A Note from the Editor

As the federal government in the United States moves towards center stage on health care reform, JHCPU continues to track the health and health care needs of the medically underserved. This issue concerns Immigrant Health, Health Policy and Care Management, and Women’s Health.

Immigrant Health

Immigration into the United States has increased markedly over the last several decades, with raw numbers equaling and most recently surpassing those of the great immigration waves of the mid to late 19th century and early 20th century.¹ To learn about who is entering the U.S., comparing immigration statistics from 1960 with those from 2007 is instructive: while immigrants from Mexico, the Dominican Republic, Cuba, and El Salvador made up nearly 40% of the foreign-born population in the U.S. in 2007 (54% coming from Latin America and the Caribbean combined), Mexican immigrants constituted only 6% in 1960 (other Latin American and Caribbean countries contributing much smaller numbers). No Asian or Pacific Island country ranked in the top ten countries sending people to the U.S. in 1960, but in 2007 China (4%), India (4%), Korea (3%), and the Philippines (4%) all made the top ten¹ and, overall, Asians constituted 27% of the foreign-born population.² Some evidence suggests that the rate of immigration into the U.S. has been slowing since 2006,² but the large population of immigrants who are already here, as well as those who are just arriving, introduces new intricacies to an already complex health care system. This is especially true as it concerns immigrants with low incomes and limited proficiency in English (the large majority of immigrants).²

Five papers in this issue focus on the health and health care of Latino immigrants, Asian immigrants, or both. One analyzes demographic data trends between 1990 and 2000 with an eye towards understanding the stresses that new Latino immigrant populations may pose to Comprehensive Cancer Centers (CCCs). The authors, Ann Flores and colleagues, note that the U.S. Latino population doubled between 1980 and 2000, primarily due to immigration. Southeastern cities saw particularly pronounced growth in their Latino populations: in the 10-year period ending in 2000, the Latino population of Greensboro, North Carolina grew by 777%; Raleigh, North Carolina by 705%; Nashville by 424%; and Birmingham by 316%. The authors predict that by 2050, the U.S. will have somewhere around 10 million Latinos in need of cancer treatment, and many times that number in need of preventive screening and education. The authors argue that CCCs in areas with very fast or fast growth in the Latino population and with demographically unstable Latino populations––i.e., populations predominantly made up of young men, rather than families––will face the most pressing demands due to immigration in the coming years.

A Brief Communication by David Eisenman and colleagues also focuses on Latino immigrants, in this case exploring via focus groups Latino families’ preparedness for disasters.

Dennis Kao also analyzes demographic trends in immigrant family profiles, in this case in relation to health services. Kao develops an emerging theoretical construct in which generational cohorts and ages at arrival within immigrant populations undergo analysis that is more fine-grained than was used in earlier research. For example, Kao is interested in health-related differences (1) between the children of one immigrant and one U.S.-born parent vs. the children of two immigrant parents, and (2) between immigrants who arrived in the U.S. as children vs. immigrants who arrived as adults. Examining datasets for both Latino and Asian immigrants in California, he finds (1) that, in general, immigrants who arrive as children have better access to services than immigrants who arrive as adults; (2) that 3rd or later generation people are more likely than adult immigrants to have a usual source of care and have more physician visits; and (3) that, in all cohorts, Latinos fared worse than Asians or Whites.

Chinatowns, one in Brooklyn and the other in the District of Columbia, are the foci of two other papers in this issue, which explore the unmet health needs of immigrant Chinese adults...