The Different Approaches to Promoting Health

I found it really interesting that both speakers we've had so far have touched upon the importance of addressing non-medical issues as a way of improving the health of communities. Dr. Wise emphasized the role of addressing social equality, poverty, and access to care as factors that affect health while Dr. Garcia discussed the different ways in which one can advocate for patients even without being a health care provider. I think this is important for a variety of reasons. First, it allows us, as undergraduates, to see that it is possible for us to do things to help make a difference even though we do not have any formal medical training. More importantly, such thinking forces us to look deeper into health issues so that we may attempt to solve the underlying problems that give rise to these issues.
I particularly liked the pie graph that Dr. Garcia showed us at the beginning of his talk, as this graph made me aware of the many factors that come into play to determine one's health. By realizing this, a person can begin to think more creatively about healthcare and can look at health from different perspectives, which in turn can lead to creative solutions that promote patient advocacy and health. This is especially important for those of us who may be interested in medicine/health but also in other areas such as politics, international development or eningeering. From the talks of the past 2 weeks alone, we have seen a few examples of how one can use the tools and knowledge of their field of interest/exxpertise to make their mark in affecting the health of hundreds or even thousands of individuals (by creating a new drug/device/treatment, helping pass a certain legislation, etc). By realizing that we can affect health in a number of ways, and not just by going to medical school, we can pursue our other interests without feeling like we are abandoning our goal of promoting healthcare.

Hello all,

In response to our discussion about immigration last week, I think it's fitting to share with you Obama and Biden's plan to deal with this issue.

Barack Obama and Joe Biden's Plan

Create Secure Borders

Obama and Biden want to preserve the integrity of our borders. He supports additional personnel, infrastructure and technology on the border and at our ports of entry.

I think what makes a nation is the the integrity of its border. The nature of our society now is that it is run on this separatist belief. No matter how idealistic we want to be and embrace unity and peace, we still have to live with the fact that we have borders and with that, we have to protect them.

Improve Our Immigration System

Obama and Biden believe we must fix the dysfunctional immigration bureaucracy and increase the number of legal immigrants to keep families together and meet the demand for jobs that employers cannot fill.

The fact that this new administration recognizes that families are being separated during this enture ordeal is very sensitive and noble of them. Nevertheless, "fixing" the immigration bureacracy is not nesscearily a snap of the fingers. I liked Paul Wise's idea of efficacy both downstream and upstream. How can we "fix" this problem most effeincetly? Dealing with immigrants as they enter the US or even before they want to leave Mexico?

Remove Incentives to Enter Illegally

Obama and Biden will remove incentives to enter the country illegally by cracking down on employers who hire undocumented immigrants.

This makes sense right? But what the video showed us was how hard it is for farmers to get by without undocumented immigrants and still make a profit. Then there is a whole other issue of who is going to enforce these rules. Would it requre more beaucracy?

Bring People Out of the Shadows

Obama and Biden support a system that allows undocumented immigrants who are in good standing to pay a fine, learn English, and go to the back of the line for the opportunity to become citizens.

I am a big fan of this reform. The cycle of deportation and then reentering the states is a costly one. Why not spend the money assimilatig and educating people to become active citizens?

Work with Mexico

Obama and Biden believe we need to do more to promote economic development in Mexico to decrease illegal immigration.

Very upstream reform. This is most likely the ultimate goal.

I know these aren't my own personal solutions to the problem but sometimes, in situations like these I feel like we have to be realistic, rational and work with what we have.

Education as a means of Migrant worker advocacy

So I know we've been talking a lot about how to improve conditions for the migrant workers themselves, but we should also consider how the workers' families are being affected. Some workers leave their families in Mexico and send money home, but others bring their relatives and make a new life here. For the children of these workers, it can be very difficult to get ahead in the US, given the social, cultural, and economic barriers often created by their situation. One way we can invest in migrant families is by investing in the education of the workers and their children. Some of the workers are still in their teen years, and I believe we should make education more accessible for them, whether it be a high school or college education or even vocational training. Special, low-interest loans could be made readily available to workers and workers' children so they can improve their socioeconomic situation. This investment will eventually bring dividends for the rest of society by increasing the number of educated, trained individuals in the workforce. I realize this requires a large economic investment, at least initially, on the part of taxpayers,  but this investment could circumvent later expenditures in healthcare, welfare, and other social services.

