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Failures of US Health Care System for Pregnant Asylum Seekers

Migrant Clinicians Network's white paper, “Failures of US Health Care System for Pregnant Asylum Seekers,” outlines how pregnant asylum seekers who have been released into the US to await their asylum hearing face extreme obstacles to secure prenatal care, despite their legal presence within the country.

Without prenatal care, infants will not have the benefit of early screening and treatment for potentially life-threatening diseases and screening for congenital abnormalities, while in utero. Additionally, pregnancies without prenatal care may result in excess utilization of emergency services which produces unforeseen strain on the health care system.

Knowledge of prenatal care needs, cost, lack of insurance, transportation, refusal by health centers, and fear are delineated as key barriers for pregnant asylum seekers from accessing the care they need during their pregnancy.

Press contact: Claire Hutkins Seda, cseda@migrantclinician.org

"The Global Report on Internal Displacement presents the latest information on internal displacement worldwide caused by conflict, violence and disasters."

This 90-minute webinar was created for physicians, nurses, and other health professionals who treat and case manage patients with active TB.  The webinar introduced the 2016 Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.  This training highlighted the guidelines development process, the key changes in recommendations, and discussed the evidence supporting the changes.  The webinar was originally presented on November 4, 2016. This training was jointly sponsored by all 5 RTMCCs.

The 1999–2013 United States Cancer Statistics (USCS): Incidence and Mortality Web-based Report includes the official federal statistics on cancer incidence from registries that have high-quality data, and cancer mortality statistics. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI). This report shows that in 2013, 1,536,119 Americans received a new diagnosis of invasive cancer, and 584,872 Americans died of this disease (these counts do not include in situ cancers or the more than 1 million cases of basal and squamous cell skin cancers diagnosed each year).

This year’s report features information on invasive cancer cases diagnosed during 2013, the most recent year of incidence data available, among residents of 49 states, six metropolitan areas, and the District of Columbia—geographic areas in which about 99% of the U.S. population resides. Incidence data are from CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. Data from population-based central cancer registries in these states and metropolitan areas meet the criteria for inclusion in this report.

The report also provides cancer mortality data collected and processed by CDC’s National Center for Health Statistics. Mortality statistics, based on records of deaths that occurred during 2013, are available for all 50 states and the District of Columbia.

The report also includes incidence rates and counts for Puerto Rico for 2009 through 2013 by sex and age, as well brain tumor and childhood cancer data.

USCS data are presented in the following applications—

 

The National LGBT Health Education Center provides educational programs, resources, and consultation to health care organizations with the goal of optimizing quality, cost-effective health care for lesbian, gay, bisexual, and transgender (LGBT) people.

http://www.asbestosdiseaseawareness.org/

ADAO is the largest independent nonprofit in the U.S. dedicated to preventing asbestos exposure, eliminating asbestos-related diseases, and protecting asbestos victims' civil rights through education, advocacy, and community initiatives. 

The Inter-professional Oral Health Faculty Toolkit, developed by the Oral Health Nursing Education and Practice program, is now available.The toolkit is an innovative web-based open source product intended to facilitate integration of oral-systemic health content and clinical competencies into nurse practitioner and midwifery curricula. 

"Abstract: Unathorized (undocumented) immigrants are less likely than other residents of the United States to have health insurance. The American College of Obstetricians and Gynecologists has long supported a basic health care package for all women living within the United States without regard to their country of origin or documentation. Providing access to qualify health care for unauthorized immigrants and their children, who often were born in the United States and have U.S. citizenship, is essential to improving the nation's publc health."

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Recently in the UK, there has been research supporting midwifery care. Due to this research, the UK has made some policy changes in regards to maternity. Midwifery care has been shown to be more safe for women with uncomplicated pregnancies and because of these new policies, the United States may follow in their footsteps.

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The National Nework for Oral Health Access has developed a user’s guide that provides a structure, options, and suggestions to help Health Centers develop programs to implement oral health competencies that integrate oral health care into primary care practice, which increases access to oral health care and improves the oral health status of the populations Health Centers serve.

This report captures important happenings in occupational health and safety from August 2013 through July 2014. Authoured by researchers from the George Washington University Milken Institute School Of Public Health, this resource focuses on workplace injury and illness statistics each spring and documents successes, challenges, and areas ripe for improvement in occupational health and safety.  

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Part 5 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: June 5, 2014
PRESENTED BY: Katherine Brieger, RD and Elizabeth Magenheimer

View Recorded Webinar

Participant Evaluation  

Presentation Slides (PDF)

To receive CME* or CNE credit after viewing any of these webinars you must do the following:
  • Complete the Participant Evaluation associated with each webinar
  • Send an email with your first and last name stating which webinar you completed to contedu@migrantclinician.org

Diabetes continues to be one of the most common and challenging health condition confronting migrants and other underserved populations. It is clear that a healthy lifestyle is critical to mitigating the impact of diabetes on individuals and the population, however effective and appropriate interventions can be difficult to design. Fairhaven Community Health Center in Connecticut and Hudson River Healthcare in New York, are two health centers that have long led the way in creating culturally appropriate lifestyle programs for migrants and other underserved patients. In this session the presenters will discuss lessons learned from the development of a variety of programs for diabetics and other patients including a community garden, nutrition classes, cooking classes, weight management and strategies to encourage exercise. The session will address the clinical core measures related to nutrition and BMI and will also discuss current research test second line drug effectiveness in Type 2 DM. Available in English

Learning Objectives:

  1. Describe culturally appropriate diabetes intervention strategies
  2. Identify strategies to address clinical core competencies related to nutrition and BMI to improve quality care.
  3. Receive “take home” examples of how to incorporate effective nutrition, weight loss, exercise and other health lifestyle strategies.

