1. Copyright © 2008 Delmar. All rights reserved. Chapter 26 Immigrant and Refugee Populations

2. Copyright © 2008 Delmar. All rights reserved. 2 Migration Patterns Estimated 150 million people live outside their native country Trends in movement –Sending countries: Mexico, Afghanistan, Philippines, Pakistan, China, Colombia

3. Copyright © 2008 Delmar. All rights reserved. 3 Migration Patterns Receiving countries: –Germany –Former Soviet Union –United States Accepts more than any other country –Canada

4. Copyright © 2008 Delmar. All rights reserved. 4 Immigration Policies National policies divide immigrants into three groups: 1.Migrant workers 2.Permanent residents/immigrants 3.Refugees U.S. Refugee Protection Act of 2001

5. Copyright © 2008 Delmar. All rights reserved. 5 Migration Migratory or seasonal workers –Low or unskilled laborers –Invited or illegally work seasonally Voluntary migration Refugees

6. Copyright © 2008 Delmar. All rights reserved. 6 Migration Premigration factors –Push factors –Pull factors

7. Copyright © 2008 Delmar. All rights reserved. 7 Socioenvironmental Conditions Immigrants and refugees may bring health problems native to their country of origin –1986 Chernobyl disaster Traumatic migration experiences –Forced migration –Impelled migration

8. Copyright © 2008 Delmar. All rights reserved. 8 Post Migration Factors Acculturation –Strategies: Assimilation Integration Separation Marginalization

9. Copyright © 2008 Delmar. All rights reserved. 9 Post Migration Factors Acculturative stress –Language barriers –Financial instability –Social problems

10. Copyright © 2008 Delmar. All rights reserved. 10 Post Migration Factors Hispanic paradox Xenophobic Racism Resilience

11. Copyright © 2008 Delmar. All rights reserved. 11 Community Context Ethnic density –Provide access to ethnic amenities –Social capital Socioeconomic issues –Home care Fastest growing field –Migrant farm work

12. Copyright © 2008 Delmar. All rights reserved. 12 Health Problems with Special Implications Stress-related chronic health problems –Hypertension –Digestive problems Communicable diseases –Tuberculosis –Intestinal parasites –Hepatitis B

13. Copyright © 2008 Delmar. All rights reserved. 13 Social Violence High rate of post-traumatic stress due to experience of traumatic events –Susceptible to: Depression, anxiety, substance abuse Avoidance, emotional numbing Nightmares/sleep disorders, irritability Difficulty concentrating

14. Copyright © 2008 Delmar. All rights reserved. 14 Social Violence May bear physical signs of past abuse –Burn marks, whipping scars, old fractures –Female circumcision –Rape Pelvic inflammatory disease Recurrent UTIs Scar abscesses Dyspareunia

15. Copyright © 2008 Delmar. All rights reserved. 15 Social Violence Human trafficking second largest crime industry in the world –Victims come from vulnerable populations –Similar medical problems as domestic violence and rape victims Bruises, other signs of battery STDs, fear, depression

16. Copyright © 2008 Delmar. All rights reserved. 16 Planning and Implementing Care Personal Responsibility and Work Opportunities Act of 1986 –May apply for citizenship after residing in the United States for five years

17. Copyright © 2008 Delmar. All rights reserved. 17 Planning and Implementing Care U.S. requires immigrants and refugees to submit to medical screening –Detects infectious disease Not comprehensive

18. Copyright © 2008 Delmar. All rights reserved. 18 Planning and Implementing Care Immigrants and refugees less likely to have health care insurance Seek or prefer care from lay healers or use folk remedies Public health nurses need to be aware of and sensitive to alternative medicine and practices

19. Copyright © 2008 Delmar. All rights reserved. 19 Planning and Implementing Care Programs should be designed for specific cultural attitudes Interpreter needs to be available when necessary