Health care

Definition: Professional medical and mental health services

Significance: The access of recently arrived immigrants to health care in the United States has often been limited by cultural and language barriers, lack of information, and economic disparities. Thus, alternative medicines and traditional healers have become important parts of immigrant health care. Immigrants’ struggle for health care has continued into the twenty-first century, with ongoing efforts to incorporate immigrants and refugees into the American health care system.

Concern about the possible threats to public health that might be brought into the United States by new immigrants has long been a concern of U.S. immigration law. The Immigration Act of 1891 required medical inspections of immigrants before they left their home countries and immediately after their arrival in the United States. Subsequent immigration acts during the 1890’s and the early twentieth century barred diseased immigrants from the United States and expanded the categories of excludable immigrants.

Although the actual number of people who were deported for medical conditions around the turn of the twentieth century was quite small, memoirs and oral histories from that era reflect immigrants’ fear of medical inspection processes and physicians at American ports. In Ellis Island, through which about 70 percent of immigrants entered the United States during that time period, U.S. Public Health Service officers examined new immigrants.With hundreds of newcomers arriving daily at the reception center, detailed and thorough examinations were often impossible, and physicians relied on various clues to weed out immigrants with physical or mental defects. Immigrants found to be suffering from contagious and dangerous diseases who could not earn their livings due to their physical or mental conditions were detained for more thorough inspections and afterward often deported to their home countries, unless they recovered. Developments in medical technology, such as X rays for tuberculosis and Wasserman tests for syphilis, aided inspections of immigrants between 1882 and the mid-1920’s.

The American Health Care System

Immigrants from the Old World found the American health care system cold, distant, and frightening. Their cultural identities were often threatened by American hospitals and reformminded individuals, who introduced them to new means of treatment and care but did not consider cultural confusions the immigrants might have experienced. Immigrants and their families did not want to commit themselves to hospitals because they were worried about possible long separations and even possible deaths through hospitalization.

Immigrants also received health care at dispensaries, alms houses, and private charities, which served diverse groups of people. Immigrant hospitals and medical facilities were built to provide health care with attention to immigrants’ cultural and medical needs. Reform-minded individuals and communities also partook in the establishment of various medical facilities for immigrants, in whichWestern medical practices and traditional cures were often combined. Immigrants also looked for alternative means of care and treatment from traditional healers within their own ethnic communities. One such example was ethnic pharmacies, where they could find more familiar and accessible treatments for their ills.

Immigrant Heath Care Problems

As late as the early twenty-first century, many immigrants were still experiencing the same kinds of health care problems that immigrants had experienced a century earlier. Their suspicions of American health care providers and hospitals have not gone away. In particular, immigrants with no prior exposure to Western medical facilities are likely to fear encounters with the American health care system. Moreover, various immigrant groups have experienced inequalities in receiving health care. They lack information regarding where and how to get appropriate health care in their new home. Language and cultural barriers prevent them from seeking health care services and increase their distrust of American hospitals and other medical institutions. Although hospitals are required to provide interpretation and translation services for non-English-speaking immigrants, they are not always equipped to fulfill such needs. The geographical inaccessibility of medical facilities has also prevented economically disadvantaged newcomers from getting proper care.

Another important problem for immigrants has been the lack of health insurance, which is partly attributable to their lower levels of education and poverty rates. Lack of health insurance has posed special problems for immigrant workers, who are typically more likely to get injured at work and to get injured more seriously than their native-born counterparts. This has been particularly true for Hispanic immigrant laborers, many of whom perform demanding physical work. When they are injured at work, they typically hesitate to take time off for medical treatment for fear of losing their jobs. Undocumented immigrant workers are even more reluctant to seek medical treatment, fearing exposure of their illegal immigration statue and possible deportation. Even insured immigrants and their families have less access to health care than insured native-born American citizens for nonfinancial reasons such as unfamiliarity with the American health care system.

Mental Health Care

Because of the stresses that many immigrants encounter in adjusting to life in the United States, their psychological well-being has become an important social and policy issue. Traumatic experiences in home countries, cultural and language barriers, and discrimination can all combine to aggravate the mental health problems of immigrants. While mental health care has been increasingly utilized in the United States, many immigrants are still unwilling to use such services because of their cultural norms and beliefs. In many Asian countries, for example, stigmas attached to mental illness inhibit people from seeking medical help.

Many immigrants are also handicapped by not having information about the availability of mental health care services. Moreover, the scarcity of mental health care providers who understand the cultural norms and languages of immigrant groups has prevented many immigrants from receiving proper care. Research has shown that immigrants often manifest their mental health problems in ways different from those of native-born Americans. For example, Asian immigrants are more likely than Americans to manifest mental distress through somatic symptoms. Medical health care providers who do not understand ethnic-specific symptoms of mental illness may not be able to offer timely medical interventions.

The mental health of Southeast Asians who have taken refuge in the United States since the 1960’s has drawn special attention from health professionals and social workers. For example, Hmong refugees from the war-torn country of Laos are known to have suffered from posttraumatic stress disorder even before their arrival in the United States. However, due to their cultural and language differences and the lack of American medical professionals familiar with Hmong culture and language, these immigrants have generally not received proper treatment and care.

