The issues related to immigrants and the health and other concerns of people living in border communities are complex and controversial and have policy and political aspects. While the concerns related to immigrant populations are felt across the United States, they are especially significant in 6 states. The states of California, Texas, New York, Florida, Illinois, and New Jersey are home to two thirds of the foreign-born population.1 The articles in this issue of Family & Community Health (33.4) describe a variety of programs directed toward minority populations. Particular attention is given to the Hispanic population since this is the most rapidly growing minority group in the United States. Other groups discussed are immigrants from Asian countries and Russia as well as immigrants living in the United States as well as in Mexico and Curacao in the Caribbean.
It is useful to clarify exactly what an immigrant is: there are 4 categories of foreign-born people in the United States. The first group, legal immigrants or lawful permanent residents, are not citizens but are legally allowed to live in the country. Once they have lived as qualified legal immigrants in the country for 10 years, they are eligible for such benefits as Aid to Families of Dependent Children, food stamps, Medicaid, and unemployment benefits. The second category is that of refugees. These individuals came to the United States to seek asylum due to fear of persecution in their own country. The third category refers to nonimmigrants and refers to people here for a limited time such as students, tourists, or temporary workers. The last category, and the one that is raising the greatest concern, includes unauthorized immigrants or illegal aliens. Some of these individuals have crossed the border illegally and others have let their legal permission to stay expire. They are eligible for only emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches. The government publication, A Description of Immigrant Population Health,1 describes the immigrant categories and explains the benefits to which they are entitled. Many states in the United States are struggling with whether to provide services to unauthorized immigrants, and if they do provide services, what kind can they afford to provide and who will pay for them?
The key to good health is prevention, and health education is a core component of prevention. Several of the articles in this issue describe tools and techniques for providing culturally relevant health education in a language, location, format, and manner that participants can understand and relate to. We could ask these questions: Will the proposed health reform plan in the United States provide services that will more adequately meet the health care needs of immigrants and people living in border communities? Specifically, will there be more community health centers in both urban and rural areas to provide quality, accessible and affordable primary care, and management of chronic health conditions? Will school health clinics be increased to provide on-site screening and primary care to children and youth? Will there be increased funding for the health care professionals who can provide the services needed by these at-risk populations in settings that they can locate and in a cost-effective manner? In particular, will there be more individuals entering health care who represent the minority populations discussed in this issue? If the contention is correct that immigrants respond more positively to practitioners who speak their language and understand their culture, then increasing the diversity of the health care workforce remains a priority.
I hope that you will find the articles in this issue both interesting and useful to your work with immigrant and other populations who need good, reliable, and available health care.
Jeanette Lancaster, PhD, RN, FAAN
REFERENCES