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1.
Int J Equity Health ; 23(1): 184, 2024 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-39277719

RESUMO

BACKGROUND: Undocumented immigrants face many obstacles in accessing emergency healthcare. Legal uncertainties, economic constraints, language differences, and cultural disparities lead to delayed medical care and thereby exacerbate health inequities. Addressing the healthcare needs of this vulnerable group is crucial for both humanitarian and public health reasons. Comprehensive strategies are needed to ensure equitable health outcomes. OBJECTIVE: This study aimed to identify and analyze the barriers undocumented immigrants face in accessing emergency healthcare services and the consequences on health outcomes. METHODS: We used a scoping review methodology that adhered to established frameworks. Utilizing MEDLINE/PubMed, Embase, Web of Science, PsychoInfo, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), we identified 153 studies of which 12 focused on the specific challenges that undocumented immigrants encounter when accessing emergency healthcare services based on the inclusion and exclusion criteria. RESULTS: The results show that undocumented immigrants encounter significant barriers to emergency healthcare, including legal, financial, linguistic, and cultural challenges. Key findings were the extensive use of emergency departments as primary care due to lack of insurance and knowledge of alternatives, challenges faced by health professionals in providing care to undocumented migrants, increased hospitalizations due to severe symptoms and lack of healthcare access among undocumented patients, and differences in emergency department utilization between irregular migrants and citizens. The findings also serve as a call for enhanced healthcare accessibility and the dismantling of existing barriers to mitigate the adverse effects on undocumented immigrants' health outcomes. CONCLUSIONS: Undocumented immigrants' barriers to emergency healthcare services are complex and multifaceted and therefore require multifaceted solutions. Policy reforms, increased healthcare provider awareness, and community-based interventions are crucial for improving access and outcomes for this vulnerable population. Further research should focus on evaluating the effectiveness of these interventions and exploring the broader implications of healthcare access disparities.


Assuntos
Acessibilidade aos Serviços de Saúde , Imigrantes Indocumentados , Humanos , Imigrantes Indocumentados/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos
2.
AMA J Ethics ; 26(8): E605-615, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39088407

RESUMO

Undocumented people in the United States face innumerable legal and structural barriers to health and health care services, including for kidney failure. Their experiences vary across states and regions due to wide variation in insurance coverage and unreliable access to health-promoting resources, including medical-legal partnerships. This commentary on a case canvasses key policy about structural and legal determinants of health for undocumented persons.


Assuntos
Acessibilidade aos Serviços de Saúde , Advogados , Humanos , Estados Unidos , Acessibilidade aos Serviços de Saúde/ética , Imigrantes Indocumentados , Cobertura do Seguro , Necessidades e Demandas de Serviços de Saúde , Médicos/ética
3.
Int J Equity Health ; 23(1): 169, 2024 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-39187839

RESUMO

BACKGROUND: Despite many efforts to provide children with legal existence over the last decades, 1 in 4 children under the age of 5 (166 million) do not officially exist, with limited possibility to enjoy their human rights. In Latin America and the Caribbean, Haiti has one of the highest rates of undocumented births. This study aimed to analyze the prevalence and the determinant factors of undocumented childhood in Haiti. METHODS: For analysis of undocumented childhood and related socioeconomic determinants, data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the associated factors were analyzed using descriptive statistics and the binary logistic regression model. RESULTS: The prevalence of undocumented childhood in Haiti was 23% (95% CI: 21.9-24.0) among children under-five. Among the drivers of undocumented births, mothers with no formal education (aOR = 3.88; 95% CI 2.21-6.81), children aged less than 1 year (aOR = 20.47; 95% CI 16.83-24.89), children adopted or in foster care (aOR = 2.66; 95% CI 1.67-4.24), children from the poorest regions like "Artibonite" (aOR = 2.19; 95% CI 1.63-2.94) or "Centre" (aOR = 1.51; 95% CI 1.09-2.10) or "Nord-Ouest" (aOR = 1.61; 95% CI 1.11-2.34), children from poorest households (aOR = 6.25; 95% CI 4.37-8.93), and children whose mothers were dead (aOR = 2.45; 95% CI 1.33-4.49) had higher odds to be undocumented. CONCLUSION: According to our findings, there is an institutional necessity to bring birth documentation to underprivileged households, particularly those in the poorest regions where socioeconomic development programs are also needed. Interventions should focus on uneducated mothers who are reknown for giving birth outside of medical facilities. Therefore, an awareness campaign should be implemented to influence the children late-registering behavior.


