Scott Rhodes: NewPublicHealth Q&A
This morning Scott Rhodes, PhD, MPH, a professor in the department of Social Sciences & Health Policy at Wake Forest University Health Sciences, presented a study on the impact of immigration enforcement on access to care among Latinos. The presentation came at a session on social and legal factors that affect health at the Public Health Law Research Program annual meeting. NewPublicHealth spoke with Rhodes about the study.
NewPublicHealth: You’ve been looking at immigration and found significant health care access issues in North Carolina?
Scott Rhodes: Yes, we’ve been working on Latino immigration issues for about ten years, but we hadn’t really looked at the role of immigration policy enforcement on access to care, specifically access to public health services among Latino immigrants. What we looked at in the research we presented at the PHLR annual meeting this morning were the limits that some of the policies pose, such as policies that allow police officers to start deportation processes with the Immigration and Customs Enforcement agency if they stop someone and find they are in the United States illegally. We wanted to know if those policies impact whether Latinos access public health services that they may need and what kind of impact that has on their health.
So, we did two things. We analyzed statewide county-level vital records data to look at the use of prenatal care services by Latinos across the state of North Carolina—pre- and post-implementation of one of the immigration policies that link police to the immigration service. And we also conducted focus groups and in-depth interviews with Latinos living in three counties in North Carolina in which the policy has been implemented, and then three counties in North Carolina where the policy was publicly rejected, to see whether there were some differences in perceptions about eligibility and about accessing and utilizing services.
NPH: And what did you find?
Scott Rhodes: In the vital records data we found that—compared to non-Latinos—Latinos did seek prenatal care later. They also had fewer prenatal care visits and were less likely to receive any prenatal care than non-Latinos. We decided to look at why Latinos are accessing public health services less, but with the knowledge that it didn’t seem to be linked to this immigration policy. What we discovered through the focus groups is that immigration policies are not well understood by immigrant Latinos in North Carolina and what they do understand just compounds existing distrust of services. So Latinos already don’t’ feel comfortable accessing services and the policies just reinforce those messages and create barriers to accessing and utilizing services. For example, focus group participants reported not having primary care providers and not having driver’s licenses. They may drive to get to work because they have to make a living, but the risk of driving without a license was not worth seeking healthcare even when healthcare is available. So they weren’t going to free clinics or public health service clinics. There’s a fear of being stopped in the street.
We heard stories upon stories of people who had a prescription written for a sick child but then were afraid to go to a pharmacy to get that prescription filled. So here they are as a parent with a sick child and have a solution right in their hands, but then have to struggle with “I’m too scared to go out on the street.” And, in many cases, while the parent is an immigrant, that child was born in the United States.
NPH: What recommendations do you have on this issue?
Scott Rhodes: In November, we convened a statewide forum during which we brought public health providers to the table and presented our findings and as a group came up with some potential ideas to move forward.
First is really educating community members about available resources, the costs, eligibility requirements and confidentiality. Because there have been breaches of confidentiality in the past, people are afraid of accessing services as undocumented.
Another idea was to bring stories of community members to policy and decision makers and to those who interpret and enforce policies. What we learned is in some communities in North Carolina, a county may not have this link with Immigration and Customs Enforcement, and yet if the police officer in that county knew that the adjacent county had that, they might take someone they suspected of being undocumented to the adjacent county so that they could initiate the process for investigating someone’s documentation status and potential deportation.
We also discussed reducing transportation barriers to public health resources. Access to driver’s licenses is a public health issue if people can’t access services, and in rural North Carolina that’s a big thing. There really is no public transportation and it becomes very, very difficult to get your healthcare needs met. Our other recommendations include educating front-line public health personnel about barriers and eligibility and using trained lay health advisors to educate the community and help navigate systems and processes. School-based health centers may be useful and we also need to link community members, organizations and researchers to build and strengthen partnerships to help promote community change.
NPH: What’s next?
Scott Rhodes: We just held our community forum in November and we’re going back to each of the communities where we collected data and holding community forum. We’re inviting local stakeholders to the table to have a better sense of what we found and to hear about what the individual groups came up with for recommended actions.