18. 18. Can immigration influence care provision?
    19. 19. <ul><li>Immigrants constitute approximately ________ % of the total U.S. population </li></ul><ul><li>5% </li></ul><ul><li>10% </li></ul><ul><li>50% </li></ul><ul><li>90% </li></ul>
    20. 20. NYC Immigrant Demographics <ul><li>44% of the NYC population is foreign born </li></ul><ul><li>1 out of 3 immigrants is a U.S. citizen </li></ul><ul><li>1 out of 3 immigrants is a LPR </li></ul><ul><li>500,000 City residents (700,000 NYS residents) are “undocumented” </li></ul><ul><ul><li>majority are adults </li></ul></ul><ul><ul><li>many living in mixed status households </li></ul></ul>Sources: New York City Department of Planning; U.S. Census Bureau (2003)
    21. 21. The New York City Picture
    22. 22. The Language of Immigration <ul><li>An immigrant is a person who is not born in the U.S. and who enters the country with the intent to remain for an indefinite period of time . </li></ul><ul><li>Main Immigrant Categories: </li></ul><ul><li>Naturalized Citizen </li></ul><ul><li>Legal Permanent Resident (LPR) </li></ul><ul><li>Undocumented Immigrant </li></ul><ul><li>Refugee/Asylee </li></ul>
    23. 23. How does one get a “Green Card”? <ul><li>Through a family member </li></ul><ul><li>Through employment </li></ul><ul><li>Through marriage (heterosexual) </li></ul><ul><li>Diversity lottery </li></ul><ul><li>Through Investment </li></ul><ul><li>Adjustment of Refugee/Asylee status </li></ul><ul><li>Others, e.g. Violence Against Women Act , International adoption </li></ul>
    24. 24. Immigrant Workers <ul><li>Often work the most dangerous jobs </li></ul><ul><li>(new influx of women in taxi industry) </li></ul><ul><li>Fewest workplace protections </li></ul><ul><li>Harassment, eve-teasing </li></ul><ul><li>Lowest wages in the labor market </li></ul><ul><li> “ high-risk” for health problems </li></ul>
    25. 25. Special Registration <ul><li>September 2002 - April 2003 </li></ul><ul><li>Males over 16, entering legally from “certain countries” </li></ul><ul><li>* Group 1: Iran, Iraq, Libya, Sudan or Syria </li></ul><ul><li>* Group 2: Afghanistan, Algeria, Bahrain, Eritrea, </li></ul><ul><li>Lebanon, Morocco, North Korea, Oman, Qatar, </li></ul><ul><li>Somalia, Tunisia, the United Arab Emirates, Yemen </li></ul><ul><li>* Group 3: Pakistan, Saudi Arabia </li></ul><ul><li>* Group 4: Bangladesh, Egypt, Indonesia, Jordan, </li></ul><ul><li>Kuwait </li></ul><ul><li>Approximately 100,000 registered, with 0 proven ties to terrorist organizations </li></ul><ul><li>What was the effect this had on the WOMEN? </li></ul>
    26. 26. What was the total income of Latino immigrants in the U.S. in 2004? <ul><li>$500 million </li></ul>$1 billion $100 billion $500 billion
    27. 27. What % of this income was spent in the United States? <ul><li>13% </li></ul>Sources: Pew Hispanic Center; National Immigration Law Center; National Conference of State Legislatures; INEGI (Instituto Nacional de Estad.stica, Geograf.a e Inform.tica) 43% 73% 93%
    28. 28. Contributions made by immigrants <ul><li>Selective service (ALL men 18-25) </li></ul><ul><li>Over the next 50 years, $407 billion in SS taxes </li></ul><ul><li>2005: Immigrants paid $18.2 billion dollars in New York (16% of NYS total income tax revenue) </li></ul><ul><li>Undocumented Immigrants </li></ul><ul><ul><li>2005: $7 billion in Social Security tax revenue </li></ul></ul><ul><ul><li>2005: $1.5 billion in Medicare taxes </li></ul></ul><ul><ul><li>2002: 9 million W-2s  $56 billion in earnings </li></ul></ul>“ Our assumption is that about three-quarters of other-than-legal immigrants pay payroll taxes,&quot; - Stephen C. Goss, Social Security's chief actuary
    29. 29. Who is Insured? <ul><li>Ethnic minorities in the US are disproportionately uninsured </li></ul><ul><li>38% of Hispanics, 24% of African Americans, and 22% of AAPIs are uninsured (compared with 14% of non-Hispanic whites) </li></ul><ul><li>More than 2 of 3 uninsured adults in NYC are immigrants </li></ul><ul><li>50% of immigrants residing in the U.S. for less than six years are uninsured </li></ul><ul><li>41% of immigrant women do not have health insurance (2001) </li></ul>
    30. 30. Potential Reasons for Health Disparities <ul><li>Health Systems-level factors: </li></ul><ul><ul><li>Legal/Financing </li></ul></ul><ul><ul><li>Structure of care </li></ul></ul><ul><ul><li>Accommodation of linguistic and cultural diversity </li></ul></ul><ul><li>Patient-associated factors: </li></ul><ul><ul><li>Literacy and language </li></ul></ul><ul><ul><li>Cultural clashes </li></ul></ul><ul><ul><li>Legal Issues </li></ul></ul>
    31. 31. “ Health Systems” aka Logistics Level Barriers <ul><li>Hours of Operation </li></ul><ul><li>Location </li></ul><ul><li>Medication  COSTLY </li></ul><ul><li>Multiple Points to Navigate </li></ul><ul><li>Transportation </li></ul><ul><li>Availability of female/LBT-friendly providers </li></ul><ul><li>No clear map/patient navigator that can help </li></ul><ul><li>The Language Barrier: Spoken and Written </li></ul>