-Sam

Tara's Blog Post Regarding Illegal Immigrants

http://www.nytimes.com/2008/07/27/us/27immig.html?partner=rssnyt

In another NPR news clip that I was listening to about this Iowa meatpacking plant, they said that the owners face 9,000 accounts of child labor accusations, and if convicted, the maximum penalty was 700 years in prison. Yes, you read that right -- 700 years. Isn't that a little bit harsh of a penalty? I think so.

Let me qualify my statements by first putting it out there that I'm completely for universal human rights, socialism, etc, but being with a group of people who all want to save the world, it's easy to lose sight of reality and be swept into the oblivion of idealism -- so I'm going to be devil's advocate, the elitist, and the Republican.

I don't understand all the hubbub about immigration policy in the United States. Yes, these migrant workers are working long hours at difficult jobs and are provided minimal compensation, but at the same time, they are entering this country illegally. On the left hand side of the New York Times article, there are interview clips with some of the underage workers. One of the kids, a 17-year-old, works from 6am until 11pm -- 17 hours shifts -- and sleeps for 5 hours each night. Atrocious. Yet he chose to stay at his job in order to provide for his family, and even though he didn't receive overtime compensation, he didn't say a word, for fear of being ousted as an illegal immigrant. It's about the same story with all of them: they work because they must provide, and they never deplore their working conditions because they live with a cloud of secrecy over their heads.

That's what they must do to survive, and they know it. If they really had a problem with that, why would they be in this country? The owners of the meatpacking plant claim that they didn't know these kids were underage. It's not hard to fathom that a 16-year-old would lie about his age in order to obtain a job that he's not supposed to have, so why is the meat packing plant responsible? Let's say that the meatpacking plant did know that the kid was underage at the time of hiring, and the kid knows that it's illegal to work at the meatplanting plant if he's under 18, so why does the kid still apply for the job? It doesn't take a genius to figure out that child labor laws exist for a reason -- because working conditions are inappropriate for children under the age of 18, and the law is meant to protect them. If these kids are purposely avoiding the protection that the law is giving them by seeking these dangerous jobs, then that's their right. And it's also their responsibility.

With rights comes responsibility. If migrants are in this country illegally, they shouldn't have the right to choose from any job they want, because they're disrespecting the laws of this country by stepping across the border without authorization. If migrants take the right of having a job, they ought to take responsibility for their actions, including stepping up to the consequences of long hours and inadequate pay. No matter how deplorable the conditions are, it's better than the conditions wherever they were coming from. And that's progress, isn't it? So what more could they ask for?

Amy's Blog Post Regarding Legacy of Shame

The documentary we watched last week encouraged me to think of how we can best serve the immigrants who come work here. The question really boils down to: what are we attacking, the leaves or the root of the problem? We should attack the leaves in the short term and make the best of the situation: that also makes us feel better, since our results are immediately visible (and we are, after all, a rather instant gratification society). However, to really make a difference, we need to identify and attack the roots of the problem.

Ideally, it would be nice to provide all migrant workers with basic needs met: adequate food, shelter, and water; adequate amenities such as shade and breaks. How do we accomplish this? Firstly, we should realize that such things, which would ideally be provided by the employer, are finite since the employers' resources are finite, and therefore the number of workers for a given farm needs to be capped, even during peak harvest season. Importantly, the roster of workers needs to be controlled directly by the employer; the documentary clearly showed that the existence of middlemen to accomplish this parceling of funds creates embezzlement issues. By eliminating middlemen, one can reduce the amount of salaries that need to go to these people and prevent the pocketing of the immigrants' extra money (which created the indentured servitude situation with the Guatemalans). This extra money that would have been pocketed can actually go to the employer to help him/her provide basic amenities for all the workers. Even if it's just a token sum for rent, etc., I think this relationship would provide both an obligatory feeling on the part of the employer to help provide cheap housing and also a sense of empowerment and legitimacy to the workers (rather than a feeling that they're existing on total charity or obligation).