 

FURTHER READING

Download the Spanish Toolkit Materials

National Diabetes Information Clearinghouse, http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram

Bright Bodies, http://brightbodies.org

The goal of this study was to describe acute occupational pesticide-related illnesses among youths and to provide prevention recommendations. Survey data from 8 states and from poison control center data were analyzed.

Public health surveillance for acute pesticide intoxications is discussed. Explanation of the goals, components and functions of population-based surveillance is provided with reference to key informational sources.

Matthew C. Keifer, MD, MPH; Iris Reyes, MPH; Amy K. Liebman, MA, MPA; Patricia Juarez-Carrillo, PhD, MPH.  Abstract. Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions. Questions were both catergorical (multiple choice) and open-ended numerical (text entry), and varied from simple queries to more sensitive points regarding immigration. Most workers answered the one-key response categorical questions with little difficulty. In contrast, some participants struggled when responding to numerical questions, especially when the response required pressing multiple clicker keys. An overwhelming majority of participants reported that the clickers were comfortable and easy to use despite the challenges presented by the more complex responses. The error rate increased as question complexity increased and the trend across three ordered categories of response complexity reached statistical significance. Results suggest that ARS is a viable method for gathering dichotomous or higher-order categorical information from LEP and low-literacy populations in a group setting while assuring anonymity. However, it is recommended that clickers be developed and tested with fewer, bigger, and more widely separated buttons, and less printing on the buttons for these populations. Further research is needed to determine the effectiveness of using clickers with simplified configurations in the workplace as a tool to collect data for surveys and assessments and to better engage LEP and low-literacy workers in training sessions. 

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The CHAMACOS study is a longitudinal birth cohort study examining chemicals and other factors in the environment and children's health. 

In 1999-2000, CHAMACOS enrolled 601 pregnant women living in the agircultural Salinas Valley.  They are following their children through age 12 to measure their exposures to pesticides and other chemicals and to determine if this exposure impacts their growth, health, and development. 

This webinar is the sixth in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, July 17, 2013
PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

To view the recorded version of this webinar, click here.

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Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski,
Mark S. Crowley, Rosanna Barrett, Adolfo Correa, Sheila
Higgins, Hugo L. Leon, Jane Correia, Alan Becker,
Ruth H. Allen and Elizabeth Evans
doi:10.1289/ehp.9647 (available at http://dx.doi.org/)
Online 21 February 2007

Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski,Mark S. Crowley, Rosanna Barrett, Adolfo Correa, SheilaHiggins, Hugo L. Leon, Jane Correia, Alan Becker,Ruth H. Allen and Elizabeth Evans

doi:10.1289/ehp.9647 (available at http://dx.doi.org/) Online 21 February 2007

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Sherry L. Baron, MD, MPH, Sharon Beard, MS, Letitia K. Davis, ScD, EdM, Linda Delp, PhD, MPH, Linda Forst, MD, MPH, Andrea Kidd-Taylor, PHD, Amy K. Liebman, MPA, MA, Laura Linnan, ScD, Laura Punnett, ScD, and Laura S. Welch, MD

Background: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity.

Methods: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations.

Results: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers.

Conclusions: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

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Carlos Eduardo Siqueira, MD, ScD, Megan Gaydos, MPH, Celeste Monforton, Dr PH, MPH, Craig Slatin, ScD, MPH, Liz Borkowski, BA, Peter Dooley, MS, CIH, CSP, Amy Liebman, MPA, MA, Erica Rosenberg, JD, Glenn Shor, PhD, MPP, and Matthew Keifer, MD, MPH

Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.

Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.

Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.

Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.

Sara A. Quandt, PhD, Kristen L. Kucera, PhD, Courtney Haynes, MS, Bradley G. Klein, PhD, Ricky Langley, MD, Michael Agnew, PhD, Jeffrey L. Levin, MD, Timothy Howard, PhD, and Maury A. Nussbaum, PhD

Background Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic.

Methods We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US.

Results Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries.

Conclusion As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.

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Arthur L. Frank, MD, PhD, Amy K. Liebman, MPH, MA, Bobbi Ryder, BA, Maria Weir, MAA, MPH, and Thomas A. Arcury, PhD

 

 

Background The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the
US is comprised primarily of Latino immigrants. Health care access for these workers
is limited and increases health disparities.

