Reasons to March, Reasons to Run

By Gardenia Casillas, Maria-Elena Young, and Daniel Madrigal

Joaquin Luna came to the US as an infant.  In high school he began applying to college with a dream of becoming an architect or civil engineer. In his application he is confronted with many questions: Are you a US citizen? No. A Resident? No. Social Security number? None. The pressure to support his family through an education and not being able to afford it are overwhelming. At 18 he takes his own life.

José Antonio Elena Rodríguez walks along the US-Mexico border in Nogales, Mexico. At the same time local US Border Patrol agents are chasing two drug dealers. In the chaos, the agents fire several shots towards the border. Six bullets tear through his body, leaving him dead.

Maria Isabel Vasquez Jimenez, a pregnant 17-year old pruned vineyards in Lodi, CA. One particularly hot day, the sun is too much. She loses consciousness into the arms of her fiancée who works with her. The job did not provide basic safety protections including drinking water, shade, or training on how to deal with heat. She dies of heat stroke.

As public health professionals our goal is to keep people healthy and we often believe that everyone has the right to be healthy – that neither a person’s race, gender, nor socioeconomic status should be a predisposition to good health. There are many factors that prevent this ideal from being attained. Sometimes, laws and policies are the factors that prevent good health. US immigration policy is one example of a factor that creates an underclass of people with fewer rights, fewer resources, and less safety. Joaquin, Jose and Maria are victims of US immigration policy.

On a daily basis, immigration policy shapes the social and political environments in which immigrants and their families live. Yet, as the public debate over immigration continues, rarely do we hear discussion of the enormous impact of immigration policy on the health of immigrants.  Policies influence the circumstances of immigrant’s lives, specifically their rights, resources, and safety.  Take a minute to answer the following questions for yourself:

> Can immigrants access appropriate and affordable health care services?
> Are there protections for the rights of immigrant workers to ensure fair wages and safe workplaces?
> Are immigrant children able to attend schools and universities?
> Do immigrants feel respected and safe in their communities?

All of these questions are decided by specific federal, state, and local policies that expand or limit the rights and resources that determine the opportunities for immigrants and their families, as well as their overall safety in this nation as they pursue those opportunities.  When protective factors – such as access to health and educational services – align, immigrants will experience greater health and well-being. The lack of any or all three of these, such as limited access to employment and educational opportunities, stress and fear due to discrimination and anti-immigrant legislation, or vulnerability to violence, result in significant health risks.

On April 17th, 2013, the Border Security, Economic Opportunity, and Immigration Modernization Act of 2013 was officially introduced in the United States Senate.  This bill, if passed, would significantly change our current immigration policy context.  It has the potential to offer a pathway, albeit a long one, to citizenship for the 11 million undocumented immigrants living in the US.  However, it also introduces harsh enforcement measures, such as increased militarization of the US-Mexico border and mandatory implementation of an electronic employment verification system.  The National Immigrant Law Center provides an excellent overview and analysis on their website.

Immigration policy is health policy, and those interested in working to create healthy and strong communities should pay attention. Given the potential positive and negative impacts of the proposed immigration bill, this is the time for public health professionals to be active in the policy process, making critical assessments of how existing and proposed policies may protect or harm the health of our nation’s immigrants!

Creating just policies that provide a pathway to citizenship will provide immigrants with rights, resources, and safety. It means that undocumented individuals and their family members will be able to live without being afraid that their immigration status will backfire and that they will be deported. It means that undocumented students no longer have to hide in the shadows, it means that farm workers will be able to bargain wages sitting as equals at the negotiation table, it means that youth and community members will be able to stand up against toxic hazards.

Fortunately, the Bay Area is a hub of activity with many passionate individuals fighting for a more equal system. We encourage you to stand in solidarity with immigrants is to finally address the systemic exclusion. First, on Wednesday May 1st, there will be a large parade winding through Oakland. It will start at Fruitvale BART Station at 3:30pm.. The second event will be a 5k Run/Walk for Migrant Justice put on by 67 Sueños, a youth led organization out of Oakland. The event will take place May 4th at 11AM at Lake Merritt’s at the Pergola. For more details check out run.67suenos.org.

If you think the system is unfair, unjust, and unhealthy, come out to support the movement for equity. Let your voice be heard!

