The Role of Culture in Health

In addition to the logistical complications cited in the Immigrant Health Care post, immigrants face social barriers that prevent them from receiving adequate health care. Instead of viewing immigrants as one group, each group’s ethnicity, age, language, and culture must be taken in to account to understand an immigrant’s approach to western health care. These socioemotional conflicts are overlooked by empirical research, but become painfully obvious when viewed through an individual experience. The Spirit Catches You and You Fall Down explores the clash between two cultures through a Hmong family and small county hospital in California to keep Lia Lee alive. Anne Fadiman delicately presents two sides that both want their respective idea of what is “best” for Lia. Faced with language and cultural barriers in addition to mutual distrust, American doctors and the Lee family led to Lia’s deterioration of health.

Amidst the Vietnam War, the United States created the Hmong Armee Clandestine. Half of the Hmong population in Laos died in the “Quiet War.” By 1970, forced to adapt their migratory habits to wartime, more than a third of the Hmong in Laos had become refugees within their own country. In the provinces of Hous Phanh and Xieng Khouang, the war has reached into every home and forced every individual to make the agonizing choice of flight or death. Today, more than 200,000 people live in settlements and military bases, confined to a mountainous strip of only 50 to 90 kilometers. The rest of the provinces are in total desolation. After the U.S. signed the Paris Agreement pledging to withdraw its forces from Vietnam, the Pathet Lao crossed the cease-fire line and announced the extermination of the Hmong. In a matter of a decade, half their population was killed in war, 3,000 were displaced, and over 10,000 were left at the hands of the Pathet Lao. The Lee’s distrust of America began here.

Lia Lee was the Lee’s first child born after arriving in the United States. She was birthed in a small county hospital in Merced, California with doctors who had no regard for spiritual practices that the Lee family felt would determine her soul’s presence, and therefore, their daughter’s reason to live. Three months later, Lia’s sister slammed the front door, and as the Lees believed, frightened the soul out of Lia’s body. The American doctors diagnosed her with epilepsy. The Hmong regard it as divine, because many of their shamans were afflicted with it. They have been chosen as the host to a healing spirit, allowing them to communicate and negotiate with the spirit realm in order to act as public healers to the physically and emotionally sick. In addition to these beliefs, Hmong also have many customs and folkways that are contradicted by those of the American mainstream and medical communities. For example, some Hmong traditionally perform ritual animal sacrifice, and because of very specific burial traditions and the fear of each human’s many souls possibly escaping, the traditional Hmong beliefs do not allow for invasive medical surgery.

Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust and misunderstandings, and the inability of the doctors to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia’s condition worsened. The dichotomy between the Hmong’s perceived spiritual factors and the Americans’ perceived scientific factors compromised Lia’s health. Ultimately, in a climax of miscommunication leading to Lia being seen as an illness rather than a complete person, Lia suffered a detrimental seizure that left her in a vegetative state. After suffering through language barriers, cultural misunderstandings and judgments, pre-conceived notions, and removal from her parents’ care, Lia Lee became the casualty in the battle of two cultures.

Anne Fadiman’s book turns a tragedy into a case study that has been used for medical patient reform throughout the country. The understanding that culture affects health just as much as the patient’s access to health is crucial in understanding the future of our nation and its people, regardless of documentation. Immigration is an undeniable mixing of cultures, and this cannot be forgotten once inside an emergency room.

Works Cited

Fadiman, Anne. 1998. The Spirit Catches You and You Fall Down. New York: Farrar, Straus, and Giroux.

Immigrant Health Care

Immigrants are often portrayed as free loaders who exploit and overuse American health services. Although immigrants are net contributors to the U.S. economy, the misconception remains that they are a burden to native-born taxpayers. However, a report by the University of California and the Mexican government found that recent immigrants from Mexico are half as likely to use emergency rooms as native-born whites and Mexican Americans (2005). Also, when controlled for minority groups, Latino immigrants accounted for $962 in per capita health care expenditures in 1998, compared to $1,870 for native-born Latinos. Black immigrants averaged $1,030 in health care expenditures, compared to $2,524 for native-born blacks (Mohanty et al. 2005). As many politicians call for the securing of our borders and the elimination of “magnets” for undocumented migrants, a 1996 study concludes, “there is no reputable evidence that prospective immigrants are drawn to the U.S. because of its public assistance programs” (International Migration Policy Program 1996:3).

Poverty, jobs that fail to offer health insurance, immigration status, and federal and state policies that limit access to publically funded insurance all reduce health insurance coverage rates for immigrants. On average, immigrants received about $1,139 in health care, compared with $2,546 for native-born residents. Although immigrants comprised 10 percent of the U.S. population in 1998, they accounted for only 8 percent of U.S. health care costs (Mohanty et al. 2005). A significant proportion of immigrants work in low-paying jobs with small firms that do not offer health insurance. Ultimately, these immigrants do not receive quality health care and lack timely preventive services. These delays result in some immigrants attaining medical care only when they become very ill. Additionally, legislative initiatives such as the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) eliminated equal access to public benefits for all legal permanent residents. The PRWORA prevented states from using federal funds to provide Medicaid and State Children’s Health Insurance Program (SCHIP) coverage for most legal immigrants who have resided in the United States for less than 5 years (International Migration Policy Program 1996). By not allowing all legal permanent residents the same public benefits, the government is directly compromising the health of immigrants until they have resided in the America for 5 years or attain health insurance through employment.

Even among immigrants who meet the qualification for publicly funded health insurance, fear and confusion often create barriers to enrollment. What could be reflections of a harmful immigration process or general distrust of the American government could cause concern about becoming a “public charge,” which would make them ineligible for U.S. citizenship and could result in deportation (Berk and Schur 2001).

Interestingly, despite the legislative and social issues complicating immigrant health care, male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born (Singh and Miller 2004). There are many possible reasons for this statistic. First, people immigrating may be healthier than those who remain in their countries of origin, for the process is generally difficult. This form of immigrant selectivity could skew the general health of their countries of origin, but underscores the point that America is not a welfare magnet. Also, it is possible that immigrants possess more favorable health habits, such as lower rates of smoke, drinking, and better diet. Regardless of the reasons, it is crucial to realize immigrants use less public assistance than native-born citizens, but may very well be suffering at the hands of harsh legislation and lack of health insurance.



Works Cited

Berk, Marc L. and Claudia L. Schur.2001. “The Effect of Fear on Access to Care Among

Undocumented Latino Immigrants.” Journal of Immigrant Health 3(3):151-6.

International Migration Policy Program of the Carnegie Endowment for International

Peace & the Urban Institute. 1996. “Immigrants and Welfare,” Research     Perspectives on Migration 1(1):1-15

Mohanty, Sarita A., Steffie Woolhandler, David U. Himmelstein, Susmita Pati, Olveen

Carrasquillo and David H. Bor. 2005. “Health Care Expenditures of Immigrants     in the United States: A Nationally Representative Analysis.” American Journal of   Public Health 95(8):1431-1438.

Singh, Gopal K. and Barry A. Miller. 2004. “Health Life Expectancy, and Mortality Patterns Among Immigrant Populations in the United States.” Canadian Journal of Public Health 95(3):14-21

University of California, Los Angeles Center for Health Policy Research and the National Population Council of the Government of Mexico. 2005. Mexico-United States Migration: Health Issues.