Latinos add stress on rural health care

Growing Latino population could place more stress on rural health care
By Lynda Waddington, Iowa Independent, 8/5/09

SIOUX FALLS, S.D. — Although only about four million of the estimated 44.3 million people of Latino descent in America live in Midwestern states, cultural differences and economic realities associated with those populations have created additional challenges for rural health care delivery systems that are already stretched thin. Experts warn, however, that society will have a high price to pay if access to medical and behavioral health care isn’t provided to immigrants regardless of their resident status.

“I believe the people who are here, whether they are documented or undocumented, if they pose significant public health challenges, we need to pay attention,” said Dr. Sergio Aguilar-Gaxiola, founding director of the Center for Reducing Health Disparities at the University of California-Davis Health System. “One example of why that is the case is the H1N1 epidemic. That virus does not recognize borders. HIV is another virus that has portability, as does substance abuse. None of them recognize or stop at a country’s border.”

Aguilar-Gaxiola, who is also a professor of clinical internal medicine at UC-Davis and just completed a four-year term on the National Institute of Mental Health’s advisory council, informed a group of primarily Midwestern mental health professionals gathered for a conference on Monday that immigrants are often caught in a vicious cycle of poverty and mental illness. After his keynote address at the conference, Aguilar-Gaxiola told The Iowa Independent that this is especially true for most immigrants who come into Iowa or other regional states to take jobs at factories and meatpacking plants.

“There are different migratory trajectories,” he explained. “The Mexican-origin immigrants that you have here in the Midwest come from certain regions in Mexico, primarily from the more rural areas. I think there are nuances and differences that one has to look at in terms of whether the immigrants come from rural or urban areas, and whether they take skilled or unskilled jobs.”

Immigrants who originate from rural regions in Mexico, he said, are far more apt to be without an adequate education and to have little or no job skill set. In contrast, immigrants who choose to pursue skilled jobs in larger cities come primarily from Puebla or other metropolitan areas that have better access to educational and vocational opportunities.

Lack of opportunity, dead-end jobs, low wages and a general feelings of helplessness have contributed to an increased instance of substance abuse among second and long-term first generation people of Latino descent living in the U.S.

According to research Aguilar-Gaxiola helped compile, roughly 20 percent of Mexican immigrants report having either alcohol abuse or dependence issues. In addition, roughly 18 percent report drug abuse or dependence. In each case the abusive disorders reported by the Mexican population are several percentage points higher than national averages. And, unfortunately, the cultural differences between immigrants from rural and urban areas don’t appear to signify any significant substance abuse disparities following migration to the U.S.

“The differences in prevalence rates between first-, second- and third-generation immigrants are very consistent and replicated findings across the U.S. and specifically in regions of the U.S. that include Midwestern states,” Aguilar-Gaxiola said.

Cultural differences do, however, create challenges for physicians who wish to deliver behavioral health services to immigrant populations.

According to Aguilar-Gaxiola, Latinos are more likely than non-Hispanic whites to terminate treatment prematurely, with as many as 60 to 75 percent of Latinos drop out after a single session. Much of this, he believes, is due to language barriers between behavioral health professionals and those they seek to serve. This can be especially true for immigrant populations who are already concerned that requesting help could lead to discrimination or deportation.

“We have many reports that have helped us to become more aware about these raids and how they separate and impact families,” he said. “Even if parents might be undocumented, and subsequently deported, often their children are born in the U.S. and are citizens.”

Although there has been speculation regarding the mental and physical health consequences faced by the children of deported parents, Aguilar-Gaxiola said that there are currently no good studies documenting the challeges the young people face in the wake of such an event.

North Carolina, a state that is experiencing one of the nation’s largest population growth from Latino immigrants, was the subject of a University of North Carolina study that looked at whether or not such populations were a burden on state services. The study authors surmised, according to Aguilar-Gaxiola, that the immigrants gave more than what they took.

“I happen to believe that if we were to pay attention to access to health care and access to education for these populations that the return would be much greater than the cost,” he said. “Unfortunately, I think that as a part of the national debate on immigration that there is an idea or a sentiment that immigrant populations are a burden, and that they are taking other people’s jobs. This is especially true in the current economy when jobs are scarce and people are really scrambling to get good jobs. But the jobs that [immigrants] take for the most part are the jobs that not many other populations are reading and willing to do — very taxing and very high-risk jobs, very low-paying and without many benefits.

“So I see this from the public health perspective that it is better to tend to the populations, especially when they are contributing in one way or another to the economic region.”