Global Health Communication for Immigrants and Refugees

Cases, Theories, and Strategies

Do Kyun David Kim, Gary L. Kreps, Do Kyun David Kim, Gary L. Kreps

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9781032132358
• eBook ISBN: 9781000583373
• Edition: 1
• Topic: Social Sciences
• Subtopic: Communication Studies
• Index: Social Sciences

This book analyzes important international cases of immigrant and refugee health from diverse communication perspectives, providing theoretical frames and effective recommendations for designing future health communication campaigns and interventions for global health promotion.

Internationally renowned scholars elucidate the reality of health communication situations that immigrants and refugees experience in host countries around the globe and examine how national and global health risk situations, including the COVID-19 pandemic, affect immigrant and refugee health during difficult health circumstances. Offering effective health communication strategies for promoting immigrant and refugee health, the book also provides lessons learned from past and present health communication campaigns, responses of diverse communities, and governmental policies.

This book with many case studies from major host countries on different continents, this book will be of interest to anyone researching or studying in the areas of health communication, public health, international relations, public administration, nursing, and social work.

1 Health Communication in Mixed Status Latino Immigrant Families in the United States

Caryn Medved

DOI: 10.4324/9781003230243-1

It was a chilly day in November of 2016 when we drove out to Long Island. As we parked, I waved to Cristine on the sidewalk waiting for us; she was ready to interpret and provide support as a community advocate. We walked up the stairs to their modest two-room apartment located just off a small downtown business district. After a warm welcome, Sarah, colleague and project co-PI, went to interview sisters Katherine and Alexa in their bedroom.¹ In the kitchen and with the help of Cristine, I interviewed their Honduran immigrant parents. Claudia and Jose Reyes immigrated to New York almost two decades earlier after the devastation wrecked by Hurricane Mitch in Honduras.

As Katherine explained, “My mom was pregnant so she could not come here. They were giving out TPS (Temporary Protective Status) and my dad was the first to get it and my mom could not get it” because of the timing of her travel to the United States. She adds, “She has been here for 16 years undocumented.” During their time in the United States, Claudia and Jose, and most recently Katherine, have experienced significant, life-threatening health conditions; the experiences and meanings of which are entangled with (a) structural constraints and enablements, (b) intersectional cultural narratives, and (c) agency exercised in health and migration family decision making along with intersecting material realities.

Jose spent a decade battling polycystic kidney disease. His TPS status provided access to Medicaid coverage. Claudia described, “He began with dialysis in July 5, 2001.” She recalled telling her daughters that

if we went back, his [health] was in danger because, I could not afford medicine [in Honduras or the cost of] dialysis and he could die. During ten years he was in dialysis. Five years ago, he got the kidney transplant.

Claudia shared that their family “conversations were never about our legal status. It was about the father’s health. Our major worry was about if he will live or die because he had a several crisis during the dialysis years.” Still Jose’s health concerns didn’t end with the transplant. Jose explained that if he went back to Honduras, he would not be able to afford his medicine; the “medicine that I take [so] my body does not reject the kidney is around a thousand monthly, plus the other medication. I have to take for life.” Then just as Jose was recovering, Claudia was diagnosed with anemia but, unlike her husband, she did not have access to health insurance due to her undocumented status. Katherine recalled,

she went to the hospital couple years ago. And she does not have any medical insurance. I was really worried that she had to pay for all of that … If she has not have a donor she could die.

Because of the emergency nature of Claudia’s treatment and access to information about potential healthcare funding assistance, she was able to apply for and receive financial help to cover her medical expenses.

Katherine’s older sister Alexa was born in Honduras; she came to the United States with her mother and was finishing high school when we spoke with her family. Alexa had earned legal status through the Deferred Action for Childhood Arrivals (DACA) program during the Obama Administration. With the Trump administration coming into power at the time of our interview, the family worried that her DACA status as well as the renewal of her fathers’ TPS status was uncertain, along with their increased fears of her mother’s deportation. Claudia shared that the insecurity of Alexa’s DACA status affected her daughter’s mental and emotional health; she explained “because we do not know what it is going to happen with the new president in this country. And although she does not express openly, she is stressed, anxious, and worried about it.” Claudia’s mental health also suffered due to her lack of documentation. She disclosed, “Yes, we are very afraid, insecure. It affects us emotionally and physically. We are afraid because … if I go out immigration will be looking for me.” She added that:

people share in social media or the other time a brother in church send us a text message to let me know and do not go out. So, I try to not go out, but if I do not, it then I cannot work and make money. We need two salaries.