• Employer-employee contract: employer needs to know all workers, employee needs to understand all terms of the contract and accept/decline accordingly. How do we enforce this?
  
• Employee standards: Migrants need to understand the situation at hand. People who have worked in the US for long periods of time have a better idea of what is acceptable, what sort of work conditions should and should NOT be endured, how people can fight. However, first-time immigrants may not know these standards, causing them to undercut the competition (since they're willing to settle for less). From a human rights perspective, however, this can only go on for so long! How can we educate and have them not settle for too little?
• Transparency of the entire process: If we need to educate, there has to be some time of transparency in the entire process. This boils down to legal immigration, which would prevent huge numbers of people from coming and being disappointed (and having to suffer through terrible living conditions). However, this process is extremely messy, as we all know.

The following is just a list of some other problems:

• Job competition with US citizens: We noticed that the woman in the documentary, who had worked in the fields for 40+ years, and who loved her job, was fired because of the competition from cheaper labor. Is this fair?
• Market: We are all partially to blame, as we love our cheap goods (look at the explosive success of Walmart, even though we all know they treat employees terribly! After all, do civilized people really run each other down in shopping sprees? What does civilized even mean??) So, we're more willing to buy, say cheaper imported foods--and even with tarrifs on these imports, the domestically produced goods can't be too expensive or consumers will complain. Because they can't sell too high, farmers need to produce more cheaply, which translates to lower salaries to workers, more human rights issues, etc.
• Insurance premiums: These are way too high!! It seems like most problems these days boil down to insurance companies.
  

This is by no means an exhaustive list--or even a truly accurate one--but since there are so many issues at hand I think it's important to get them down and think about each one logically so we have more of a chance of really solving the problem.

the value of migrant workers

     The issue of migrant workers is very complicated and as such, require creative solutions are required to help these people. The fact that the U.S. economy would not hold up without these workers makes them indispensable (in "Legacy of Shame' it was even mentioned that some immigration services people had a "hands off" policy when it came to illegal migrant workers)    and the fact that these workers want these jobs makes it impossible to get rid of migrant workers. I think migrant workers should take advantage of just how important they are to the U.S. economy, and in doing so, they could help better the conditions under which they work. The only problem with this is that all, or at least most,  workers must "play by the rules." For example, there were many instances in the documentary in which workers said they did not report harsh conditions or retaliate against wrong practices (farmers paying them for fewer hrs than they worked, pesticides being used around them, etc) because they knew that if they did, they would easily be replaced by another worker. Thus it can be inferred that if this were not the case (ie: if it weren't so easy to replace one migrant worker with another), the migrant workers would have more freedom to bargain and get the condition and wages that they deserve; they would not be afraid to speak up for fear of losing their jobs. 

   While this may not be easily achieved, there are a few ways in which to make migrant workers realize their full value and as such, keep them from selling themselves short. This should be done by educating the workers about how valuable they are and try to convince them to bargain for better pay and conditions. The success of this will depend on just how many workers take this attitude rather than settling for the status quo. Those seeking to help migrant workers can educate migrant workers about their full value and encourage them to not settle for current conditions. They should also encourage these workers to spread this mentality (and the benefits of not settling for current conditions) to others they know who may also be considering coming to the U.S. to find work. This information can also be spread via pamphlets (in Spanish) and by getting the word out in towns where these workers come from.

Health Problems among Migrant Farm Workers and Children

Obviously we all know that the health of the average migrant worker is pretty bad-what with working in the intense heat, being exposed to pesticides and having little resources for maintaining good health, it's not a big surprise.

