Immigration, Culture and Health Care

Investigator: Alicia Fernandez, MD
Sponsor: Russell Sage Foundation

Location(s): United States


Alicia Fernandez, MD and Elizabeth Jacobs, MD will investigate alternative explanations of the “immigrant health paradox.” On average, newly arrived immigrants to the U.S. are healthier than demographically comparable native-born Americans. However, this advantage decreases and even reverses for immigrants who have lived in America for a long time. Why do immigrants become less healthy as they settle into life in America? Leading a multi-disciplinary team of social scientists and clinical researchers, Fernandez and Jacobs will consider three broad answers to this question. One explanation is that some aspect of immigrants’ native cultures reduces their health risks, and that as they adopt American customs, they lose this protective advantage. Another possibility is that immigrants’ declining health is tied to diminished self-perceptions of their social status compared to their previous status in their home country. A third explanation points to cultural and linguistic barriers between immigrant patients and U.S. health care practitioners.
Fernandez and Jacobs will conduct a survey of Mexican-American immigrants, African Americans and Caucasians with diabetes in San Francisco and Chicago, two cities with large Mexican immigrant populations. In addition to common measures of cultural integration such as language use and length of stay in the U.S., the survey will also measure context-specific assimilation: changes in immigrants’ knowledge and behavior pertaining to diabetes. The investigators will also measure participants’ objective and perceived social status, perceptions of societal discrimination, and psychological well-being. Participants will also be asked about their experiences with the health care system and about structural factors affecting their access to care, such as legal status, lack of insurance, and community support networks. At the same time, the investigators will assess the medical care participants receive, while measuring health outcomes based on both their self-reported health and on blood tests. These wide-ranging survey questions will allow Fernandez and Jacobs to assess the relative importance of acculturation, perceived social status, and cultural and linguistic barriers in determining the care diabetes patients receive and their health outcomes. By comparing Mexican immigrants to African-American and Caucasian control groups, they will be able to determine whether and how the health care system affects immigrants differently from native-born Americans. This ambitious study of the immigrant health paradox will shed important insights on the integration of immigrants into American society, as well as on growing disparities in the U.S. health care system.