Running head: HEALTH CARE DISPARITIES PAPER 1

Health Care Disparities and Health Care Policy Paper

Migrant Workers

Kristyn M. Beaver, RNC

Ferris State University

HEALTH CARE DISPARITIES PAPER 2

Abstract

Health disparities can be linked with public policy. Migrant workers in this country have

multiple disparities and social determinants to health. The North American Free Trade

Agreement, otherwise known as NAFTA, has been linked to contributing to disparities along

with laws that promote racial profiling; like the immigration law enacted in the state of Arizona.

The new Affordable Care Act, enacted in 2010, does not include undocumented immigrants.

These public policies will be discussed with how they contribute to the health disparities and

social determinants of health for the Mexican migrant worker.

Keywords: NAFTA, social determinants, health disparities, immigration, migrant

workers, Affordable Care Act.

HEALTH CARE DISPARITIES PAPER 3

Health Care Disparities and Health Care Policy Paper Migrant Workers

The definition of determinants of health is “factors that affect the outcomes of health

status, such as physical environment, social environment, health behaviors, and individual health,

as well as broader factors such as access to the health services and overall health policies and

interventions (Harkness and DeMarco, 2012 p. 45). Health disparities are described as “racial or

ethnic difference in the quality of healthcare” (Harkness and DeMarco, 2012 p. 25).

The Mexican immigrant has been in the news a great deal in the last year. In 2010,

Arizona enacted a new law granting state police “arrest authority for administrative violations of

federal immigration law, even though state police do not even have that authority under federal

law” (as retrieved from www.americanprogress.org., para. 2). This law encourages racial

profiling; not only of Mexican immigrants, but also anyone meeting the description of a Mexican

immigrant. This laws, and laws like it, contribute to the disparities of this population.

Another policy that our government has that contributes to the Mexican immigrant’s

health disparity and social determinant of health is the North American Free Trade Agreement,

or NAFTA. This agreement first signed into law in 1994 by then president Bill Clinton with

neighboring countries Canada and Mexico. This agreement was to promote free trade between

the three countries, with the goal of promoting a better economy in Mexico and bring higher

paying jobs to Mexico and the United States. This agreement was the first of its kind between

three very different nations in very different stages of economic growth (as retrieved from

www.citizen.org/page.aspx).

The third of the policies is the Affordable Care Act. In this reform to the American

healthcare industry, all Americans will be required to have health insurance. Insurance prices are

to go down and if one cannot afford insurance, there will be subsidies provided to help cover the

HEALTH CARE DISPARITIES PAPER 4

cost (Errickson et al., 2011). However, undocumented immigrants are excluded from this reform,

further limiting access to affordable health care (Errickson et al., 2011).

Health Disparities

While working on the pretext of protecting American interests, these policies ultimately

negatively impact the whole population. Harkness and DeMarco (2012) point out those policies

like the Arizona Immigration law that promote the “us and them” mentality for “those who

deserve care and those that do not” (p. 336) contribute to the disparities. Healthy People 2020, a

governmental initiative that is to promote equality in health and health care, cite immigrants as

one of the seven populations at risk (Harkness and DeMarco, 2012). This population has limited

access to health care with relation to their mostly rural location; farms; and lack of or limited

transportation to seek care. Poverty limits their access to care; in that they cannot afford health

insurance. This populations only health care is when they are so sick, then they are forced to seek

help in the Emergency Room, at a much higher cost than preventative medicine. Rural

communities in which migrant workers live have limited resources available (Harkness and

DeMarco, 2012). Language barrier is another obstacle that an immigrant must face; healthcare

should be delivered in a client’s native language. Rural clinics and hospitals have limited

resources for these services.

Social Determinants

The Mexican migrant workers social determinants include isolation due to rural location

and language barriers. They live in poverty due to limited education opportunities and low

paying jobs as a result of this. In the cases of the Mexican migrant workers in Michigan, they are

not offered medical insurance as they are seasonal workers who only live in the state for the

growing season. Laws like the one in Arizona, further alienate these people, discouraging them

HEALTH CARE DISPARITIES PAPER 5

from seeking health care for chronic or minor illnesses until these illnesses are out of control and

they are in need of major medical attention. Fear of deportation or incarceration is a driving force

in the migrant worker not obtaining medical care. The Affordable Care Act does not allow

undocumented workers from participating in the insurance exchanges; this puts them at further

risk of alienation (Errickson et al., 2011).

