Migrant status must be part of public health discussions

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Public health experts often analyze the world via “public determinants of health,” or the factors that contribute to health risks and health outcomes of individuals and groups. Their analysis includes broad factors, like public policies and cultural norms, and individual factors, such as a person’s education level and income.

But a Centers for Disease Control and Prevention (CDC) expert says it’s time for another factor to be part of the mix: migrant status.

It’s not just an academic exercise. Leaving migrant status out of the discussion risks ignoring the huge disparities facing that population. Only by recognizing those disparities can the appropriate support be targeted to those groups, argued Alfonso Rodriguez-Lainz, an epidemiologist with the CDC.

“At least in my experience, migrants are frequently forgotten or ignored in many community health initiatives,” Rodriguez-Lainz said Thursday (Oct. 12) at a conference on migrant health in Galveston, organized by The University of Texas Medical Branch at Galveston, Oxfam America and the Pan American Health Organization/World Health Organization. The Texas Medical Center Health Policy Institute was also a partner in the event.

The United Nations considers any person living in a country other than their country of birth to be a migrant. About 13.4 percent of the U.S. population is foreign-born.

That population is more likely to face stigmas, Rodriguez-Lainz said, and on average has less education and works in lower-paid jobs than native-born U.S. residents.

He argues that someone’s migrant status is a significant factor that can help shape his or her health, and that experts should pay particular attention to this factor when analyzing a community’s health. Statistical analyses show that, in many cases, foreign-born status has an independent effect on health outcomes, even when controlling for other factors, such as income.

Rodriguez-Lainz offers several examples, such as huge disparities in the number of tuberculosis cases between U.S.-born and foreign-born populations. For the U.S.-born black population, the rate is about 3.3 cases per 100,000 people. But for the foreign-born black population, the rate is 22.8 per 100,000. Similarly, Asian Americans born in the U.S. have 2.1 TB cases per 100,000 people, compared to 28.2 per 100,000 for the foreign-born Asian population.

Huge disparities in vaccination rates exist, as well. About 26.7 percent of foreign-born children living in the U.S. have received their recommended vaccines, compared to 65 percent of U.S.-born children.

Not all the disparities are negative, though. Within the U.S., the foreign-born population hailing from every country but China has a lower smoking rate than U.S.-born Americans, Rodriguez-Lainz said.

He argued that if researchers and health care providers fail to collect information on whether a population is foreign-born, it’s more difficult to identify, track and respond to those disparities. He also pleaded with community health experts to understand the foreign-born population and provide critical information in languages besides English. Doing so isn’t just the right thing to do; in some cases, it’s necessary to more effectively target treatment and prevention efforts.

For example, Asian Americans and Pacific Islanders make up fewer than 5 percent of the U.S. population but account for more than 50 percent of the cases of chronic hepatitis B in the U.S., according to the CDC. The agency runs a program targeting outreach, education and screening for hepatitis B to high-risk areas that have large Asian-born populations.

He also cited another CDC program, CureTB, that works to help Mexican migrants access treatment as they go back and forth between the U.S. and Mexico.

But he said those types of programs are relatively rare, and it’s unusual for health agencies to specifically target foreign-born populations, even if it often makes sense.

He urged special training for health professionals in migrant health issues and said more diversity in the health care workforce will also help serve the population.

“I think we have tremendous evidence that migration is a critical factor to understanding the health of communities in the U.S.,” Rodriguez-Lainz said.

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