The languages of some immigrant cultures do not have words for mental illness, but this does not mean that the people themselves are immune from mental distress. Thus, Southeast Asian refugees frequently use traditional healers and therapies. When administered in conjunction with Western medical practices, such measures are of great benefit to mentally stressed immigrants. American health care professionals have consequently become increasingly aware of the importance of understanding cultural and ethnic differences and finding ways to provide better care for immigrants and refugees.

Cultural Negotiations in Health Care

Understanding cultural differences of immigrants is crucial to providing appropriate health care services. As was the case during the early twentieth century, immigrant hospitals and medical facilities in major American cities have continued to serve not only members of their own ethnic groups but also those of other immigrant groups. Immigrants are also active in cultural negotiations. In general, they have received less health care than native-born Americans, but they have tried hard to improve their conditions. In addition to visiting American hospitals for medical care, they have also utilized traditional and ethnic care systems within their immigrant communities, often receiving good results by using both systems. Increasingly, American health professionals have accepted alternative drugs and therapy systems brought to the United States by immigrants. They have shown greater respect for various measures adopted by immigrants to treat their minds and bodies and been willing to work with non-Western medical practitioners. Growing numbers of ethnic medical professionals who understand cultural and ethnic differences of immigrant patients have been making available better health care services for immigrants.

Welfare Policies and Immigration

Policy issues regarding heath care of immigrants have interested many Americans. Again, as was the case during the early twentieth century, concerns that immigrants may bring diseases into the country and drain taxpayer dollars to pay for their care have persisted into the twenty-first century. The federal Personal Responsibility andWork Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 both restricted Medicaid eligibility of immigrants, except in emergencies, during their first five years of residence in the United States.

California’s Proposition 187, which eliminated all public services except emergency health care for undocumented immigrants, helped start nationwide debates on health care and immigrants. Despite government efforts to restrict health care for undocumented immigrants, there have been continuing efforts to provide immigrants with health care, regardless of their legal status. Stateand community-based programs, such as free clinics and nonprofit institutions, have served immigrants, both documented and undocumented. Educational efforts to informimmigrants of available resources have been launched as well.

Immigrants and refugees in the United States have often been misunderstood and unfairly stigmatized as potential health menaces. During the early twentieth century, Jewish immigrants from eastern Europe were blamed for spreading trachoma, the eye disease that eventually led to blindness. Italian immigrants were associated with polio epidemics. In late nineteenth century San Francisco, Chinese immigrants were accused of bringing bubonic plague. During the 1930’s, Mexicans in Los Angeles were expelled for tuberculosis. During the 1970’s tuberculosis reemerged as the immigrant disease in many American urban centers. During the 1980’s and 1990’s, Haitian immigrants were widely associated with acquired immunodeficiency syndrome (AIDS). As a consequence, a large number of Haitians in the United States lost their jobs, housing services, and other opportunities due to their perceived association with the disease.

In addition to being stereotyped without concrete evidence, immigrants and refugees—in particular, those who are undocumented—have been blamed for draining health care resources of the United States. However, their cultural values and ethics have made positive contributions to American society as well. Various efforts to promote cultural understanding and knowledge of the immigrant population have been going on in spite of numerous problems that have threatened the health care access of immigrants in the United States.

Ji-Hye Shin

Further Reading

  • Conway, Lorie. Forgotten Ellis Island: The Extraordinary Story of America’s Immigrant Hospital. New York: Collins, 2007. History of the Ellis Island Hospital with photographs and vignettes from the early twentieth century. 
  • Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus and Giroux, 1997. Accounts of a Hmong refugee family and various parties involved in providing care and treatment for Hmong refugees in America. 
  • Hoy, Suellen. Chasing Dirt: The American Pursuit of Cleanliness. New York: Oxford University Press, 1996. History of American attitudes toward cleanliness that includes Americanization efforts toward immigrants and minority groups. 
  • Kraut, Alan M. Silent Travelers: Germs, Genes, and the “Immigrant Menace.” Baltimore: Johns Hopkins University Press, 1995. Synthesis of immigration history and the history of medicine that provides an overview to public health, diseases, and health care of immigrants during the nineteenth and twentieth centuries. 
  • Kretsedemas, Philip, and Ana Aparicio, eds. Immigrants, Welfare Reform, and the Poverty of Policy. Westport, Conn.: Praeger, 2004. Analysis of how welfare policy is implemented and experienced at the local level by immigrants and minorities. 
  • Markel, Howard. When Germs Travel: Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed. New York: Vintage, 2004. Study that examines six epidemics—tuberculosis, bubonic plague, trachoma, typhus, cholera, and AIDS—to explore American public health efforts in relation to immigration. 

See also: Acquired immunodeficiency syndrome; Disaster recovery work; Ellis Island; Illegal Immigration Reform and Immigrant Responsibility Act of 1996; Immigrant aid organizations; Immigration Act of 1891; Infectious diseases; Intelligence testing; Proposition 187; Welfare and social services.

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