Racism and prejudices contribute to their social separation. Language barriers make it

difficult to communicate need and limit their ability to obtain citizenship; especially if they are

illiterate.

As mentioned above, NAFTA was to help Mexico attain financial independence and raise

the standard of living there. This has not happened, in fact, the opposite has happened. Jobs that

were once higher paying jobs have since moved overseas to China; just like they have for

Americans. Once China joined the World Trade Organization (WTO), they were able to offer

labor at a much lower price; contributing to the poverty in Mexico (as retrieved from

http://topics.nytimes.com). Jobs moving overseas have caused an influx of Mexican immigration,

which has climbed sixty percent in the first six years of NAFTA alone, and undocumented

numbers has skyrocketed 185% (as retrieved from www.citizen.org/pages.aspx). All of this

contributes to the hostility seen in society in areas like Arizona; the point of entry into the USA.

These events increase the health disparities and social determinants to health for this population.

Personal Bias in Healthcare

No matter whom it is; a Senator or House of Representative member or a nurse or doctor,

personal bias affects how we act and what we believe. This in-turn affects healthcare delivery

from doctors or nurses and policies made by lawmakers. Each person is a product of their

culture; culture of family, religion, region of the country and country he/she lives in.

HEALTH CARE DISPARITIES PAPER 6

Understanding how one is brought up and what your “culture” is will help in identifying areas

that may impact society (in the case of lawmakers) or individual and family care (in the case of a

doctor or nurse). To be aware of these biases or prejudices is the first step in eliminating them;

from public policy to care of the patient in the hospital or clinic (Galanti, 2008). There must be

equality in healthcare if there is to be elimination of the disparities that exist.

The Affordable Care Act has excluded much of this population from participating in the

insurance exchanges (Errickson et al,2011). Most Americans, when poled, do not want to let the

undocumented workers participate in state or federally funded programs (Sanchez et al, 2011).

Although the Affordable Care Act will help millions in obtaining health insurance, Congress still

has much work to do with immigration issues to decrease the continued disparities suffered by

this population (Errickson et al, 2011). This adds to the disparities suffered by the immigrant.

To help decrease some of the social disparities, there needs to be an acceptance of other

cultures and social justice in regards to healthcare reform and income equality. Schools must

have equality in programs that are offered to students. By improving education, poverty should

decrease. Poverty is a key factor in many social and health inequalities. Nurses can take

opportunities to teach healthy living on limited budgets, educate their clients on Medicaid

enrollment, and work with local politicians and religious organizations to reach out to various

communities that are in need and most at risk. Emergency Medicaid can be obtained by

undocumented workers to cover pregnancy at this present time (Errickson et al, 2010). It is

important to know the community, its culture and its people, and programs that exist to help

those in need.

Nurses, collectively, can bring about change in public thinking regarding social justice

and inclusion of undocumented workers into the new insurance exchanges created by the

HEALTH CARE DISPARITIES PAPER 7

Affordable Care Act. By sheer numbers, nurses can bring about change in society’s thinking

regarding the value and benefits of caring for the very poor, such as the migrant worker. Without

proper preventive care, when the poor enter the system taxpayers usually spend much more

money to care for them. Fundamentally, it makes much more sense to include this population in

the insurance exchanges to get the proper preventive care to maximize health.

HEALTH CARE DISPARITIES PAPER 8

References

Arizona Immigration Law Retrieved from www.americanprogress.org/issues/2010.

Errickson, S.P., PT, PhD, Alvarez, M., MHA, Forquera,R.,MPH, Whitehead, T.L., PhD,

MSHyg, Fleg, A., MD, Hawkins, T., BA, Browne, D.C.,MSW,DrPH, Newsome,

M.C.,PhD, Schoenbach, V.J., PhD (2011) “What will health-care reform mean for

minority health disparities?” Public Health Reports. 126, 170-175.

Galanti, G.A. (2008). Caring for patients from different cultures. Philadelphia, PA. University of

Pennsylvania Press.

