The Access to Healthcare for Latinx Immigrants in the Walla Walla Valley (Dissertation Sample)

The Access to Healthcare for Latinx Immigrants in the Walla Walla Valley Abilene Alcantara Wilma Hepker School of Social Work and Sociology, Walla Walla University SOWK650B: Capstone Research Project I Dr. Cheris Current , 2023 Chapter Two Review of Literature Research Questions and Specific Aims This project focuses on Latinx immigrants in the Walla Walla Valley (WWV) (henceforth, WWV) and their barriers to healthcare. We want to learn more about the experiences of people in our area to better understand their lives and to understand if problems identified in other studies are also present in our area, such as fear of deportation, fear of immigration status discrimination, language barriers, stigma, and lack of health insurance. We define fear of deportation as the apprehension or anxiety experienced by Latinx immigrants in relation to potential encounters with immigration enforcement authorities, which may deter them from seeking necessary healthcare. Fear of immigration status discrimination refers to the concern of being subjected to prejudiced treatment or discrimination due to one's immigration status when accessing healthcare services. Language barriers encompass the difficulties faced by Latinx immigrants in communicating with healthcare providers or understanding healthcare information due to limited English proficiency. Stigma refers to the negative societal attitudes and stereotypes that Latinx immigrants may encounter, resulting in reluctance to seek healthcare services. Lack of health insurance is defined as the absence of sufficient coverage to afford necessary healthcare services. Addressing these challenges can lead to improved healthcare access and outcomes for the Latinx immigrant population in the WWV. The literature review focus exclusively on Latinx immigrants in the WWV and exclude children, teenagers, and non-immigrant populations from our analysis. Additionally, while we aim to explore the common barriers faced by Latinx immigrants, we may not capture the entirety of the nuanced experiences of every individual in the region. The significance of narrowing our scope and focusing on Latinx immigrants above the age of majority is to gain a comprehensive understanding of the specific challenges they encounter when seeking healthcare services in the WWV. This project aims to identify and examine the primary obstacles faced by Latinx immigrants in the WWV when accessing healthcare services. Dynamics of immigration and immigrants’ conditions According to the Kaiser Family Foundation (2022), about 20.8 million non-citizens were living in the US in 2021, accounting for 6% of the overall population. Of these, 6 in every 10 non-citizens were legal immigrants, while the rest were undocumented. Most migrants work in 3D jobs (i.e., dirty, degrading, and dangerous) in positions that are shunned by the natives in the receiving countries. Immigration to the WWV has been shaped by historical and socio-economic factors, influencing the composition and experiences of the Latinx immigrant population in the region. These patterns have been crucial to understanding the challenges experiences by the immigrants in accessing healthcare services. An influx of immigrants into the region can be traced to the Bracero Program, though sporadic immigration has been happening as far as the Mexican revolution (Gachet, 2022). The program played a significant role in labor migration to the WWV, for Mexican agricultural workers were recruited to address labor shortages in the United States (Gachet, 2022). Although the Bracero Program officially ended in 1964, its impact was long-lasting, as many workers who initially came under the program settled in the WWV and continued working in the agricultural sector (Gachet, 2022). A majority of immigrants, whose arrival continued in the following decades remained unregistered (Brick et al., 2011; Sullivan & Rehm, 2005). However, the Immigration Reform and Control Act in 1986 brought about substantial changes in immigration policy. IRCA provided a pathway to legal status for undocumented immigrants who could demonstrate continuous residency and employment in the United States. The immigrants whose status was regularized under the act were able to establish more stable lives enabling them to participate in the economy of WWV. A majority were employed in the seasonal or year-round agricultural labor, contributing significantly to the local agricultural industry and the region's economy (Andrews, et al., 2002). They also established some communities in the region. Today, they form labor communities serving the economy in mostly low paying jobs (Brick et al., 2011). These jobs include construction, agriculture, sex work, and domestic work, where the pay is low, and the likelihood of abuse is high, especially during transit. These abuses, combined with low pay, economic necessity, low educational attainment, low skill