By Susan Downs-Karkos
Each year Colorado becomes the new home to immigrants and refugees from across the world, bringing a vast diversity of experience and perspective to our state. Their health care interactions have continued to demonstrate the need to strengthen health literacy, health system navigation and health promotion activities among newcomer populations while working with the health care system to consider the implications for services.
Integrating into a new community is never easy, and differences in language and culture typically make the task a stressful one. Of all the community institutions immigrants and refugees have to learn to navigate, perhaps none is as overwhelming or as crucial as health care. From learning about insurance coverage to even knowing how to use a physician offices phone tree, many newcomers find understanding the health care system and receiving basic services absolutely daunting.
Whether coming to Colorado for employment opportunities, to reunify with family already living here or fleeing war and persecution, our states immigrants and refugees face significant financial, linguistic and cultural barriers to receiving high quality care. Helping them overcome these challenges so that our communities continue to thrive and they can fully integrate, is an important task for all of us.
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Challenges facing this population include:
- Insurance coverage and enrollment: While it is well known that undocumented immigrants are ineligible for publicly funded health care in Colorado, even most legally present immigrants who have been in the country for fewer than five years are unable to qualify for public health insurance coverage. This leaves many newcomers at risk of avoiding health services altogether, even when they are quite ill, or only receiving care in emergency situations when it is much more expensive to provide. Even refugees, who do qualify for such health coverage upon admission into the country, struggle to fill out the redetermination paperwork to continue their coverage beyond their initial coverage period. Because it is in English, they do not know what the forms are for and frequently only realize that their coverage has lapsed after they try to receive health services.
- Receiving high quality care: From knowing how to make an appointment and then finding the transportation to get there, to having basic communication with their provider, newcomers face many challenges in receiving care. Chief among these are language access issues, for despite Title VI of the U.S. Civil Rights Act, many health care providers continue to provide language interpretation only sporadically. Many times, small children serve as interpreters for their parents, providers have relied on a patients very limited knowledge of English, or housekeeping staff have been called in to serve as interpreters. Without using professional interpreters, patients are at great risk of lacking a basic understanding of their physicians instructions and are unlikely to receive good care.
- Health literacy and health navigation: The U.S. health system is drastically different than those in the countries from which most newcomers come. Most learn to navigate it through trial and error. For example, one young woman from Asia became despondent when her baby had a high fever. Rather than knowing to simply try over-the-counter medication to bring the childs temperature down, she dialed 911 and an ambulance took the baby to the hospital where Tylenol was administered. Indeed, the U.S. Department of Health and Human Services has identified health navigation as a priority area for addressing racial and ethnic health disparities.
- Health professions: Having a diverse workforce is recognized as one important way to reduce racial and ethnic health disparities. Many immigrants have expressed concerns that when they have received health care services, they have felt a communication gulf between themselves and their providers, partly due to language and cultural differences. In some cases, this has been extreme, such as when a man from Somalia was not told that his pregnant wife was being rushed into surgery for a cesarean section. For hours he tried to find someone who would explain to him what was happening and, in the process, missed seeing the birth of his baby.
Spring Institute for Intercultural Learning has launched several health initiatives to improve the health of Colorados immigrants and refugees. These efforts are in addition to language interpretation and interpreter training, ESL classes, workplace readiness classes and cross-cultural communication workshops that we have offered for years.
Spring Institutes Project SHINE pairs AmeriCorps volunteers with older adult immigrants and refugees to deliver health literacy classes and one-on-one assistance with health navigation. By delivering health content and activities in apartment complexes, English classes and faith-based organizations the places where newcomers frequent Project SHINE has already witnessed positive health changes.
Many participants report more confidence in talking to their doctor, can now navigate Medicaid re-enrollment and make healthy changes to their diet and exercise levels. A soccer club is starting at one of the apartment complexes. A new community garden has just been established and a host of people are receiving one-on-one assistance with health care appointments and medications. The sense of isolation that many newcomers feel is slowly abating as they become connected with each other through health.
Colorado Welcome Back provides foreign-trained health professionals including doctors, nurses, pharmacists and dentists with educational case management to help them establish realistic short- and long-term goals for their health care careers in the U.S. Rather than driving taxis or working in the retail sector, Colorado would be much better served to have these health professionals providing culturally competent care to our medically underserved communities, in particular. Many are overwhelmed by re-credentialing requirements and benefit from trusted information, guidance and consideration of alternative health care careers.
Immigrants and refugees are relying on health care policymakers, the health care system and nonprofits to adopt policies that will enhance their access to health. Colorado has the opportunity to benefit from the talents and skills of immigrant and refugee health professionals. Only we can make it so.
Susan Downs-Karkos is director of Integration Strategies at Spring Institute for Intercultural Learning. Spring Institute seeks to strengthen the health and cohesiveness of communities by helping immigrants and refugees integrate successfully into their new country and community and by helping longer-term residents understand the economic and cultural contributions that newcomers bring.