Immigrants & Health Care: Separating Politics from Policy

Immigrant health check

An immigrant farm worker gets a heart rate check during a visit to a mobile clinic in Colorado. John Moore / Getty Images

President Obama’s recent executive order extending legal status to millions of undocumented immigrants in this country has become a fulcrum of partisan debate. Advocates for immigrant communities have expressed disappointment that the order does not extend benefits of the Affordable Care Act to people whose status is now protected. The Obama administration has indicated immigrants who demonstrate the ability to pay taxes for at least five years will eventually become eligible, but has maintained throughout the public debate they would not immediately receive benefits.

Analysis by Bloomberg News says this has not prevented conservative critics from suggesting the order will result in millions of illegal immigrants getting medical benefits, even as  immigrant advocates complain about their stakeholders being left out.

For the nearly 11 million undocumented immigrants in the United States and the medical providers who serve them, the executive order doesn’t actually change much.

The UCLA Center for Health Policy Research reports that many immigrants access care at “safety net” community clinics and hospital emergency rooms. These clinics receive some federal reimbursement for care through emergency Medicaid and the Medicaid Disproportionate Care Hospital Program.

Politico’s analysis suggests that there may still be an uptick in the number of people in some immigrant communities who buy health insurance. That’s because legal residents who have undocumented relatives may feel more comfortable signing up for benefits.

Controlling Genes with your Thoughts

Remember the 1970’s television show The Bionic Woman? Jaime Sommers used her robotic legs, arm and ear to solve crimes for a U.S. intelligence agency.

At the time it was science fiction, but just last year researchers unveiled the first robotic leg controlled by a person’s brain, a project funded by the U.S. Army’s Telemedicine and Advanced Technology Research Center. Here’s a quick video of the leg at work:

Now, Martin Fussenegger, a scientist of the Swiss Federal Institute of Technology Zurich, has taken that technology in a new direction. He is using electrical signals sent from the brain to control the expression of certain genes that impact pain and chronic disease. If a person has a migraine, the brain transmits an electrical signal which reaches specific genes that, when “turned on,” can end the migraine. Picture Jaime Sommers with the super-human ability to control pain.

Fussenegger’s work was just published in the highly regarded journal Nature Communications. It’s quite technical, so the L.A. Times offers a layman’s version. So far experiments have involved mice and Fussenger says it will likely be 10 years before the technology is ready for human use.

An African Model for American Health Care

NPR’s Joe Palca profiles the work of City Health Works, a Harlem clinic that uses health coaches to get medical care to patients before they become seriously ill. Coaches help make sure patients stay well by visiting them after treatment to help support follow-up care, medication, and diet.

City Health Works is the creation of Manmeet Kaur and her husband Dr. Prabhjot Singh, with help from a variety of philanthropic funders.

Dr. Singh recently gave this overview of their work in Harlem, and the African model of health care delivery that inspired it, in this presentation at the Mayo Clinic’s 2014 Transform symposium in Rochester, Minnesota.

Teaching LGBT Health to Med Students

The Association of American Medical Colleges (AAMC) has released guidelines – two years in the making – for training physicians on caring for lesbian, gay, bisexual, transgender and gender nonconforming patients. “This document discusses how to integrate and assess 30 competencies for how students should be able to perform in a clinical setting,” says Kristen Eckstrand, a fourth-year medical student and editor of the guidelines. She adds:

Over the past 25, or 30 years, there’s been slowly increasing evidence about the health disparities that are faced by individuals who identify as LGBT, who are gender nonconforming, or who have been born with some kind of difference in sex development. There’s a fair amount of evidence saying that these individuals face discrimination and healthcare disparities when accessing and receiving care. There could be challenges with obtaining insurance, challenges being able to disclose their sexual orientation or gender identity, being able to name their spouse as next of kin, having providers being aware of the health concerns of the community. All of these things cumulatively add up.

LGBT individuals, we know, face disparities in mental health care. They are much more likely to attempt and succeed at committing suicide, they’re more likely to have eating disorders, more likely to have certain kinds of cancer, obesity, and cardiovascular disease. All of these things lead to increased morbidity and mortality in the LGBT community.

Medical education itself plays an incredibly important role in this, because if we can train our providers to meet the healthcare needs of the LGBT community, which makes up a good chunk of the American population, we can increase the health of 15 million Americans. That is a substantial number and not something that should be ignored.

For a quick sense of what issues the guidelines address, see health care reporter Martha Bebinger’s post on tips for treating transgender patients. It includes this brief interview with Dr. Joshua Safer of Boston University Medical School:

Dr. Safer says Boston University’s med school has the nation’s first transgender medicine curriculum focused on the biology of gender identity.

The post also links to Bebinger’s series on the challenges transgender teens face through the story of Nate, a 16-year-old transgender male.

No Joke: World Toilet Day

November 19th is World Toilet Day, an event that draws its share of casual humor. It is estimated that 2.5 billion people do not have access to toilets, a fact that leads to another: almost 2 billion people worldwide drink water contaminated by feces.

This real public health problem finds expression in various examples of media cleverness, including this World Toilet Day Quiz from The Guardian. But it’s a critical situation: meeting the world’s sanitation needs is among the least successful targets of the United Nations Millennium Development Goals, and 1000 children a day die preventable deaths because of disease caused by inadequate sanitation.