level, the lack of legal and employment-related information, cultural and language barriers, and denied access to health care, often cause their health to deteriorate (Grover, 2013). In additionAddressing health care needs also requires While correctives are possible, the lack of private and public effective safeguards and effective enforcements to protect migrant workers from exploitative employment practices and the increasingly hostile immigration laws and practices leave these workers with no redress mechanisms. Many other immigrants, especially undocumented ones, work as migratory and seasonal agricultural workers (MSAWs). The Public Health Services Act define migratory agricultural workers as persons who principally work in agriculture on a seasonal basis and therefore have temporary abodes to suit their work (Rural Health Information Hub (RHIH), 2013). They are usually paid on an hourly, daily, or piecework basis. MSAWs are estimated at 1-3 million in the US, with the majority being Hispanics or Latinos originating mainly from Mexico. Other minority groups, such as African Americans, Asians, and Haitians, are also overrepresented in agricultural jobs. MSAWs are also predominantly male (68%) and undocumented (49%) RHIH (2013). According to RHIH (2013), these workers face numerous challenges, including hazardous working environments, unsafe housing, scarcity of clean water and sanitation systems, lack of transportation, and inadequate access to healthcare due to immigration status and the lack of insurance. Because of the migratory nature of their work, these workers rarely develop stable relationships with healthcare providers, keep track of their health records, or maintain treatment regiments, leading to serious health conditions such as malnutrition, diabetes, substance use, pesticide poisoning, depression, and occupational injuries (RHIH, 2013). Therefore, addressing these challenges is a public health imperative. Restrictive immigration policies feature prominently studies of the lives of immigrants. For example, Kiehne & Hafen (2022) examined how state and local integration policies affect the physical and psychological health of illegal immigrants in the US. The findings showed a prevalence of restrictive immigration policies and negative public opinion impacts individuals. The negative rhetoric is often propagated by the political class, which cultivates fear, mistrust, and misinformation to secure political scores. Political discourse and policies that targeting immigrants can contribute to a climate of discrimination and stigma. Perceived or experienced bias, cultural insensitivity, or discrimination within healthcare settings all impacted health outcomes for immigrants (Szaflarski & Bauldry, 2019). Discourse and national policy changes impact the lived experiences of immigrants. Hacker et al. (2011) community-based participatory study examined how the enforcement of immigration and customs policies affected the health of immigrants in Everett, Massachusetts. A sample of 52 immigrants participated in 6 focus groups in May 2009. The authors noted in their review of literature that two factors are to blame for the increasingly restrictive policing environment. The first one is the 1996 Illegal Immigration Reform and Immigrant Responsibility Act, which increased the detention of illegal immigrants and deportation of legal immigrants for minor offenses. The second is the 9/11 terrorist attack that spurred massive detention and deportation operations. The results from the focus groups suggested that Immigration and Customs Enforcement (ICE) had a significant negative impact on the health of immigrants in Everett, Massachusetts. Participants reported increased fear, anxiety, and stress, leading to adverse mental health outcomes. Fear of accessing healthcare services due to immigration concerns resulted in delayed care and reliance on emergency services. Because of deportation fears, immigrants distrust giving out personal information to obtain health insurance and other health-related documentation. This fear also impacted their decisions to miss healthcare appointments, thus worsening conditions such as hypertension and depression. Held et al. (2020) specifically focused on the impact of deportation fears on the utilization of healthcare services among Latinx immigrants in Texas. The participants who were purposefully recruited from provider databases participated in focus groups and individual interviews soon after the conclusion of the 2016 presidential election. The findings showed the prevalence of resource limitation and service utilization barriers related to the undocumented status of the participants. These barriers were exacerbated by the Trump administration, which perpetuated anti-immigration rhetoric and implemented stricter enforcement and punitive immigration policies. Political contexts were similarly important in Doshi et al.’s (2020) examination of the barriers and facilitators to healthcare access among Latino...