SOCIAL INTEGRATION OF LATIN AMERICAN IMMIGRANTS TO THE UNITED STATES FROM A BEHAVIORAL-MEDICINE PERSPECTIVE

1. SOCIAL INTEGRATION OF LATIN AMERICAN IMMIGRANTS TO THE UNITED STATES FROM A BEHAVIORAL-MEDICINE PERSPECTIVE Fabiana Franco, Ph.D. LLC The George Washington University

2. Paper prepared to be presented at the Conference: The Social Integration of Immigrants in Maryland: A New Comprehensive Approach, sponsored by the Social Integration and Community Development Association (SICDA), Annapolis, MD September 22, 2009.

3. CURRENT TRENDS IN INTERNATIONAL MIGRATION OF LATIN AMERICAN IMMIGRANTS • Note: My presentation is based on research data, my experience as a Latin American immigrant, and my experience as a clinician who specializes in multicultural psychology, behavioral medicine, trauma, law and forensics. Seventy percent of my current patient population is from another culture and from that seventy percent of international patients, ninety percent of them are of Latin American origin.

4. Background Data • International migration is a complex phenomenon where on the one hand is tightly linked to the United States social integration trends and on the other, it refers to the inclusion and exclusion process of a global society. Within such context, international migration of Latin American immigrants has dramatically changed its flow intensity and orientation. • The 1980 decade was a critical point in the migration scenario of Latin American immigrants migrating to the United States. Furthermore, Immigration to the United States is the most important migratory flow of Latin American countries in the last two decades.

5. MIGRATION IS A COMPLEX PHENOMENON • The Latin American immigrant population in the United States is characterized by its rapid growth. Approximately 35.3 million individuals identify themselves as Hispanic/Latin Americans. This number is expected to increase to 97 million by 2050, nearly one fourth of the U.S. population. Latin Americans are considered the fastest growing ethnic group. It is believed that by the year 2010 which is shortly approaching, Latin Americans will be considered the largest minority group in the country. • According to the US Census Bureau, two out of every five Latin Americans born out of the United States who reside in the country migrated during the last decade. It is worth noting that 40% Latin Americans residing in the US are foreign born and more importantly, 46% of this non US born Latin American immigrant group immigrated during the decade of 1990.

6. REASONSFOR IMMIGRATION • Latin Americans migrated to the United States essentially for a few reasons: • 1-Labour • 2-Education • 3-Reunification with family members • 4-Polytical Asylum/Safety • 5-Opportunity

7. Latin American immigrants are usually located in the inferior and superior extremes of the labor force, depending on their social strata, qualification levels, education level, and/or capital. Interestingly enough, although the labour model of the United States is usually praised, it is also highly censured as it paradoxically while on the one hand it exhibits relatively low levels of unemployment on the other, it maintains a wide discrepancy in terms of salary inequity. The social context of our society is marked by uncertainty, social inequity, and growing poverty. Latin Americans in this context are considered one of the most the affected and economically marginalized immigrant groups. • Interestingly, continued migration also suggests continued residential segregation of new waves of immigrants. Thus, continued levels of Latin American immigration, would presumably translate into continued levels of high segregation for this ethnic group. Therefore, policies that promote social integration of immigrants, such as increasing access to English-as-a-Second language courses and facilitating naturalization, are highly needed given the existing realities of labor migration to the United States. The current body of literature offers much food for thought as the Nation strives to guarantee the civil rights of all ethnic minorities in this country-US citizens and immigrants alike.

8. MULTIPLE ORIGINS, UNCERTAIN FUTURES • Latin Americans currently recognized as the fastest growing ethnic minority group. Numbering 40 million today and growing by more than 1.5 million annually from both continuing migration and natural increase. Currently Latin Americans are scattering nationally and communities are facing the multiple challenges presented by a new and quickly growing immigrant population. The Latin American population is characterized by a youthful age structure, a large number of foreign born immigrants including many undocumented, low levels of education, and disproportionate concentrations of low skilled/low wage jobs. Its presence now more than ever, is being felt intensively in the Nation’s schools, labor market, health care system, mental health system, and political life. It is worth noting that the economic and social integration of Latin Americans at that level will highly depend on educational investments and the acquisition of job-related skills made today for future generations.