Assuntos
Imigrantes Indocumentados , Humanos , Haiti , Feminino , Lactente , Prevalência , Pré-Escolar , Masculino , Adulto , Imigrantes Indocumentados/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Modelos Logísticos , Adulto Jovem , Recém-Nascido , Pobreza/estatística & dados numéricos , Pessoa de Meia-Idade
5.
Am J Public Health ; 114(10): 1051-1060, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39146520

RESUMO

Insurance coverage for prenatal care, labor and delivery care, and postpartum care for undocumented immigrants consists of a patchwork of state and federal policies, which varies widely by state. According to federal law, states must provide coverage for labor and delivery through Emergency Medicaid. Various states have additional prenatal and postpartum coverage for undocumented immigrants through policy mechanisms such as the Children's Health Insurance Program's "unborn child" option, expansion of Medicaid, and independent state-level mechanisms. Using a search of state Medicaid and federal government websites, we found that 27 states and the District of Columbia provide additional coverage for prenatal care, postpartum care, or both, while 23 states do not. Twelve states include any postpartum coverage; 7 provide coverage for 12 months postpartum. Although information regarding coverage is available publicly online, there exist many barriers to access, such as lack of transparency, lack of availability of information in multiple languages, and incorrect information. More inclusive and easily accessible policies are needed as the first step toward improving maternal health among undocumented immigrants, a population trapped in a complicated web of immigration policy and a maternal health crisis. (Am J Public Health. 2024;114(10):1051-1060. https://doi.org/10.2105/AJPH.2024.307750).


Assuntos
Acessibilidade aos Serviços de Saúde , Cobertura do Seguro , Medicaid , Governo Estadual , Imigrantes Indocumentados , Humanos , Imigrantes Indocumentados/legislação & jurisprudência , Imigrantes Indocumentados/estatística & dados numéricos , Estados Unidos , Feminino , Gravidez , Cobertura do Seguro/legislação & jurisprudência , Cobertura do Seguro/estatística & dados numéricos , Medicaid/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Cuidado Pré-Natal/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Governo Federal , Cuidado Pós-Natal/legislação & jurisprudência
6.
Ethn Dis ; 34(2): 84-92, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38973802

RESUMO

Background: The immigration enforcement system has significant effects on the health of immigrants, their families, and society. Exposure to the immigration enforcement system is linked to adverse mental health outcomes, which may have been exacerbated by sustained immigration enforcement activities during the COVID-19 pandemic. Objectives: This study was conducted to investigate the association between exposure to immigration enforcement and the mental health of undocumented young adults in California during the COVID-19 pandemic. Methods: Data are from the COVID-19 BRAVE (Building Community Raising All Immigrant Voices for Health Equity) Study, a community-engaged cross-sectional survey of the impacts of the COVID-19 pandemic on undocumented immigrants in California. A total of 366 undocumented immigrants between 18 and 39 years of age completed the online survey, which was conducted between September 2020 and February 2021. Multivariable logistic regression models were fit to examine the association between immigration enforcement exposure and depression. Results: Almost all participants (91.4%) disclosed exposure to the immigration enforcement system, with most reporting an average of 3.52 (SD=2.06) experiences. Multivariate analyses revealed that an increase in the immigration enforcement exposure score was significantly associated with higher odds of depression (adjusted odds ratio [aOR]=1.24; 95% confidence interval [CI]: 1.10, 1.40), and women were 92% more likely to report depression than were men (aOR=1.92; 95% CI: 1.12, 3.31). Those who reported deportation fears were significantly more likely to be depressed (aOR=1.24; 95% CI: 1.10, 1.40). Conclusions: Researchers should consider the mental health implications of a punitive immigration enforcement system, and policymakers should examine the impacts of immigration policies on local communities.


