Immigration As A Social Determinant Of Health

Since 1965 the foreign-born population of the United States has swelled from 9.6 million or 5 percent of the population to 45 million or 14 percent in 2015. Today, about one-quarter of the U.S. population consists of immigrants or the children of immigrants. Given the sizable representation of immigrants in the U.S. population, their health is a major influence on the health of the population as a whole. On average, immigrants are healthier than native-born Americans. Yet, immigrants also are subject to the systematic marginalization and discrimination that often lead to the creation of health disparities. To explore the link between immigration and health disparities, the Roundtable on the Promotion of Health Equity held a workshop in Oakland, California, on November 28, 2017. This summary of that workshop highlights the presentations and discussions of the workshop.

The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.

The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience. These conditions have come to be known as the social determinants of health. This information - based on decades of research and hundreds of studies in Canada and elsewhere - is unfamiliar to most Canadians. Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience. Our health is also determined by the health and social services we receive, and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living conditions are - for better or worse - imposed upon us by the quality of the communities, housing situations, work settings, health and social service agencies, and educational institutions with which we interact. Improving the health of Canadians requires we think about health and its determinants in a more sophisticated manner than has been the case to date. Social Determinants of Health: The Canadian Facts considers 17 social determinants of health: 1. Income and Income Distribution 2. Education 3. Unemployment and Job Security 4. Employment and Working Conditions 5. Early Child Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Net 10. Health Services 11. Geography 12. Disability 13. Indigenous Ancestry 14. Gender 15. Immigration 16. Race 17. Globalization The publication outlines why they are important; how Canada is doing in addressing them; and what can be done to improve their quality. The purpose of the document is to provide promote greater awareness of the social determinants of health and the development and implementation of public policies that improve their quality.

Social Emergency Medicine incorporates consideration of patients’ social needs and larger structural context into the practice of emergency care and related research. In doing so, the field explores the interplay of social forces and the emergency care system as they influence the well-being of individual patients and the broader community. Social Emergency Medicine recognizes that in many cases typical fixes such as prescriptions and follow-up visits are not enough; the need for housing, a safe neighborhood in which to exercise or socialize, or access to healthy food must be identified and addressed before patients’ health can be restored. While interest in the subject is growing rapidly, the field of Social Emergency Medicine to date has lacked a foundational text – a gap this book seeks to fill. This book includes foundational chapters on the salience of racism, gender and gender identity, immigration, language and literacy, and neighborhood to emergency care. It provides readers with knowledge and resources to assess and assist emergency department patients with social needs including but not limited to housing, food, economic opportunity, and transportation. Core emergency medicine content areas including violence and substance use are covered uniquely through the lens of Social Emergency Medicine. Each chapter provides background and research, implications and recommendations for practice from the bedside to the hospital/healthcare system and beyond, and case studies for teaching. Social Emergency Medicine: Principles and Practice is an essential resource for physicians and physician assistants, residents, medical students, nurses and nurse practitioners, social workers, hospital administrators, and other professionals who recognize that high-quality emergency care extends beyond the ambulance bay.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.

Taking an interdisciplinary approach and focusing on the social and psychological resources that promote resilience among forced migrants, this book presents theory and evidence about what keeps refugees healthy during resettlement. The book draws on contributions from cultural psychiatry, anthropology, ethics, nursing, psychiatric epidemiology, sociology and social work. Concern about immigrant mental health and social integration in resettlement countries has given rise to public debates that challenge scientists and policy makers to assemble facts and solutions to perceived problems. Since the 1980s, refugee mental health research has been productive but arguably overly-focused on mental disorders and problems rather than solutions. Social science perspectives are not well integrated with medical science and treatment, which is at odds with social reality and underlies inadequacy and fragmentation in policy and service delivery. Research and practice that contribute to positive refugee mental health from Canada and the U.S. show that refugee mental health promotion must take into account social and policy contexts of immigration and health care in addition to medical issues. Despite traumatic experiences, most refugees are not mentally ill in a clinical sense and those who do need medical attention often do not receive appropriate care. As recent studies show, social and cultural determinants of health may play a larger role in refugee health and adaptation outcomes than do biological factors or pre-migration experiences. This book’s goal therefore is to broaden the refugee mental health field with social and cultural perspectives on resilience and mental health.

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.