Families living in U.S.-Mexico borderlands see limited access to asthma health care
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Key takeaways:
- Language barriers and a lack of resources limit access to health care for Latinx and indigenous Mexicans.
- Geographical positioning at the U.S. Mexico border is a factor determining access to care.
Rural unincorporated colonias in the U.S.-Mexico borderlands have limited access to health care, showing that geography is a determinant of health in low-income communities, according to a study published in Social Science & Medicine.
“We found that the community was most concerned about the health and well-being of children, with asthma being one of the primary concerns,” Ann Cheney, PhD, an associate professor of social medicine, population and public health at University of California, Riverside, and one of the authors of the study, told Healio.
The study included interviews with 36 caregivers of children with asthma and respiratory disease, who the study authors referred to as “Latinx” and indigenous Mexican, and found that participants living in unincorporated colonias lack basic critical infrastructure such as health care access.
The study defined an unincorporated colonia as an area that is not part of any municipality and falls under county control instead. Previous research has shown that residents of unincorporated colonias had higher rates of chronic diseases and limited access to health care services, according to the researchers.
Study design
Participants were recruited from the Coachella Valley, which sits along the northern part of the Salton Sea. Residents in this area were predominantly Spanish-speaking foreign born Latinx and/or indigenous Latin American persons. Most lived below the federal poverty line.
There were 36 adult participants (28 women; 54% aged 35-44 years; 76% Latinx/Hispanic; 24% indigenous Purépecha) included in the study, of which 97% were born in Mexico and 55% were farmworkers.
Most participants lived within walking distance of the Salton Sea, which participants characterized as contaminated with agricultural runoff and a source of toxic dust that impacts their asthma and allergies.
The study was conducted from September to December 2020. The research team was led by a bilingual Purépecha community researcher who conducted four virtual focus groups with 16 participants and 20 one-on-one virtual interviews.
The community researcher used a semi-structured interview guide to obtain information on child respiratory health problems, health care access and utilization, and perceptions of the Salton Sea on children’s respiratory health.
A sociodemographic survey was administered at the end of the focus group or interview, which included questions on age, gender, race/ethnicity and education as well as questions about proximity to the Salton Sea and the health of the caregiver’s child with asthma or other respiratory disease. Caregivers who identified as indigenous Purépecha were also asked about their use of home remedies for their children’s respiratory problems.
Results
The study found that structural factors such as being a part of an unincorporated community and government inaction intersected with social determinants of health that made caregivers cross the U.S.-Mexico border to access health care in Mexico for their children.
“We were most surprised by a number of our participants indicating they traveled to or knew someone that traveled to Mexicali for their children’s medical services,” Gabriela Ortiz, first author of the study and graduate student in anthropology at University of California, Riverside, told Healio.
“It was surprising because our interview guide did not directly ask if caregivers went to Mexico for medical services. However, this theme kept emerging as participants shared their experiences when seeking health services in the Coachella Valley,” Ortiz continued. “This prompted us to closely examine the role of geography (ie, unincorporated colonias) as a structural determinant of health.”
Overall, the researchers said, the Eastern Coachella Valley lacks health care infrastructure. Mecca, which the researchers called the unincorporated community with the most infrastructure, has one federally qualified health care center that provides primary care.
Also, the nearest pediatric clinic that offers pulmonology and other specialty care is between 15 and 40 miles away from the region. When these families use providers in the U.S., the researchers continued, they often are unsatisfied.
Excerpts from interviews showed a widespread sentiment that U.S.-based physicians were not providing the caregivers with enough information to adequately treat their child’s asthma or other respiratory disease. There was a shared feeling that these physicians either did not speak their language or were dismissive about their concerns. The caregivers perceived that Mexico-based physicians provided care more adequately by providing immediate information, treatment and diagnosis.
“After taking them [my children] there [the emergency room in the US] almost a day or two days later, we [then] go to Mexicali,” one of the caregivers said.
“There, they [the doctors] always give me an explanation or [the doctors say] ... ‘Give them these vitamins.’ or ‘Make sure they drink more water.’ And if it [his symptoms] get to something more serious, I’ll take him here [US] to the pediatrician. Although, I already know they [the doctors] are going to tell me: ‘Oh, wait a few days, nothing’s wrong with him.’ And then, I’ll take him to Mexicali, just to see if there is another option,” the caregiver continued.
Results further showed that some caregivers and their children, including those without documentation status in the U.S., did not have the option of using health care services in Mexico, which limited their access to meet their health care needs significantly, leading to geography as a structural determinant of health.
“Structural determinants of health refer to the underlying societal and systemic factors that influence the health and well-being of a population, such as the social, economic, political, and environmental structures of society,” Ortiz said.
Structural determinants are linked to social determinants such as where people live, age and grow, but they also emphasize broader, often invisible systems that shape social determinants, she continued.
“By centering geography as a structural determinant, it allows us to consider the geographic inequities in health care access, environmental exposures (the Salton Sea), as well as socioeconomic conditions, and how the manifestations of this relationship impact health outcomes, particularly among already marginalized Latinx and indigenous Mexican communities, moving away from the prevalent discourse that individuals are solely to blame or responsible for their poor health,” Ortiz said.
Next steps
Healio asked Ortiz how the findings in her study can better inform physicians who care for these marginalized populations.
“By recognizing the influence of geography on health disparities, medical doctors can adopt a more holistic approach to patient care in rural settings,” she said.
For example, Ortiz said, she and her colleagues accounted for the structural determinants of health — in this case, geography — and the existence of colonias in this study.
“We recognize that there are a number of deeply passionate and committed health providers in the region, making their appeal to policymakers even more crucial,” she said.
Solutions may involve advocating for and implementing targeted interventions to address specific geographic barriers to health care access, such as providing transportation assistance like free shuttle services or telehealth services for patients in rural areas, Ortiz continued.
“This is especially crucial as rural hospitals continue to experience record closures across the country, placing communities of color at greater risk for poor health outcomes,” she said.
The researchers emphasized that policymakers can drive the most impact when it comes to helping those most affected by structural determinants of health.
“We hope the findings can urge much-needed conversations among county officials about the negative impacts municipal unincorporation can have on structurally vulnerable populations,” Ortiz said.
“For example, policies can be implemented to improve access to health care in underserved rural areas by incentivizing health care providers to practice in these regions, something Mexico has standardized for various health providers, including nurses and dentists, known as ‘pasantia,’” she said.
Ortiz also noted the language barrier that prevents many non-English speakers from receiving the health care they need or the lack of internet access to participate in telehealth services. Policies to reduce the harm of environmental pollutants that sometimes are the root of the problem in respiratory disease also need to be addressed, she said.
“Policies aimed at reducing environmental pollution and improving housing quality can mitigate health risks associated with exposure to environmental hazards,” Ortiz said.
The first step in achieving a number of these policy recommendations would be acknowledging that municipal un-incorporation can have negative effects on the community’s health unless it is able to economically sustain itself.
“As the literature has demonstrated, this is rarely the case for colonias,” Ortiz said. “This reality should propel county leaders to assess and incorporate the communities’ needs and demands regarding municipal incorporation, which can serve as a first step toward residents of the Eastern Coachella Valley to establish a governing board to advocate in their best interest.”
Reference:
- Location, location, location: How geography acts as a structural determinant of health. https://news.ucr.edu/articles/2024/04/26/location-location-location. Posted April 26, 2024. Accessed May 9, 2024.