Immigration Policy and Women’s Health

In honor of Women’s History Month, we will highlight the impact of state and national policies on immigrant women’s health. Immigrant women are often left out of conversations on a path to citizenship, deportation, and labor. When immigrant women are considered, it is often through negative stereotypes – from the portrayal of immigrant women a threat to national security because of “anchor babies” to raising the fear of immigrant women as taking advantage of social safety net programs. These harmful portrayals justify harmful laws, with real impacts on women’s health and safety.

Policies and laws shape the safety, rights and resources of all people. Immigrant women are no exception: fear of deportation and family separation causes stress and anxiety; unauthorized status diminishes women’s rights and may lead to a range of forms of exploitation, from labor to sexual exploitation; or poor wages and lack of access to care can create barriers to health-promoting resources. The safety of immigrant women is threatened when immigration enforcement policies such as Secure Communities prevent women from accessing services or calling police.

Other social policies also shape health. Health reform initiatives actively bar immigrant women from receiving safety net benefits. While the Affordable Care Act (ACA) opened many doors for women to receive reproductive health care, expanding coverage for preventive health care including family planning, STI screening, and screening for domestic violence, undocumented immigrants are excluded from the ACA. In addition, in the US we are currently experiencing broad attacks on women’s reproductive health; 43 new policies were passed in 2012 restricting access to abortion services (Guttmacher Institute). Low-income and undocumented women are disproportionately impacted by these laws as they rely more heavily on community clinics to receive reproductive health services. These policies, whether part of our immigration, social welfare, or health care systems, determine what services and supports immigrant women have a “right” to and shape access to health-promoting resources – from U-Visas for domestic abuse survivors to health insurance.

Women’s Health
One of the main narratives in research on immigrant health is the “Healthy Immigrant Paradox” (or the “Latino Paradox”) – in which immigrants have equal or better health outcomes despite lower wealth and education than US-born populations. This “paradox” hides many important issues and, despite some findings to support the theory, does not justify complacency about the health of immigrant women. Both gender and immigration status are important predictors of health. These multiple forms of discrimination overlap, or ”intersect,” to put immigrant women and particularly undocumented immigrants, at risk of a number of health challenges. Here is a brief overview of some of the many issues public health and immigrant rights activists might consider in their work. For more information, check out the research bibliography at the end of the post or feel free to contact The Curious Ostrich with any questions.

Health Care
• Due to public health insurance program policies and limited access to employer-based health insurance, immigrant women are less likely to have health insurance, and less likely to have a regular source of health care, than non-immigrants (CDC 2005).
• After the 1996 Welfare Reform that barred many immigrants from receiving public benefits, immigrant women were less likely to access pre-natal care and other services (Fuentes-Afflick et al 2006)
• When Massachusetts implemented their health care reform policy, immigrants were left out. And the increased fear of deportation created new barriers to care among women who had previously accessed services at community clinics (Dennis et al 2009).

Occupational Health
• Immigrant women often work in informal jobs such as domestic work and in jobs with high risks for injury (e.g. garment work). Undocumented workers face discrimination in the workplace, lack adequate protections due to insufficient regulation of informal labor markets, work in high-risk industries, and have higher rates of occupational injuries.
• Immigrant women are additionally affected by gender inequities, such as wage disparities (Browne and Misra 2003), and gender and sexual discrimination in the workplace.

Reproductive and Maternal Health
• Immigrant women have higher rates of mortality from cervical cancer
• Undocumented women have lower use of prenatal care services and higher rates of low birth weight, than documented immigrants (Korinek and Smith 2011).
• In border states with few abortion providers, such as Texas, Internal Border Patrol Checkpoints limit mobility, making it difficult for immigrant women to travel to abortion clinics.

Violence Against Women
• Intimate partner violence (IPV) is a risk factor for poor mental and physical health (Yick 2003, Barkho 2007). Although women of all national and ethnic backgrounds are victims of violence (Han 2010, Grzywacz 2009, Brabeck 2009, Bhuyan 2008, Barkho 2007), the immigration experience can exacerbate violence in relationships, putting immigrant women at particular risk (Han 2010, Grywacz 2009).
• Some women report that their partners use their vulnerable legal status as a way to control and threaten them – in a study of South Asian immigrant women in Boston, there was a strong association between having a partner who refused to help change their immigrant status and experiencing IPV (Raj et al 2005).
• A study of mother’s in New York City cited the fear of being “bad” mothers if they reported abusive family members (who would then face deportation) (Earner et al 2010).

Mental Health
• Immigrant women are at increased risk for poor mental health. Fear of deportation and family separation, as well as the challenges such as language and cultural barriers, are significant stressors for immigrant women (Arbona 2010, Norris 2011).

