In This Article Expand or collapse the "in this article" section The Impact of Systemic Racism on Latinxs’ Experiences with Health Care

  • Introduction
  • Systemic Racism at the Policy Level
  • Systemic Racism at the Geographical Level
  • Systemic Racism at the Organizational Level
  • Systemic Racism at the Interpersonal Level

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Social Work The Impact of Systemic Racism on Latinxs’ Experiences with Health Care
by
Rocío Calvo, Victor Figuereo, Robert Rosales
  • LAST MODIFIED: 27 October 2021
  • DOI: 10.1093/obo/9780195389678-0306

Introduction

Race is a social construct that categorizes individuals by markers of difference, including phenotype, nationality, ethnicity, language, or immigration status. Racism is a system that allocates valued collective resources based on race. Racism is maintained by the idea that the white race is superior to other races and therefore has preferential access to resources for advancement. Systemic racism upholds, perpetuates, and justifies racism through institutions, including the health-care system. Systemic racism in health care leads to negative health outcomes for Black, Indigenous, and People of Color (BIPOC). The United States Office of Management and Budget (OMB) defines Hispanic, Latina/o, Latinx as an ethnicity that can be of any race. Latinxs experience systemic racism in the US health-care system at four levels: the (1) policy, (2) geographic, (3) organizational, and (4) interpersonal levels. First, anti-immigrant policies deter Latinxs from accessing health care, thus perpetuating health and mental health disparities. Second, immigrant enforcement policies differ by state, and access to health-care resources depends on where Latinxs live (e.g., urban versus rural, traditional enclave versus new destination). Third, systemic racism is embedded in health-care organizations, compromising the quality of care that Latinxs receive. Finally, some Latinxs experience racism and discrimination at the interpersonal level when interacting with health-care providers. This bibliography consists of peer-reviewed articles that highlight the impact of systemic racism among Latinxs at these four levels. The use of the term “Latinx” is used throughout this bibliography to be explicitly inclusive of multiple genders that are typically not represented by other terms. However, we advise that those working with Latinx populations (clinicians, researchers) use the preferred terms by which individuals identify.

Systemic Racism at the Policy Level

Racially biased immigration policies have been shown to perpetuate historical inequities, specifically in the health-care field. Bruzelius and Baum 2019 and Philbin, et al. 2018 examine how nativist approaches to immigration policy (e.g., anti-immigrant executive orders) play an integral role in maintaining entrenched health and health-care disparities among Latinxs. Federal policies, such as the Affordable Care Act, have shown promise in increasing access to health care for Latinxs, but the effect has not been uniform across Latinx subgroups and has decreased over time (Alcalá, et al. 2017; Rosales, et al. 2021). Perreira and Pedroza 2019 reviews restrictive state immigration policies, such as Arizona’s SB 1070, that legitimate racism and restrict immigrants from receiving the same services as US-born individuals. It also shows that these restrictive state policies have deterred Latinxs, regardless of immigration status, from accessing and using health care, which negatively impacts their mental health status. Ayón 2020 contributes to this body of literature in a study that found that such restrictive policies heighten stress levels among Latinx parents. Pedraza, et al. 2017 as well as Vargas, et al. 2019 also reports delayed access to health care and negative mental health effects among Latinxs, regardless of migratory status, and individuals who knew someone who was deported. Anti-immigrant policies have a particular negative effect among the most vulnerable segments of the Latinx population, namely children and older adults. For instance, Cholera, et al. 2021 found that Latinx youth cancelation and no-show rates of health-care visits were substantially impacted by anti-immigrant policies. According to Calvo 2020, a letter to the editor of the Journal of Gerontology in Social Work, there is an urgent need to increase attention to the impacts of Covid-19 on older Latinxs, whose health-related vulnerability and lack of health care access is exacerbated by restrictive anti-immigrant policies. Even policies not specific to immigration enforcement have disproportionately placed Latinxs at risk of higher exposure to Covid-19. More information regarding this can be found in Rodriguez-Diaz, et al. 2020.

  • Alcalá, H. E., J. Chen, B. A. Langellier, D. H. Roby, and A. N. Ortega. 2017. Impact of the Affordable Care Act on health care access and utilization among Latinos. Journal of the American Board of Family Medicine 30.1: 52–62.

    DOI: 10.3122/jabfm.2017.01.160208

    The authors examine the Affordable Care Act’s impact among Latinxs based on country of origin, language, and immigration status. Puerto Ricans experienced the greater gains in health-care access after the ACA. By contrast, the ACA had a limited impact on improving Latinxs’ access to health care based on language and citizenship status.

  • Ayón, C. 2020. State-level immigration policy context and health: How are Latinx immigrant parents faring? Social Work Research 44.2: 110–122.