Background The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in theUS is comprised primarily of Latino immigrants. Health care access for these workersis limited and increases health disparities.

 

Methods This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.

 

Contents Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers.C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US. Am. J. Ind. Med.

 

By Amy K. Liebman, MPA, MA, Melinda F. Wiggins, MTS, Clermont Fraser, JD, Jeffrey Levin, MD, MSPH, Jill Sidebottom, PhD, and Thomas A. Arcury, PhD

Background Immigrant workers make up an important portion of the hired workforce inthe Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industrysectors in the US. Despite the inherent dangers associated with this sector, workerprotection is limited.

Methods This article describes the current occupational health and safety policies andregulatory standards in theAgFF sector and underscores the regulatory exceptions and limitationsin worker protections. Immigration policies and their effects on worker health and safety arealso discussed. Emphasis is placed on policies and practices in the Southeastern US.

Results Worker protection in the AgFF sector is limited. Regulatory protections are generallyweaker than other industrial sectors and enforcement of existing regulations is woefullyinadequate. The vulnerability of the AgFF workforce is magnified by worker immigrationstatus. Agricultural workers in particular are affected by a long history of “exceptionalism”under the law as many regulatory protections specifically exclude this workforce.

Conclusions A vulnerable workforce and high-hazard industries require regulatoryprotections that, at a minimum, are provided to workers in other industries. A systematicpolicy approach to strengthen occupational safety and health in the AgFF sector mustaddress both immigration policy and worker protection regulations.

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The West Virginia Rural Health Research Center (WVRHRC) pursues a multi-disciplinary research effort directed to improve environmental health for rural populations. Collaborators from public health, geographic information systems, nursing, pharmacy, environmental science, health policy and other disciplines work together to conduct policy-relevant research to achieve this goal.

This study, conducted by the West Virginia Rural Health Research Center, identified the availability and characteristics of agricultural medicine training opportunities for health care professionals.  Agricultural workers and their families face numerous threats to health and safety, and yet there is limited information on health care expertise in place to recognize and prevent threats, and to diagnosis and treat agriculturally-related injury and illness.

Good article on cultural humility--basically the groundbreaking one used to propose the term

Journal of Health Care for the Poor and Underserved; May 1998; 9, 2; Research Library
Melanie Tervalon; Jann Murray-Garcia 

Objectives. We assessed implicit and explicit bias against both Latinos and

African Americans among experienced primary care providers (PCPs) and
community members (CMs) in the same geographic area.
Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizations
in the Denver, Colorado, metropolitan area completed Implicit Association
Tests and self-report measures of implicit and explicit bias, respectively.
Results. With a 60% participation rate, the PCPs demonstrated substantial
implicit bias against both Latinos and African Americans, but this was no
different from CMs. Explicit bias was largely absent in both groups. Adjustment
for background characteristics showed the PCPs had slightly weaker ethnic/racial
bias than CMs.
Conclusions. This research provided the first evidence of implicit bias against
Latinos in health care, as well as confirming previous findings of implicit bias
against African Americans. Lack of substantive differences in bias between the
experienced PCPs and CMs suggested a wider societal problem. At the same
time, the wide range of implicit bias suggested that bias in health care is neither
uniform nor inevitable, and important lessons might be learned from providers
who do not exhibit bias. (Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.
2012.300812)

This article from the American Journal of Public Health is on implicit bias.

Authors: Irene V. Blair, PhD, Edward P. Havranek, MD, David W. Price, MD, Rebecca Hanratty, MD, Diane L. Fairclough, DrPH, Tillman Farley, MD, Holen K. Hirsh, PhD, and John F. Steiner, MD, MPH

Objectives. We assessed implicit and explicit bias against both Latinos and African Americans among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area.

Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizationsin the Denver, Colorado, metropolitan area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively.

Results. With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs had slightly weaker ethnic/racial bias than CMs.

Conclusions. This research provided the first evidence of implicit bias against Latinos in health care, as well as confirming previous findings of implicit bias against African Americans. Lack of substantive differences in bias between the experienced PCPs and CMs suggested a wider societal problem. At the same time, the wide range of implicit bias suggested that bias in health care is neither uniform nor inevitable, and important lessons might be learned from providers who do not exhibit bias.

(Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.2012.300812)

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This website contains information on the 156 health centers that get federal funds to provide primary care to migrant and seasonal farmworkers regardless of immigration status. Most are part of community health centers that also receive additional federal funding to serve all low-income people. They offer services on a sliding fee scale.

A preliminary total of fatal work injuries recorded in the United States. According to results from the 
Census of Fatal Occupational Injuries (CFOI) program conducted by the U.S. Bureau of Labor
 Statistics.

Children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Acute poisoning risks are clear, and understanding of chronic health implications from both acute and chronic exposure are emerging. Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems.
In this policy statement, the American Association of Pediatrics outlines the symptoms and suggested course of treatment for acute exposure pesticides belonging to the eight most predominant classes of pesticides. The policy statement also makes recommendations for both pediatricians and government to take measures to improve pesticide safety.
© AAP - 2012; This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors.

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