Promising Developments
Yet, there are also policies and social movements that are promising to create better protections and facilitating increased social and economic opportunities for immigrant women.

Protecting Women’s Rights: The Violence Against Women Act, renewed this year, continues to provide protections for immigrant women in abusive situations. The act includes the U-Visa, which allows women who have been abused who are here with temporary or unauthorized status to gain legal residence (Moynihan 2008, Conyers 2007).

Supporting Integration: Policies that offer pathways to citizenship, or increase access to the rights that of citizenship, improve the health of immigrant women. In Western Europe, researchers found that in countries with more progressive immigration – or “integration” – policies including pathways to citizenship, anti-discrimination and affirmative action legislation, and policies protecting against economic and social exclusion, the health inequalities between immigrant and non-immigrant women were reduced and in some cases eliminated (Bollini et al 2009). In the US, state laws supporting immigrants rights also reduce health inequity. In 1999, Utah passed a law allowing undocumented immigrants to get driver licenses. While in general, undocumented women had poorer health outcomes than documented immigrants, those women who participated in the driver license program had higher rates of pre-natal care, demonstrating that policies supporting access to rights and resources among undocumented immigrants can significantly improve the health outcomes of women and children (Korinek and Smith 2011).

Organizing: Immigrant women around the nation are actively involved in promoting policies and opportunities for themselves and their communities. There are many immigrant women’s groups working to empower immigrant women. Mujeres Unidas y Activas in Oakland, California provides immigrant women with support, from crisis intervention services to job training, as well as leads statewide advocacy campaigns. The National Domestic Workers Bill of Rights is a nationwide campaign to protect domestic workers, who are predominantly immigrants, in their workplaces. This movement is quickly spreading throughout the nation. There are also many immigrant women entrepreneurs – 13% of all woman-owned businesses – working to create job opportunities for themselves and others.

There is a growing movement to protect the health of immigrants by expanding access to care and by pushing for a more humane immigration system. Women have distinct health needs (e.g. reproductive health services), and face distinct health challenges (e.g. the overlapping discrimination of gender and immigration status); and policies can unwittingly create new health risks for women when these specific issues aren’t taken into consideration. As these policy efforts move forward, we hope to see the rights of women explicitly considered and included in policy conversations.

Republicans submit faux-DREAM Act proposal, the Plight of Domestic Workers, and the History of US Immigration Laws

Senators Jon Kyl and Kay Bailey Hutchison (Getty Images)

Post-presidential election paths to immigration reform are emerging

In the presidential election Mr.Obama won the Latino and Asian vote by a large margin. Post-election analysis has suggested that Mr. Romney’s hard line approach to immigration was a major factor for the gap. He was never able to present a convincing argument to these constituencies and maintain his “self-deportation” strategy. There now appears to be consensus between the two major political parties that immigration reform should be a priority. Democrats may feel like they have a mandate, while Republicans understand they won’t be able to win elections without receiving more of the Latino and Asian vote.

Republicans are pushing forward two immigration measures, the ACHIEVE ACT and the Science, Technology, Engineering and Math (STEM) Bill. The ACHIEVE Act was introduced by Jon Kyl of Arizona and Kay Bailey Hutchison and would create a new visa for undocumented youth. The ACHIEVE act requires that applicants arrive before the age of 14, instead of age 16 as specified in the DREAM act. The visa holders would also be prohibited from federal student loans or any other kind of public benefits. Another bill the Republicans are pushing is the STEM Bill which would create visas for advanced degree graduates. These visas would be taken from another program that promotes immigration from low-immigration countries. There will likely be many months of wrangling between Republicans and Democrats before we see the new immigration reforms. These policies continue to offer minimal relief, and would end up causing many more problems in the long term.

Immigration status and affects domestic workers’ pay

A new report on pay and working conditions from the National Domestic Workers Alliance has found that undocumented domestic workers are worse off than citizen domestic workers. Undocumented workers on average receive 20% less pay, are more likely to be required to do strenuous work, more likely to be injured on the job, and more likely to work while injured. The current immigration policies weaken worker protections and create situations across the country where immigration status is exploited by employers.

23 moments of immigrant policy in the United States
ABC News and Univision have created summary of 23 pieces of legislation that have shaped the US’s current immigration policy, starting with the Naturalization Act of 1790. The article is a glimpse into the complicated and shameful history of US immigration law.