    DOI: 10.1093/swr/svaa003

    The author of this study uncovers a strong relationship between restrictive immigration policies and high stress levels among immigrant parents. Practice implications include working with families to address concerns about how immigration policies affect their children, including fears about family separation.

  • Bruzelius, E., and A. Baum. 2019. The mental health of Hispanic/Latino Americans following national immigration policy changes: United States, 2014–2018. American Journal of Public Health 109.12: 1786–1788.

    DOI: 10.2105/AJPH.2019.305337

    The authors present national findings of how the aggressive enforcement of anti-immigrant policies impacts the mental health of Latinxs in the United States. The public health effects of aggressive immigration enforcement are discussed.

  • Calvo, R. 2020. Older Latinx immigrants and Covid-19: A call to action. Journal of Gerontological Social Work 63.6–7: 592–594.

    DOI: 10.1080/01634372.2020.1800884

    The author argues that is imperative to pay attention to the effect of Covid-19 on older Latinxs, particularly regarding issues stemming from entrenched systemic inequities. Actions for policymakers and providers of services to design services tailored to this population are discussed.

  • Chen, J., M. J. O’Brien, J. Mennis, et al. 2015. Latino population growth and hospital uncompensated care in California. American Journal of Public Health 105.8: 1710–1717.

    DOI: 10.2105/AJPH.2015.302583

    This study investigates the relationship between uncompensated care and hospital use in areas with a high concentration of Latinxs. Findings reveal the need for improving health-care resources for Latinx communities that do not have access to health coverage through the Affordable Care Act (ACA).

  • Cholera, R., S. I. Ranapurwala, J. Linton, et al. 2021. Health care use among Latinx children after 2017 executive actions on immigration. Pediatrics 147.2: e20200272.

    DOI: 10.1542/peds.2020-0272

    The authors examine the effect of anti-immigrant executive actions on Latinx children’s health-care use. Types of restrictive policies, their impact on uninsured Latinx children, and consequences for the health care of this vulnerable population are discussed.

  • Pedraza, F. I., V. C. Nichols, and A. M. LeBrón. 2017. Cautious citizenship: The deterring effect of immigration issue salience on health care use and bureaucratic interactions among Latino US citizens. Journal of Health Politics, Policy and Law 42.5: 925–960.

    DOI: 10.1215/03616878-3940486

    This article shows that discussing the topic of immigration during the provision of health care deters Latinx citizens from booking further appointments because they perceive the health-care setting as unsafe.

  • Perreira, K. M., and J. M. Pedroza. 2019. Policies of exclusion: Implications for the health of immigrants and their children. Annual Review of Public Health 40:147–166.

    DOI: 10.1146/annurev-publhealth-040218-044115

    This comprehensive review focuses on how federal, state, and local laws and administrative practices impact Latinx immigrants’ access to public programs, including health care.

  • Philbin, M. M., M. Flake, M. L. Hatzenbuehler, and J. S. Hirsch. 2018. State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States. Social Science & Medicine 199:29–38.

    DOI: 10.1016/j.socscimed.2017.04.007

    This literature review summarizes evidence on state-level immigration policies that affect Latino health. Potential links between policy and health outcomes, and areas for further research about the relationship between policy and health outcomes, are discussed.

  • Rodriguez-Diaz, C. E., V. Guilamo-Ramos, L. Mena, et al. 2020. Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics. Annals of Epidemiology 52:46–53.

    DOI: 10.1016/j.annepidem.2020.07.007

    This quantitative study examined differential Covid-19 diagnoses and deaths based on Latinx demographic profiles, such as county population, percentage of Latinxs, age, health insurance coverage, and language. Authors discuss the implications of structural factors that provide context to the findings, including executive orders.

  • Rosales, R., D. Takeuchi, and R. Calvo. 2021. After the Affordable Care Act: the effects of the health safety net and the Medicaid expansion on Latinxs’ use of behavioral healthcare in the US. Journal of Behavioral Health Services & Research 48.2: 183–198.

    DOI: 10.1007/s11414-020-09715-3

    This article investigates the impact of the Affordable Care Act (ACA) on US Latinxs’ behavioral health use. Authors observed a short-term increase of behavioral health among Latinxs after the ACA that was not sustained over time, except in safety net organizations in Medicaid expansion states. Policy and practice implications to provide sustained support to safety net organizations are presented.

  • Vargas, E. D., M. Juárez, G. R. Sanchez, and M. Livaudais. 2019. Latinos’ connections to immigrants: How knowing a deportee impacts Latino health. Journal of Ethnic and Migration Studies 45.15: 2971–2988.

    DOI: 10.1080/1369183X.2018.1447365

    This study uses stress process theory to investigate how personal connections to a deportee is associated with a heightened need for mental health services. Authors discuss implications in light of current anti-immigration policies.

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