Katherine was the only US citizen by birthright in the family and had dreams of serving in the US military. Yet her ambitions, and health, came into question after she was a victim in a ‘hit and run’ car accident leaving her with severe and ongoing back pain. Jose explained “everything is really hard for her and she’s wondering ‘why did it happen to me? I did not look for it.’” Jose consoled his daughter by sharing that “as Christians we know God has a plan for her and us.” Her mom provided significant daily care. While insurance wasn’t an issue given her citizenship status, Katherine worried about what would happen if her mother got deported. She revealed,

she takes me to physical therapy and all of that. So, it is scary if one day when I come back home, she is not here. That uncertainty kind of scares me. She cannot permanently be here. It is like what I am going to do without my mom?

Katherine also lives with the same kidney disease that necessitated her father’s transplant and knows she will struggle with this life-long health condition.

Culture-Centered Approach (CCA)

Often-marginalized experiences of migration, family and health communication are visible in the case study of the Reyes family. This complex and intersectional narrative is constructed through the voices of four family members, all with different legal statuses and varying access to healthcare as well as three critical physical conditions. As of 2018, the Pew Center for Research reported that 44.8 million people living in the United States were foreign born and accounted for 13.7% of the US population. Of the total foreign-born population living in the United States, 77% (35.2 million) are lawful immigrants including 12.3 million lawful permanent and 2.2 million temporary permanent residents and 23% (10.5 million) are unauthorized (Budiman, 2020). And, while the number of mixed status immigrant families is difficult to estimate, more than 8 million US citizens, of which 1.2 million are naturalized citizens, have at least one unauthorized family member living with them (Mathema, 2017). While immigration itself can bring particular physical and mental health stressors (Elder, 2003), health communication in the context of mixed status families is complicated by, at times, stark differences within one family unit to health care access and financing, language abilities, acculturation opportunities, generational health beliefs, as well as perceived safety when seeking healthcare.

Drawing on concepts from the Culture-Centered Approach (CCA) (Dutta, 2008; Dutta & Basu, 2011) as well as empirical research on immigrant and Latino health communication (e.g., Elder et al., 2009; Greder & Reina, 2019; Hubbell, 2006; Katz, 2014), this chapter explores structures, culture(s), and agency in relation to meaning making and negotiation about health and migration in mixed status Latino immigrant families. The Reyes family experiences are connected and contextualized with related research, followed by the provision of recommended strategies for health communication praxis.

Communication-Centered Approach

According to Dutta (2008), the culture-centered approach (CCA) “is value-centered and is built on the notion that the various ways of understanding and negotiating meanings of health care are embedded within cultural contexts and the values deeply connected with them” (p. 2). Different from biomedical models of health communication, CCA begins with culture and challenges dominant ways of viewing health communication in research and practice. Three key concepts provide the framework for CCA: structure, culture, and agency, all of which are deeply embedded in issues of materiality – embodied, economic, and geographic – in the lives of mixed status immigrant families (Bishop & Medved, 2020).

Structure

Structures, from a CCA perspective, are “those aspects of social organization that constrain and enable the capacity of cultural participants to seek out health choices and engage in health-related behavior” (Dutta & Basu, 2011, p. 330). Mixed status immigrant families’ experiences and meanings of health and illness are shaped by healthcare, legal/political, economic, and community structures. Although the 2010 Affordable Care Act provided insurance options to previously uninsured individuals, healthcare structures in the United States remain significantly tied legal employment, and, by extension, to citizenship. While basic medical assistance for immigrants of varying legal statuses exists, the extent of assistance and financial coverage of treatment varies by state (National Immigration Law Center, 2021). Jose, as a recipient of federally-granted TPS had access to a life-saving kidney transplant and ongoing prescription coverage through Medicaid. And, as a DACA recipient, Alexa also had access to state funded health insurance. However, health care and insurance for undocumented individuals living in the United States is precarious and, ultimately tied to larger state and federal political structures. Claudia did not have the option to purchase health insurance; yet due to the emergency nature of her health condition, Claudia had access to treatment she could not have afforded without financial assistance. Other barriers that can affect unauthorized persons access to healthcare include discrimination and fear of deportation (Hacker et al., 2015).