Harkness, G.A. and DeMarco, R.F.(2012) Community and public health nursing: evidence for

practice. Philadelphia, PA. Lippincott, Williams and Wilkins.

Malkin, E. (2009) NAFTA’s promise, unfulfilled. Retrieved from

http://topics.nytimes.com/topics/reference.

North American Free Trade Agreement Retrieved from www.citizen.org/page.aspx?pid=531

Sanchez, G.R.PhD, Sanchez-Youngman, S., BA, Murphy, A.A..R, PhD, Goodin, A.S., MA,

Santos, R. PhD, Valdez R.B. PhD (2011). Explaining public support (or lack thereof) for

extending health coverage to undocumented immigrants. Retrieved from http://0-

muse.jhu.edu.libcat.ferris.edu/journals/journal_of_health_care_for_the_poor.

HEALTH CARE DISPARITIES PAPER 9

CHECKLIST FOR SUBMITTING PAPERS

CHECKDATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

4/2 kmb 1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]

4/2 kmb 2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40]

4/2 kmb 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41]

4/2 kmb 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42]

4/2 kmb 5. Margins: Did you leave 1” on all sides? [p. 229]4/2 kmb 6. Double-spacing: Did you double-space throughout? No triple or extra spaces

between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59]

4/2 kmb 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]

4/2 kmb 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.

4/2 kmb 9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]

4/2 kmb 10. Typeface: Did you use Times Roman 12-point font? [p. 228]4/2 kmb 11. Abbreviation: Did you explain each abbreviation the first time you used it? [p.

106-111]4/2 kmb 12. Plagiarism: Cite all sources! If you say something that is not your original idea,

it must be cited. You may be citing many times…this is what you are supposed to be doing! [p. 170]

4/2 kmb 13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this:“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, 2007, p. 1).Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]

HEALTH CARE DISPARITIES PAPER 10

4/2 kmb 14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]

4/2 kmb 15. Paraphrase: A paraphrase citation would look like this:Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007).It may also look like this: Bell-Scriber (2007) found that…… [p. 171 and multiple examples in text on p. 40-59]For multiple references within the same paragraph see page 174.

4/2 kmb 16. Headings: Did you check your headings for proper levels? [p. 62-63].4/2 kmb 17. General Guidelines for References:

A. Did you start the References on a new page? [p. 37]B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same.C. Is your reference list double spaced with hanging indents? [p. 37]

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE

4/2 kmb 18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.)

4/2 kmb 19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?

4/2 kmb 20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?

4/2 kmb 21. Conversational tone: Don’t write as if you are talking to someone in a casual way. For example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone?

4/2 kmb 22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?4/2 kmb 23. Did you check to make sure there are no hyphens and broken words in the right

margin?4/2 kmb 24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check

for improper use of etc. & i.e.?4/2 kmb 25. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as

“they” or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should be “The nurse who gave the injection…” Did you check for subject agreement?

4/2 kmb 26. Don’t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing profession uses empirical data…..

4/2 kmb 27. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed activities with which I was not happy.”

4/2 kmb 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

HEALTH CARE DISPARITIES PAPER 11

4/2 kmb 29. Did you have other people read your paper? Did they find any areas confusing?4/2 kmb 30. Did you include a summary or conclusion heading and section to wrap up your

paper?4/2 kmb 31. Does your paper have sentence fragments? Do you have complete sentences?4/2 kmb 32. Did you check apostrophes for correct possessive use. Don’t use apostrophes

unless it is showing possession and then be sure it is in the correct location. The exception is with the word it. It’s = it is. Its is possessive.

Signing below indicates you have proofread your paper for the errors in the checklist:

______________________KM Beaver______________DATE:___________4/2/12_____

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

________________________________________________________DATE:_______________

CHECKLIST FOR SUBMITTING PAPERS

CHECK

DATE,

TIME, &

INITIAL

PROOFREAD FOR: APA ISSUES

4/4/12 CG 1. Page Numbers: Did you number your pages using the automatic functions of your Word

program? [p. 230 and example on p. 40)]

4/4/12 CG 2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less

than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of

your title page? (Should be a few words from the title of your paper). [p. 229 and example

on p. 40]

4/4/12 CG 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and

it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the

margin without an indentation? Is your abstract a summary of your entire paper?