    32. 32. “ Patient Associated” aka Structural Access Barriers <ul><li>When you ASSume… </li></ul><ul><li>Racism & Other forms of ethnic/religious discrimination (e.g. islamophobia, antisemitism, etc.) </li></ul><ul><ul><ul><li> misdiagnoses (e.g. somatisizing?) </li></ul></ul></ul><ul><li>Class ($$$) </li></ul><ul><li>Gender </li></ul><ul><li>Age </li></ul><ul><ul><ul><li>Limited services for youth, teasing by peer groups </li></ul></ul></ul><ul><li>LGBTQ populations </li></ul><ul><li>Stigma, stigma, stigma </li></ul><ul><ul><ul><li> misdiagnoses </li></ul></ul></ul>
    33. 33. From a provider’s viewpoint… <ul><li>&quot;The biggest challenge that we face as practitioners is the waiting list,&quot; &quot;Each one of us has so much of a caseload. And yet we have more and more of a population that really needs the services.“ </li></ul><ul><li>- Asst PD Reshma Shah, Child Center in NY </li></ul><ul><li>&quot;A lot of my son's issues were: 'How can you tell me not to be afraid when you leave your office and you go home, and I have to return to my block?'&quot; she said. &quot;He may see drug deals going down on the corner, he may see gang fights - and that affects you.&quot; </li></ul><ul><ul><ul><ul><ul><li>Parent Advocate Wanda Green, MHA NYC </li></ul></ul></ul></ul></ul><ul><li>[Latina girls talked about stress tied to community problems, like gang violence and unwanted pregnancy, and voiced fears that clinicians would not be able to understand them]; “they feel they're going to be blamed for these feelings. They don't believe that they should be on medication” </li></ul><ul><ul><ul><ul><ul><li>President Rosa Gil, Comunilife </li></ul></ul></ul></ul></ul><ul><li>“ The Western model targets individual youth, with family involvement being supplementary treatment,&quot; she said. &quot;But for Asian American youth, this 'one size fits all' treatment model is not effective, because family dynamics and culture play an important role within Asian families. Effective treatment must incorporate cultural aspects as well as the family.&quot; </li></ul><ul><ul><ul><ul><ul><li>- (Former Mental Health Policy Coordinator) Ruchika Bajaj, CACF </li></ul></ul></ul></ul></ul>
    34. 34. Title VI of the Civil Rights Act of 1964 <ul><li>No person shall &quot;on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.&quot; </li></ul>
    35. 35. The Language Barrier <ul><li>Limited English Proficiency (LEP): a limited ability to </li></ul><ul><li>understand, </li></ul><ul><li>speak, </li></ul><ul><li>read & </li></ul><ul><li>write in English </li></ul><ul><li>less than “very well” </li></ul>
    36. 36. In New York City, ___% of the overall population has limited English ability.
    37. 37. Proportion of Population that is LEP 48% Pakistani 70% Chinese 64.5% Russian 50% Spanish 36.1% Italian 27% Indian 21% Filipino
    38. 38. Language Barriers: Impact on Health Care <ul><li>Less likely to receive care </li></ul><ul><li>Less likely to understand care </li></ul><ul><li>Increased risk of medical errors </li></ul><ul><li>Reduced quality of care </li></ul><ul><li>Increased risk of unethical care </li></ul><ul><li>Less satisfied with care </li></ul>
    39. 39. So…what is being done? <ul><li>National Asian Women’s Health Organization </li></ul><ul><li>Asian Women’s </li></ul><ul><li>Chai Chat (Chicago) </li></ul><ul><li>Sakhi & Manavi </li></ul><ul><li>American Cancer Society (SAOP) </li></ul><ul><li>SACH </li></ul><ul><li>AANCART </li></ul><ul><li>Elmhurst Hospital Center: SOAP </li></ul><ul><li>Planned Parenthood of NYC </li></ul><ul><li>SAHP </li></ul><ul><li>SALGA </li></ul><ul><li>SAHI & partner organizations on Advisory Board </li></ul>
    40. 40. Data cited from: <ul><li>Social Security Administration data </li></ul><ul><li>National Foundation for American Policy </li></ul><ul><li>NYS Department of Health & Mental Hygiene </li></ul><ul><li>NYC Department of Health & Mental Hygiene </li></ul><ul><li>New York City Department of Planning </li></ul><ul><li>US Census </li></ul><ul><li>The Commonwealth Fund </li></ul>
    41. 41. Resources to Learn More <ul><li>Organizations listed on prior page </li></ul><ul><li>Immigration Equality – http://www.immigrationequality.org </li></ul><ul><li>National Women’s Health Network </li></ul><ul><li>HIV Law Project - http://www.hivlawproject.org/ </li></ul><ul><li>New York Association for Gender Rights Advocacy (NYAGRA): http:// www.nyagra.com </li></ul><ul><li>Transgender Legal Defense & Education Fund (TLDEF): http:// www.transgenderlegal.org </li></ul><ul><li>www.med.nyu.edu/cih </li></ul><ul><li>www.ethnomed.org </li></ul><ul><li>www.thenyic.org </li></ul><ul><li>www.census.gov </li></ul>Developed for SVH by NY Assoc. for Gender Rights Advocacy (NYAGRA) and the Transgender Legal Defense & Education Fund (TLDEF).

    ×