The Public Health Impact of Immigration and Border Enforcement Policy and a Service-Learning Approach to Counter Ethno Racial Health Disparities in the US-Mexico Borderlands

Abstract

Background: Historically, US immigration policy, including border enforcement, has served to define national belonging and through this process, has constructed particular groups as undesirable or threatening to the nation. Such political-economic strategies contribute to oppression through gender, ethnic, and class discrimination and economic and political exclusion. This dissertation is based on three studies that collectivity explored these issues as structural determinants of health (SDH) and forms of structural and everyday violence. Objectives: These studies aimed to (1) examine the relations between immigration related mistreatment and practices of ethno-racial profiling by immigration officials on health of Mexican immigrants of the Arizona border (2) contextualize the structural and everyday violence of such institutional practices through mistreatment narratives and (3) evaluate the impact of an intensive Border Health Service Learning Institute (BHSLI) on public health students' ability to locate such forms of violence and identify the role of public health advocacy. Methods: Study one and two are a secondary analysis of quantitative and qualitative data drawn from a random household sample of 299 Mexican-origin farmworkers. Study three is a qualitative analysis of 25 BHSLI student reflection journals from 2010-2012. Results: Farmworkers were US permanent residents and citizens, employed in US agriculture for 20 years. Approximately 25% reported immigration related mistreatment, more than 50% were personally victimized and 75% of mistreatment episodes occurred in a community location while residents engaged in routine activities. Immigration mistreatment was associated with a 2.3-increased risk for stress in adjusted models (OR 2.3, CI 1.2, 4.1). After a week at the US-Mexico border, BHSLI students articulated aspects of immigration and economic policy impacting health. Students framed economic and immigration policies as health policy and found the role of public health to convene stakeholders toward multi-institutional policy solutions. Conclusion: Immigration related mistreatment and ethno-racial profiling are historically embedded at institutional and individual levels and reproduce inequality overtime. Such institutional practices of discrimination are SDH and forms of structural and everyday violence. Academic public health programs, engaged in service learning strengthen students' abilities to learn and act on such SDH and contribute to campus-community engagement on related ethno-racial health disparities.