Remember it is not an introduction to your paper. Someone should be able to read the

HEALTH CARE DISPARITIES PAPER 12

abstract and know what to find in your paper. [p. 25 and example on p. 41]

4/4/12 CG 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not

use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the

introduction and no heading is needed. [p. 27 and example on p. 42]

4/4/12 CG 5. Margins: Did you leave 1” on all sides? [p. 229]

4/4/12 CG 6. Double-spacing: Did you double-space throughout? No triple or extra spaces between

sections or paragraphs except in special circumstances. This includes the reference page. [p.

229 and example on p. 40-59]

4/4/12 CG 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin

uneven, or ragged? [p. 229]

4/4/12 CG 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P.

229 for exceptions.

4/4/12 CG 9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]

4/4/12 CG 10. Typeface: Did you use Times Roman 12-point font? [p. 228]

4/4/12 CG 11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]

4/4/12 CG 12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must

be cited. You may be citing many times…this is what you are supposed to be doing! [p.

170]

4/4/12 CG 13. Direct Quote: A direct quote is exact words taken from another. An example with

citation would look like this:

“The variables that impact the etiology and the human response to various disease states

will be explored” (Bell-Scriber, 2007, p. 1).

Please note where the quotation marks are placed, where the final period is placed, no first

name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p.

HEALTH CARE DISPARITIES PAPER 13

170-172]

4/4/12 CG 14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40

words or longer? [p. 170-172]

4/4/12 CG 15. Paraphrase: A paraphrase citation would look like this:

Patients respond to illnesses in various ways depending on a number of factors that will be

explored (Bell-Scriber, 2007).

It may also look like this: Bell-Scriber (2007) found that……

[p. 171 and multiple examples in text on p. 40-59]

For multiple references within the same paragraph see page 174.

4/4/12 CG 16. Headings: Did you check your headings for proper levels? [p. 62-63].

4/4/12 CG 17. General Guidelines for References:

A. Did you start the References on a new page? [p. 37]

B. Did you cut and paste references on your reference page? If so, check to make

sure they are in correct APA format. Often they are not and must be adapted. Make

sure all fonts are the same.

C. Is your reference list double spaced with hanging indents? [p. 37]

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE

4/4/12 CG 18. Did you follow the assignment rubric? Did you make headings that address each major

section? (Required to point out where you addressed each section.)

4/4/12 CG 19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing

unless punctuation is present. If you become breathless or it doesn’t make sense, you need

to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?

4/4/12 CG 20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?

2nd 21. Conversational tone: Don’t write as if you are talking to someone in a casual way. For

HEALTH CARE DISPARITIES PAPER 14

paragraph

on page 6 a

little

personal???

example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over

that.” Did you stay in a formal/professional tone?

4/4/12 CG 22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?

4/4/12 CG 23. Did you check to make sure there are no hyphens and broken words in the right margin?

4/4/12 CG 24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for

improper use of etc. & i.e.?

4/4/12 CG 25. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they”

or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather

“who”. For example: The nurse that gave the injection….” Should be “The nurse who gave

the injection…” Did you check for subject agreement?

Paragraph

2 page 6

used a we

26. Don’t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be

clear in identifying. For example don’t say “Our profession uses empirical data to support

….” . Instead say “The nursing profession uses empirical data…..

Your on

your own

with this

one. I am

not good at

this

27. Did you check your sentences to make sure you did not end them with a preposition?

For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed

activities with which I was not happy.”

4/4/12 CG 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

HEALTH CARE DISPARITIES PAPER 15

Looks

good

29. Did you have other people read your paper? Did they find any areas confusing?

4/4/12 CG 30. Did you include a summary or conclusion heading and section to wrap up your paper?

4/4/12 CG 31. Does your paper have sentence fragments? Do you have complete sentences?

4/4/12 CG 32. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is

showing possession and then be sure it is in the correct location. The exception is with the

word it. It’s = it is. Its is possessive.

Signing below indicates you have proofread your paper for the errors in the checklist:

Catherine Giles________________________________________________DATE:_______4/4/12

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

________________________________________________________DATE:_______________

Revised Spring 2010/slc