The framing of healthcare as a ‘human right’ vs. ‘citizenship right’ is a divisive public debate in the United States particularly when connected to issues of immigration (Luhby, 2019). At the same time, professional organizations such as the American Medical Association (AMA) have issued ethics policy statements on undocumented health care. AMA H-440.876 states their opposition to criminalization of medical care provided to undocumented immigrant patients (AMA, 2014). Within individual healthcare interactions, research on Latino immigrant families documents parents often rely on their children to be linguistic, cultural and media brokers or intermediaries when they have limited English language facility in the context of health care and other settings. Immigrant children are able to perform this role due to their advanced language skills and cultural knowledge (Katz, 2014). Katz conceptualizes brokering as not just an individual phenomenon experienced by immigrant children, but also part of family and institutional communication systems.

Health and healthcare structures, and by implication, the families who must navigate within these systems, are deeply intertwined with political/legal structures. Claudia worried about her own and her daughter’s mental health with the change in political party at the national level that directly coincided with the timing of our interviews. Artiga and Diaz (2019) reported that changing political messages and policies affect the health seeking behaviors of immigrants, both legal and noncitizen. Research reviewed by these authors for the Kaiser Family Foundation suggested that fears resulting from the former Trump administration policies caused families to turn away from utilizing programs and services for themselves as well as their children, who were primarily US born citizens. And, further, they argue that decreases in coverage for immigrant families “would increase barriers to care and financial instability, negatively affecting the growth and healthy development of their children” (p. 5). Similar to the work of Sun and Dutta (2017), meaning structures, in this case political ones, about the risk of healthcare seeking can intersect with embodied materiality as individuals may choose to delay or forgo necessary health treatments. The ongoing political/legal negotiation of immigration status and related healthcare access can be seen as recently as the June 2021 Supreme Court ruling stating that immigrants living in the United States with temporary protective status – most often granted for humanitarian reasons, including fleeing political violence or natural disasters – are ineligible to apply for permanent residency (Barnes, 2021). Thus, healthcare for these immigrants, such as Jose, is tied to the TPS designation; if the status is revoked, according to the ruling, they are unable to apply for citizenship and will lose health coverage as well as legal status.

Finally, community structures also are critical to understanding immigrant health and health communication. In the context of mental health, for example, research documents the primarily protective value of social support from communities, extended family members, friends and neighborhoods (see Kia-Keating et al., 2016 for a review). Claudia mentions social support provided by community and church members in the form of warnings about sightings...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Contributors
• Preface
• 1 Health Communication in Mixed Status Latino Immigrant Families in the United States
• 2 Cultural Factors Influencing Health Literacy, Health Care Access, and Health Behaviors Among Korean-Americans
• 3 Addressing the Health Communication Challenges facing Chinese American Immigrants
• 4 Survival Against Odds: Undocumented Immigrants and Communication about Policies and Access to Health Care in the United States
• 5 Language Barriers as a Social Phenomenon: Distinctive Impacts on Health Communication in Japan and the United States
• 6 Mapping Young Female Refugees’ Personal Communication System for Health Promotion: A Pilot Project in the United States
• 7 Communicating COVID-19 Health and Safety Measures to Vulnerable Communities: The Case of Refugees and Migrants in Austria and Germany
• 8 Segregation within Welfare Societies – Communication Barriers to Migrants’ Healthcare in Scandinavia
• 9 Diffusion of Information and Influence for Promoting Health among Joseon-Jok Workers in South Korea
• 10 Immigration, Social Support, and Well-Being: A Case Study of Immigrants in Hong Kong
• 11 Covid-19 Pandemic Experienced by Migrant Workers in Densely Populated Singapore: Case Perspectives for Health Communication
• 12 Health Communication Barriers Faced by Rohingya Refugees During COVID-19
• 13 Communicative Health Promotion for Refugee Children in Uganda
• 14 South-South Migration and the Health Communication Concerns Confronting Venezuelan Refugees in Peru
• 15 Ecological Message Design Strategies Based on Narrative Evidence from Immigrants and Refugees in Diverse Socio-Cultural Contexts
• 16 Health Campaigns and Message Design for Immigrant Populations
• Index