Rose George is a journalist and author of “The Big Necessity: The Unmentionable World of Human Waste and Why It Matters.” Watch her 2013 TED talk.

The Emperor of All Maladies Comes to Film

Siddhartha Mukherjee’s 2011 best-seller “The Emperor of All Maladies, a Pulitzer Prize winning “biography” of cancer, is the basis for a new PBS special by WETA and acclaimed documentarian Ken Burns premiering in March 2015.

The book offers an exhaustive history of cancer in America as well as the search for treatments and cures. The documentary series turns that sweeping story into three films presented as the past, present and future of the disease.

In the series trailer, executive producer Burns explains that his mother’s death from cancer during his childhood has had a lasting impact on him humanly and creatively.

Nature: A Global View of Depression’s Burden

According to the World Health Organization, depression “accounts for the biggest share of the world’s burden of disease, measured by years lost to disability.” This month’s issue of Nature features a series of articles and commentaries exploring the global picture of depression, the progress of science, and the issue of stigma. It includes an interview with Dan Chisolm, a WHO health economist whose work focuses on mental disorders, about the worldwide prevalence of depression and how “stigma effects everything.” The interview begins at 7:51 of this podcast:

Linda Eagle Speaker on Healing Historical Trauma

Victims of historical trauma include specific cultural groups that have been systematically traumatized by past events (e.g. slavery, genocide, colonialism, war, for example), and whose descendants experience health disparities attributed to those circumstances. The attempt to identify the effects of historical trauma is meant to help resolve the lifelong health issues that can accompany it.  (Wisdom of the Elders)

Source: Lake Roosevelt National Recreation Area

Source: Lake Roosevelt National Recreation Area

Among American Indians, historical trauma represents a history of forced removal from homelands and prohibitions against freedom of religious expression, language and other cultural traditions. American Indian ceremonies were outlawed in the United States until the early 1970s. Only recently has the forced attendance of American Indian children at boarding schools been acknowledged. Boarding schools upheld strict rules against native languages and traditions, and imposed harsh punishments for infractions.

According to the theory of historical trauma, unresolved anguish from these experiences is passed down through generations and can lead to despair, depression, drug abuse and disease. Historical trauma is considered by some a root cause of the tremendous health disparities among American Indian people. Some believe the trauma takes root in the DNA, others say it’s learned behavior and still others say there is a blood memory — we are metaphysically connected to the experiences of our ancestors.

The idea of historical trauma helps communities affected understand the roots of their own condition. In the struggle to restore health, people find something clicks into place when they understand their personal problems in the context of the history of their community.

At a recent conference in Minneapolis, Linda Eagle Speaker, a citizen of the Blackfoot Tribe and Program Director at the Minnesota Indian Women’s Resource Center, shared her story of being forcibly taken from her family and spending years in a boarding school. She says decades of hard work have helped her to heal, so she is not handing down to her children the pain of her boarding school experience.

Listen to her story here.

The Disillusionment of Doctors

Dr. Sandeep Jauhar is the author of a new book, “Doctored: The Disillusionment of an American Physician,” a memoir that relates his path from an idealistic young medical student to a harried, frustrated, and sometimes cynical practitioner in a broken health care system.

He spoke to MPR’s Kerri Miller on The Daily Circuit last week.

Growing frustration among physicians, especially primary care physicians, has led to high rates of burnout, with many doctors reporting their intention to give up the practice of medicine. A 2012 survey found 30% of American doctors between the ages of 35 and 49 reported they were planning to leave medicine.

Dr. Daniel L. Roberts, chief resident of internal medicine at the Mayo Clinic in Arizona, gives an overview of the data on doctor burnout in this 2013 video, produced by the Mayo Clinic.

ICYMI: Dessa’s Interviews at “A Celebration of Women & Recovery”

The gender gap in substance abuse has been shrinking for several years, and it’s estimated that women are nearly twice as likely to suffer from major depression than men. But while millions of women know what it’s like to struggle with addiction or some form of mental illness, the good news is many recover to lead purposeful and meaningful lives of health and wellness.

To acknowledge this major public health issue and to break down the stigma associated with addiction and mental illness, Healthy States and Hazelden Betty Ford Foundation recently presented an evening of conversation and music that celebrated women’s experiences of recovery.

The audience partakes in a body stretch exercise led by Jennifer Matesa / Caroline Yang for Healthy States

The audience partakes in a body stretch exercise led by Jennifer Matesa / Caroline Yang for Healthy States

Over 600 people gathered at the Fitzgerald Theater in St. Paul to hear writer and musician Dessa speak with two authors, Jennifer Matesa and Gayathri Ramprasad, about their own stories of recovery.

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Dessa! A talented host. / Caroline Yang for Healthy States

Matesa is author of the new book “The Recovering Body: Physical and Spiritual Fitness for Living Clean and Sober.”

WomenRecovery-12

Jennifer Matesa and Dessa / Caroline Yang for Healthy States

Ramprasad is the founder and president of ASHA International and author of “Shadows in the Sun: Healing from Depression and Finding the Light Within.”

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Gayathri Ramprasad / Caroline Yang for Healthy States

You can listen to both interviews here.