Assuntos
COVID-19 , Depressão , Imigrantes Indocumentados , Humanos , Masculino , Feminino , COVID-19/epidemiologia , COVID-19/psicologia , California/epidemiologia , Adulto , Adulto Jovem , Estudos Transversais , Depressão/epidemiologia , Depressão/etnologia , Adolescente , Imigrantes Indocumentados/psicologia , Imigrantes Indocumentados/estatística & dados numéricos , Emigração e Imigração/legislação & jurisprudência , Violência/estatística & dados numéricos , Violência/etnologia , Inquéritos e Questionários
8.
Ethn Dis ; 34(1): 8-18, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38854789

RESUMO

Historically, the US immigration system (ie, institutions, agencies, and laws) has served the goals and principles of white supremacy through its treatment of globally displaced people and this appears to have continued through the COVID pandemic. Yet, the implications for immigrant health are not routinely addressed in mainstream public health discourse, and especially so in regard to public health disasters. This study conducted a series of focus groups with participants from social justice organizations working with immigrants, migrants, undocumented persons, refugees, persons seeking asylum, and persons detained in immigration jails to collect stories on how the immigration system undermined efforts to control the spread of COVID-19 and exacerbated health inequity within immigrant jails and across related community contexts during the pandemic. Focus groups were conducted to explore issues related to immigrants and immigration detention during the COVID-19 pandemic. There was a total of N=14 participants across the 4 focus groups with a dedicated focus group on perspectives of Black immigrants/from Black immigrant organizations only. Each focus group consisted of 3 to 4 participants. Five key themes emerged: 1) dehumanization of immigrants and migrants and devaluation of their lives; 2) inhumane conditions of confinement that propagate risk of disease; 3) denial of resources for COVID-19 prevention and mitigation; 4) expansion of intersecting oppressive systems; and 5) community-based resistance and mobilization against immigration policies and enforcement. Our findings highlight the harms from policing, criminalization, and exclusion that racialized communities face as a result of the (in)actions within the immigration system during a public health disaster including the COVID context.


Assuntos
COVID-19 , Grupos Focais , Pesquisa Qualitativa , Imigrantes Indocumentados , Humanos , COVID-19/etnologia , COVID-19/epidemiologia , Estados Unidos , Emigrantes e Imigrantes/psicologia , Emigração e Imigração/legislação & jurisprudência , Feminino , Masculino , Refugiados/psicologia , Adulto , SARS-CoV-2
10.
Sante Publique ; 36(2): 95-96, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38834530

RESUMO

In late December 2023, the French parliament debated legislation that would endanger access to state medical aid (AME) for seriously ill migrants living undocumented in France. The limits of an over-restrictive approach to health care are well known: poorer access to care, additional burden on public hospitals, and the weakening of the whole system. The risks weigh particularly heavily on migrants living with HIV. Yet we know that the number of HIV-positive diagnoses continues to rise among men who have sex with men and who were born abroad. This situation raises public health concerns and risks undermining the ethical foundations of medicine. The French health minister, Aurélien Rousseau, resigned the day after the bill was passed last December, having repeatedly stated his opposition to measures abolishing or weakening AME. In doing so, he demonstrated his commitment to the humanist foundations of medicine, setting an example for all political leaders.


Assuntos
Acessibilidade aos Serviços de Saúde , Humanos , França , Infecções por HIV , Migrantes , Masculino , Imigrantes Indocumentados
12.
Soc Sci Med ; 353: 117055, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38897075

RESUMO

BACKGROUND: Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register. METHODS: We included women 18-49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as 'undocumented migrants' (without an identity number), 'documented migrants' (with an identity number and born abroad), and 'non-migrants' (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin. ETHICAL APPROVAL: Regional Ethical Committee (REK South East, case number 68329). RESULTS: We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly. CONCLUSION: Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance.


Assuntos
Mortalidade Perinatal , Sistema de Registros , Migrantes , Humanos , Feminino , Noruega/epidemiologia , Adulto , Gravidez , Adolescente , Pessoa de Meia-Idade , Migrantes/estatística & dados numéricos , Mortalidade Perinatal/tendências , Imigrantes Indocumentados/estatística & dados numéricos , Adulto Jovem , Fatores de Risco , Recém-Nascido , Emigrantes e Imigrantes/estatística & dados numéricos
14.
Front Public Health ; 12: 1371119, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38756883

RESUMO

Background: The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population. Methods: In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor. Findings: 21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced. Discussion: The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs. Conclusion: There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.


Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Pesquisa Qualitativa , Refugiados , Humanos , Lituânia , Refugiados/psicologia , Feminino , Masculino , Adulto , Imigrantes Indocumentados/psicologia , Necessidades e Demandas de Serviços de Saúde , Pessoa de Meia-Idade , Determinantes Sociais da Saúde , Entrevistas como Assunto , Saúde Mental , Migrantes/psicologia , Migrantes/estatística & dados numéricos
15.
Pediatr Ann ; 53(5): e178-e182, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38700916

RESUMO

Children who arrived at the United States border without a parent or legal guardian (ie, unaccompanied children) are present in communities throughout the country in growing numbers. For them to receive the highest-quality medical and mental services available, pediatric practitioners should have a foundational understanding of their unique set of circumstances and experiences. However, formal education on how to care for this specific immigrant subpopulation is not routinely incorporated into pediatric training programs, and limited clinical guidance is available in the published literature. This article provides best-practice recommendations for pediatric practitioners caring for unaccompanied children after their release from government custody, incorporating guidance for clinical encounters as well as suggestions of processes to meet their health-related social needs and advocacy actions to improve their well-being. [Pediatr Ann. 2024;53(5):e178-e182.].


Assuntos
Pediatria , Humanos , Estados Unidos , Criança , Pediatria/métodos , Imigrantes Indocumentados , Serviços de Saúde da Criança , Emigrantes e Imigrantes/psicologia , Guias de Prática Clínica como Assunto
16.
Pediatr Ann ; 53(5): e183-e188, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38700918

RESUMO

Many children in immigrant families may qualify for legal protection-for themselves if unaccompanied, or as a derivative on parents' claims-on humanitarian grounds related to persecution or forced migration. Pediatric providers can offer a spectrum of multidirectional medical-legal supports to increase access to medical-legal services and support children who are undocumented or in mixed-status families. These activities can include providing trusted information, incorporating screening for health-related social needs, establishing networks for multidirectional referrals, and providing letters of support for legal protection. To expand workforce capacity for medical-legal services related to immigration, pediatric providers can also receive training to conduct specialized, trauma-informed forensic evaluations and can advocate at individual, local, state, federal, and global levels to address factors leading to persecution and forced migration while supporting individuals who may be eligible for legal protection. [Pediatr Ann. 2024;53(5):e183-e188.].


Assuntos
Altruísmo , Humanos , Criança , Socorro em Desastres/legislação & jurisprudência , Estados Unidos , Refugiados/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Emigrantes e Imigrantes/legislação & jurisprudência , Pediatria/legislação & jurisprudência , Imigrantes Indocumentados/legislação & jurisprudência
17.
BMC Public Health ; 24(1): 1261, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38720262

RESUMO

BACKGROUND: In Bangladesh, remittances constitute a substantial portion of the country's foreign exchange earnings and serve as a primary source of income. However, a considerable number of Bangladeshi citizens reside overseas without proper documentation, exposing them to significant challenges such as limited access to healthcare and socioeconomic opportunities. Moreover, their irregular migration status often results in engaging in risky health behaviors that further exacerbate their vulnerability. Hence, this study aimed to investigate the risky health behavior and HIV/STI susceptibility of Bangladeshi irregular international migrants residing across the globe with undocumented status. METHODS: Using a qualitative Interpretative Phenomenological Approach (IPA), 25 illegal migrants were interviewed who are currently living illegally or returned to their home country. The author used a thematic approach to code and analyze the data, combining an integrated data-driven inductive approach with a deductive approach. Concurrent processing and coding were facilitated by employing the Granheim model in data analysis. RESULTS: The study identified four risky health behaviors among irregular Bangladeshi migrants: hazardous living conditions, risky jobs, suicidal ideation, and tobacco consumption. Additionally, the authors found some HIV/STI risk behavior among them including engaging in unprotected sex, consuming alcohol and drugs during sexual activity, and having limited access to medical facilities. CONCLUSIONS: The findings of this study can be used by health professional, governments, policymakers, NGOs, and concerned agencies to develop welfare strategies and initiatives for vulnerable undocumented migrant workers.


Assuntos
Comportamentos de Risco à Saúde , Pesquisa Qualitativa , Infecções Sexualmente Transmissíveis , Migrantes , Humanos , Bangladesh/etnologia , Feminino , Masculino , Adulto , Infecções Sexualmente Transmissíveis/etnologia , Migrantes/estatística & dados numéricos , Migrantes/psicologia , Adulto Jovem , Pessoa de Meia-Idade , Imigrantes Indocumentados/estatística & dados numéricos , Imigrantes Indocumentados/psicologia , Ideação Suicida , Assunção de Riscos
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