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In the United States, undocumented residents face unique barriers to healthcare access that render them disproportionately dependent on the emergency department (ED) for care. Consequently, ED providers are integral to the health of this vulnerable population. Yet special considerations, both clinical and social, generally fall outside the purview of the emergency medicine curriculum. This paper serves as a primer on caring for undocumented patients in the ED, includes a conceptual framework for immigration as a social determinant of health, reviews unique clinical considerations, and finally suggests a blueprint for immigration-informed emergency care.

This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care., (© American Sociological Association 2015.)

As it stands there is no viable health care option for undocumented immigrants of low socioeconomic status. Even more worrisome is that Affordable Care Act simply does not address this issue with any direct plan. The US is in a very influential time period in terms of undocumented immigration and its relationship with health care. The purpose of this paper is to examine international examples of undocumented immigrant health care and their implications for the United States' undocumented immigrant health care. This study found that physicians in the US must work to prevent the initiation of policies which exclude undocumented immigrants from accessing health care. Exclusionary policies implemented in European nations have had disastrous effects on physicians and patients. This paper examines the implications which similar policies would have if implemented in the US.

The study concerns ethnicity, spatial equity, and healthcare access in the context of diversity and integration. The paper first explores how Chinese immigrants in the Toronto Census Metropolitan Area choose between ethnic Chinese family physicians and other family physicians, based on a probability survey. It then applies and modifies gravity-type accessibility measures, of which a special type is the so-called floating catchment area (FCA) method, to evaluate three types of geographical accessibility in family physician utilization. The study suggests a certain degree of spatial inequality among Chinese immigrants in accessing culturally sensitive care. The paper yields important methodological and policy implications.

This paper examines federal and state restrictions on immigrants and the negative impact of these restrictions on local efforts to serve the uninsured. It examines a health coverage program offered to low-income residents in Alameda County, California from 2000 to 2005, illustrating local efforts to expand health coverage to both adults and children, regardless of immigration status. After five years of operating the pilot program, leaders of Alameda County's health care safety net conclude that local health coverage programs are unsustainable over a long period of time without significant federal and state support. The financial resources that federal, state, and local governments are patching together for health coverage could be used more efficiently if consolidated. Stabilizing the federal tax base and recognizing the phenomenal amount of federal, state, and local funding that is already spent on medical care for the uninsured are the first steps towards achieving meaningful health care reform.

This paper explores the public health system's differential construction of Mexican and Cuban immigrants' "deservingness" of citizenship benefits and its preparation of them for different roles in U.S. society. Civic institutions such as the public health care system are charged with inculcating normative behavior in immigrants and instilling in them different conceptions about their rights and responsibilities. Faced with limited resources under the implementation of Medicaid managed care, hospital administrators created new categories of "deserving" and "undeserving" immigrants based on neoliberal standards of individual responsibility and self-discipline. As a result, hospital policies construct different types of "cultural citizenship" for Cuban and Mexican immigrants, preparing the former to be active citizens and discouraging the latter from pressing demands on American civil institutions. I show that this negative construction of Mexican immigrants' moral worth leads to unmet health needs and poor health outcomes.

"The purpose of this paper is to study the determinants of interstate migration in the United States from 1965-1970 when a new change in direction of migration has started, and to examine the flow creation or flow diversion that results from migration to some appealing regions. Several related variables have been selected and tested for gross interstate migration flows. The results show that overall both push and pull factors have not been important.... Distance was not found to act as a significant deterrence to migration, whereas population density of origin and destination was significant. Previous migration was found to have a very strong effect on migration. The results of the study also suggested that there has been a major change in the location of growth areas in the United States during 1955-1970.", (excerpt)

Little is known about health care access and advocacy for elders of color, and even less is known about immigrant elders, whose growing number is the major reason that almost one of every three older persons in the U.S. by the year 2050 will be an elder of color. This paper explores a number of access barriers faced by underserved elders, including inequitable long-term care services and counterproductive "colorblind" approaches to caregiving. It also addresses barriers, such as problematic immigration policies, that present particular challenges to elderly immigrants. While available materials provide baseline information and help providers learn about underserved elders, real change in how target populations gain access to health and social services comes when providers make explicit efforts to improve the accessibility and quality of services.

"This paper presents and tests a regression-based model of black interstate migration. Explanatory variables include characteristics of origins and destinations, distance, and two migrant stock measures. The model is tested using black interstate migration flows published by the U.S. Bureau of the Census for 1965-70 and 1975-80." The emphasis is on the determinants of black migration, particularly for the period 1975-1980., (excerpt)