But when I read this article from the U.S. Eric Digest (http://www.ericdigests.org/1993/migrant.htm)
and learned that the infant mortality rate for migrant children is 125% higher than the national average, I was shocked. When I saw that about 300 migrant children died from work-related injuries in 4 years, I was outraged.

Agricultural labor is definitely one of the most difficult professions one can have, so it's expected that accidents will happen and injuries will occur; it's a tough job, but someone's got to do it. It's a fallacy that migrant children as young as ten years old often have to spend their childhood working alongside their parents in fields and factories, just to help their family get by. Unfortunately there's no way of changing that.

But there IS a way to keep migrant children from dying from accidental and heat related injuries, and death from chemical poisoning can definitely be prevented. Laws and legal protection for migrant workers and their families, which is currently limited, needs to be strengthened and well enforced; migrant workers need to be educated in the best ways to care for themselves and their families while doing fieldwork; migrant families need access to drinking water and shade.

A good 90% of the health issues migrant workers and their families are dealing with can be prevented; so why aren't they being prevented?

humanitarian extremism

Is it just to deny impoverished immigrant workers entry into the US? I would argue no, it isn't. Consider this contrived little parable that I made up: The water pipe breaks in your neighborhood, cutting off you and your neighbors' water supply. Luckily for your family, your dad is one of those "always be prepared" boy scout types, so you have a stockpile of bottled water in your basement. It's really hot out, and your neighbor's family is showing symptoms of severe heat stroke. Would you keep the water for yourselves, or share with your neighbors and keep them alive? You paid for all the water, and you have no idea how long it will be until the pipe is fixed again. Is the situation of denying the immigrant worker a job different from denying the neighbor water? Should the potential adverse effect on your own family prevent you from helping your neighbor?

Many Americans are outraged that "illegals" are taking jobs, clogging ERs, disrupting education, and "imposing" their cultures on America. These are all valid concerns (except the last one), and I don't mean to sound too condescending by dismissing them, but quite frankly, I think it's ridiculous that Americans feel like immigrants owe them a huge debt. I'll go back to the water analogy - it's like expecting your neighbors to pay you for the water you give them after they have been helping you to fix your broken pipes the entire day. Immigrants, illegal or legal, work in America's economy, to benefit American consumers. American companies take advantage of the poverty in their home countries by hiring cheap labor. U.S. interference in countries like Nicaragua and Haiti perpetuated civil wars and propped up dictatorships against the people's wishes. Our addiction to drugs gives cartels and gangs the funds they need to continue to destabilize entire regions (and governments, for that matter).

And we complain that they aren't paying taxes on their meager paychecks.

Is it possible for us to let go of our self-interests, our nationalism, and our pride to realize that maybe it is we who owe them something? Like a few of our opportunities in this "land of opportunity?" I didn't earn my status as an American - I just happened to be born in the right place. I see no reason not to share my resources with people who did not have the luck that I had. The "illegals" are no less worthy of a dignified, fulfilling life than I am, so who am I to deny them the pursuit of happiness?

The North American Free Trade Agreement( NAFTA) consists of three distinct economies: wealthy United States, middle-class Canada and striving Mexico. The agreement was meant to create millions of jobs, reduce mexican immigration and raise the quality of life from "the Yukon to Yucatan." Talks about the program began under President George Bush and the agreement was passed under Bill Clinton's administration. Since then the agreement has been subjected to much criticism such as the deindustrialization of the US, the strained relationship between Canada and the US, and the failed economic promises of Mexico.

After NAFTA was passed, the United States invested money into Mexico's factories, factories to build automobiles, electronics, etc. Mexico was expected to invest in infrastructure, education, housing and sanitation. Mexican president Carlos Salinas de Gortari assured the Clinton administration that Mexico would do its part. But, this did not happen. Instead, mexican manufacturers were being shut down because they were no longer protected by tarriffs. Maquilladoras, or cheap-labor, fast and high quality factories began to open in the border towns of Mexico and US. These factories soon replaced Mexican-owned manufacturers.

