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Five ways to improve health care for immigrants

Providing adequate health care for immigrants is critical for public health and to smooth the acclimation process.

Immigration continues to be a divisive topic across the US and in the media. Regardless of where you stand on the issue, providing optimal health care for children, adults and families who have migrated to the US is not just a matter of public health, it's the right thing to do.

In the medical community, we have an obligation to be apolitical. However, it is critical that we as clinicians are aware of the growing policy changes that affect immigrant populations. We must build our capacity to discuss these issues, given the fact that family separation, access to public benefits and migration restrictions affect a significant proportion of the families we see every day. Immigrants face a multitude of challenges, including toxic stress from being separated from their children and families, the growing threat of possible deportation and the negative impacts on individuals and families.

In New York, one in four children is born into a family where at least one parent is an immigrant. By 2050, that statistic will be one in three. As our communities continue to become more diverse, we need to ensure better ways of providing care for these families. Here's how.

1. Provide a welcoming environment

Try to make sure the entrances of your practice are welcoming. Be culturally sensitive and let patients now that your practice is a safe space. You can achieve this by providing access to translator phones and posting signs in various languages. Offering information sheets in other languages is also a plus. Immigrants may limit their use of health care in clinical settings because they fear deportation, resulting in them being less forthcoming with information, especially if they don't feel welcomed.

2. Address the physical and multitude of social needs

Caring for any population requires much more than focusing on a person's disease. For immigrants, social isolation, difficult household situations and poverty may be significant challenges to health care access. Incorporate this understanding of the effects of these social determinants of health into your care. Find out if they have insurance problems and set up universal screening for social determinants. Forty to 50 percent of health outcomes are related to a person's social environments rather than health behaviors or access to care. Offer all families, especially immigrant patients, questionnaires and ask about dilapidated housing, food insecurity, unemployment and other potential causes of financial strain. Learn if they need more information and provide patients with resources to connect to social services.

3. Understand their migration history

As you develop stronger relationships with your patients, try to explore how they came to the US. This information may help you to identify other needs for the family, possibly mental health and/or legal support. As this may be sensitive information, it's important to make sure that as you build relationships with immigrant patients, you understand the family dynamic and what actually happened in terms of their acculturation into the US. For many of our families, it's a rude awakening to come to an unfamiliar environment with foreign customs, and where there are obstacles in accessing necessary resources to live and thrive. Establish a full assessment of the family to understand their stressors and connect them to the help they need.

4. Look into resources to self-educate

Stay abreast of how changes in immigration policy might affect your patients. For example, tens of thousands of immigrants from countries like El Salvador and Haiti will lose their legal temporary protected status in the coming months and essentially become undocumented. Ask if families are affected by administration policies. Having built a rapport with their doctors, immigrants see the clinic as a trustworthy place for health care and finding information about solving other issues they face. With more medical practices integrating traditional care and behavioral health, clinics can address all of their needs.

5. Become an advocate

Given the enormity of the many current issues affecting immigrants, doctors have an important voice across communities, local and federal governments. We should advocate against changes that could jeopardize the well-being and economic stability of our patients. Restrictions on public charge rule will severely limit access to safety benefits like Medicaid, food stamps and childhood nutritional programs. By restricting access, immigrants are pushed deeper into poverty, which is inextricably linked to poor health. Also, clinicians can participate in writing op-eds, voicing their concerns in news media and working within the local chapters of their professional societies. We have the power to be heard and use ourvoice for change.

Omolara Thomas Uwemedimo, MD, is assistant professor of pediatrics and occupational medicine, epidemiology and prevention at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the founding director of GLOhBAL (Global Learning. Optimizing health. Building Alliances Locally) at Cohen Children's Medical Center. GLOhBAL is an inter-professional, clinical and research training in global and immigrant health to fellows, residents, medical students and public health students. Over the past 13 years, Dr. Uwemedimo has worked as a clinician in sub-Saharan Africa, Asia and Latin America and continues to work in Queens, New York as an outpatient pediatrician, with a focus on supporting ethnic minority children from immigrant families. She is a member of the New York State American Academy of Pediatrics (AAP) Immigration Committee and has worked with local advocacy groups such as the New York Immigration Coalition. She is also a member of the AAP's Section of International Child Health and the Immigrant Health Special Interest Group and has received the National Institute of Minority Health Disparities Scholars Institute and is currently a fellow of the Robert Wood Johnson Foundation Clinical Scholars Leadership Institute.

"Caring for any population requires much more than focusing on a person’s disease. For immigrants, social isolation, difficult household situations and poverty may be significant challenges to health care access. Incorporate this understanding of the effects of these social determinants of health into your care."
— Omolara Uwemedimo, MD
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