In unincorporated communities in the US-Mexico border areas, historically and socially marginalized populations become invisible to the health system, demonstrating that geography acts as a structural determinant of the health of low-income populations . This is the conclusion of a study conducted by a team from the University of California, Riverside, which focused its attention on the border area of Southern California, specifically in the eastern Coachella Valley.
From September to December 2020, the team, led by Ann Cheney, associate professor of social medicine, population and public health at the School of Medicine, conducted interviews in collaboration with María Pozar, community researcher and executive director of Conchita Servicios de la Comunidad , with 36 Latino and indigenous Mexican caregivers of children with asthma or respiratory difficulty. Researchers found that communities in the “colonies” (unincorporated areas in border areas) lack basic critical infrastructure, including access to health care.
The border area between the United States and Mexico is home to almost 2.7 million Hispanic or Latino people. The immigrant population in the colonies has limited English proficiency, health literacy levels and income, and lower levels of formal education. Many are undocumented.
“Our work shows the importance of geography in health and how geography acts as a structural determinant of health,” Cheney said. “For example, foreign-born caregivers who speak Spanish or Purépecha prefer to take their children across the US-Mexico border to receive respiratory health care because doctors there provide them with a diagnosis and treatment plan that perceive that it improves the health of their children.
The study, published in the journal Social Sciences and Medicine, found that caregivers perceive that American doctors do not provide them with enough information, as most doctors do not speak their language and do not adequately listen to or dismiss their concerns about their children’s respiratory health. Caregivers perceive that doctors based in Mexico provide a diagnosis and treatment plan, while doctors based in the United States often prescribe medications and do not provide any concrete diagnosis.
“In addition, only those with legal documentation can cross the border, contributing to disparities in children’s respiratory health,” Cheney said. “Therefore, caregivers without legal status in the US must access health care services in the US for their children and receive what these caregivers perceive as suboptimal care.”
Cheney added that she was surprised to learn that caregivers who did not have legal documentation in the U.S. were asking trusted family members and friends to take their children across the border to receive health care services for childhood asthma and conditions. related.
“Geography, that is, living in unincorporated communities, is detrimental to health,” he said. “The geography and politics of the place determine who can and cannot cross borders.”
Study participants discussed the distance they had to travel to receive specialized pediatric care for the care and treatment of their children’s respiratory health problems. Some commented on the lack of interaction and communication with physicians during medical visits. Some participants commented on doctors’ lack of knowledge about the connections between their children’s exposure to environmental hazards and poor respiratory health and allergic symptoms.
The research was conducted in four rural unincorporated communities (Mecca, Oasis, Thermal, and North Shore) in the eastern Coachella Valley, along the northern section of the Salton Sea. People living in the colonies here are subject to the health effects of environmental hazards. Many are agricultural workers who live and work in nearby agricultural fields. Most of the workforce lives in mobile parks and below the federal poverty line.
“In addition to the toxic water and dust of the Salton Sea, other environmental health hazards, such as exposure to agricultural pesticides, waste processing facilities, and unauthorized waste dumps, also contribute to the high incidence of poor respiratory health in this area. community,” said Gabriela Ortiz, the first author of the research paper and a graduate student in anthropology working with Cheney. “These communities are vulnerable to policies and decisions governing exposure to environmental hazards and infrastructure development. Absence of infrastructure and lack of healthcare infrastructure limit their access to primary care and specialty care services.”
Ortiz explained that anthropologists and social scientists have long maintained that environmental injustices are the product of structural violence.
“This is indirect violence caused by social structures and institutions that prevent individuals from satisfying their basic needs due to political economic domination and class exploitation,” he said. “Understanding the complex interaction between geography, borderlands and health is essential for developing effective public health policies and interventions.”
The title of the research paper is “Seeking Care Across the US-Mexico Border: The Experiences of Latino and Indigenous Mexican Caregivers of Children with Asthma or Respiratory Difficulty.”
Cheney, Ortiz and Pozar were joined in the study by Ashley Moran and Sophia Rodríguez of UCR.
The study was funded by the National Institutes of Health/National Institute on Minority Health and Health Disparities.