Next, the agriculture business in Mexico did not run its planned course. Under the NAFTA agreement, politicians assumed Mexico would transition to producing strawberries and vegetables, instead of massive amounts of corn and with the help of foreign investment, they export the products to the US. Instead, the farmers exported on their own, partly because Mexico reduced the tariffs on corn. Then, in the same year NAFTA was passed, Mexico experienced an economic crisis from '94 to '95.

Meanwhile, immigration has increased. In addition to the poor economy in Mexico, many new people are immigrating to the US to reunite with their families. It is a natural action and sometimes economics are not involved.

More information about NAFTA and immigration can be read in this New York Times Article:http://www.nytimes.com/2007/02/18/weekinreview/18uchitelle.html?scp=3&sq=NAFTA&st=cse

One Practical Approach to Help Migrant Farmers

We had a brief discussion in class about whether we should help Mexico so it becomes a much more independent country. We also debated whether we should let these migrant farmers freely move in and out of the country so they are no longer illegal immigrants. The more important goal is that we must directly solve the imminent problems, specifically the health issues and living conditions of the migrant farmers. Although it is possible to raise the price of the agricultural products such as bell peppers by only 10 cents, many citizens would be unwilling to do so because they are not yet aware of the living and health conditions of these farmers. Also, the increase of the already expensive products will more or less affect the economy because of the fact that a rise in food price will ultimately increase the living expenses in general.

 Thus, a solution that would have immediate effect would be to mainly focus to improve the living conditions and to solve the medical problems that are the result of overworking in a pesticide-cover fields. One can start by drawing attention of the government to enforce the regulations that have already been passed to help the migrant farmers. For instance, there should be regular checkups by local inspectors to see whether farm owners are providing proper housing and shaded areas for resting.

Effects of Economic Downturn on migrant workers

An article from the front page of the Sacramento Bee on Thursday, January 15, reported that the recent economic downturn is NOT resulting in an increase in the number of migrant workers returning to their home countries. To read the article, please follow the link:

http://www.sacbee.com/341/story/1543628.html

While this article did not provide any hard numbers with respect to changes in immigrant inflow and outflow, I did find an interview with one recently laid off construction worker particularly telling. He said that while not having a job in the U.S. has provided him with fewer reasons to remain in the U.S., he would still rather stay here than return to Mexico because he knows how difficult it will be to try to reenter the U.S. if and when the economy recovers. The article also touched upon a topic we were discussing during last week's class. That is, the overriding obligation many migrants feel towards supporting their families back home. According to the Migration Policy Institute, the amount of money being sent back home to families in central and south America from the U.S. has not faced a significant decline because of the recession. Legal and illegal immigrants are choosing to sacrifice their quality of life and spend less here in the U.S. (where goods may be significantly more expensive than in their home country) rather than allow their families back home to suffer. This makes me question a comment I made last week with regards to the practicality of a migrant worker program in border states. I contended that if workers from Mexico were allowed to enter the U.S. every day to work and the allowed to leave freely, there might be fewer migrants who choose to stay in the U.S. on a permanent basis. While this argument may still be true, the sense of responsibility and promise of a better life in the U.S. seems to be a very compelling reason why many choose to stay in the U.S. for a longer period of time than they might otherwise (especially if work is not guaranteed on a day to day basis).

Finally, the parallels that the author brought up between migration in Europe and North America seemed quite intriguing. I read somewhere else (http://www.alternet.org/immigration/118048/a_better_way_to_end_unauthorized_immigration/) that the EU's approach to full economic integration and more open borders has drastically reduced the number of immigrants who choose to permanently stay in foreign countries for economic reasons and has built greater economic parity among at least Western European countries. This brings back a point brought up in our discussion on Wednesday as to whether it's the U.S.' responsibility to help Mexico and Central American countries bolster their own economies. While I personally believe that the market will work to correct itself (aka free trade is good), the issue of "illegal" immigration might become less of an issue should the U.S. approach the issue of economic integration more from a perspective of lending a helping hand and less so from an "exploitative" perspective (let's face it, we're in love with cheaper foreign goods).