9. LATIN AMMERICAN IMMIGRATION TRENDS IN THE WASHINGTON METROPOLITAN REGION • In the latter decades of the twentieth century, the number of Latin American immigrants to the Washington metropolitan region grew, in large part due to the economic stability offered by the expansion of the federal government, international organizations and embassies, and universities, all of which affect both native and foreign born populations. In addition, since the late 1970s, the U.S. government has resettled thousands of refugees in the region, as civil wars intensified in several countries and as natural disasters further devastated already damaged living conditions and local economies. While Washington’s increasing internalization began largely with professionals and students has continued with both high-and low skilled immigrants arriving through various networks that join them to family and friends already living in the region or simply in search of a better future.

10. CURRENT IMMIGRATION TRENDS IN THE US • Currently, the United States is in the midst of a National debate over the role of immigrants in the economy and society. One of the consequences of this debate is that Latin American immigrants are increasingly becoming targets of local legislation designed to restrict access to services which makes them feel rejected and unwelcome. While most of the proposed policy changes are aimed at those without legal status, public officials failed to present a reassuring scenario that legal immigrants will not be caught up in the enforcement of new provisions intended for the undocumented. Therefore, immigrants of Latin American origin fear being singled out based on the way they look or speak. A deliberate blurring and luck of clarity of those distinctions has created a hostile social atmosphere throughout the Washington DC metropolitan region

11. Latin American immigrants that live in the Washington DC metropolitan region have a relatively recent history of settlement in the region, marked by a small early flow of professionals and continuing with a much larger flow of immigrants from the ravaged countries of Central America. While Latin American immigrants live all across the Nation, they are relative new comers to some of the farther-flung suburbs of the DC metropolitan region. In these farther-flung regions, we have seen this immigrant population grow quickly over a very short period. Thus, the economic and social integration of Latin American immigrants to the Washington DC metropolitan region is vital for its viability to be able to grow in this globalized economy. It is in the best interest of local institutions, leaders, and the public-as well as immigrants-for true social integration on a grand scale to take place. This includes a dual process of immigrants adapting to and becoming actively involved in their new communities and learning English, as well as members of their communities to provide a welcoming and supportive environment.

12. NEW POLICIES • The new policies proliferating across the United States are partly a result of the increase number of immigrants and partly a result of the larger national immigration debate. The society at large is understandably wary about the changes they see happening around them. Local officials and leaders are feeling pressure to control immigration at the local level, leading to some highly charged debates in the political sector. Local officials and leaders should take the next step in leading the public to a new awareness of their local immigrant populations while at the same time working with the immigrant community-newcomers and long-term residents alike-to help them understand the current changes better,aiming at working together toward the difficult and long-term process of true social integration

13. LATIN AMERICAN IMMIGRANTS: IMMIGRATION FROM A BEHAVIORAL MEDICINE APPROACH • Studies have found that Latino youth experience proportionally more anxiety-related and delinquency problem behaviors, depression, and drug use than do non Latino youth. Older Latin American immigrants, studies found that more than 26% are depressed but in most cases the depressive symptoms were related to physical health and only 5.5% of those in the studies, reported depressive symptomatoloty in the absence of a medical condition. Culture-bound syndromes frequently seen in the Latin American cultures include susto (fright), nervios (nerves), mal de ojo (evil eye), and ataque de nervios (nervous breakdown). Reported symptoms may include crying uncontrollably, trembling, screaming, verbal or physical aggression, dissociative experiences, fainting episodes, feelings of helplessness and hopelessness, and suicidal ideation

14. PSYCHIATRIC CONDITIONS • Although some studies found a 6% suicide rate for Latinos compared with 13 percent for whites, in a national survey of high school students, Latinos reported more suicidal ideation and attempts than whites. From the prison population, 9% of Latin Americans compared to 3% of whites are incarcerated. Latino men are nearly four times as likely to be incarcerated at some point during their lifetimes, than are white men. Latinos who served in Vietnam were at higher risk for war-related Post Traumatic Stress Disorder (PTSD) than their white counterparts. Refugees from Central America experienced considerable more war-related trauma and torture in their homelands. Studies have found rates of (PTSD) among Central American patients ranging from 35 to 60%. Although in general Latinos have alcohol and drug abuse rates similar to whites, Latino women have unusually lower rates of alcohol and other drug use than white women, whereas Latino men have relatively higher rates of alcohol and substance abuse than whites.

15. HEALTH RISKS • Reviewing available literature regarding Latinos health, studies found that this ethnic group is at higher risk for intestinal parasites, gastric cancers, tuberculosis, hepatitis B, schistosomiasis, leprosy, American trypanosomiasis (Chagas disease), malaria, HIV infection, cervical cancers, sickle cell trait, malnutrition, anemia, iron deficiency, incomplete immunizations, dental problems, diabetes mellitus, and hypertension. Even though there is not enough data to evaluate fully the screening strategies for most of these conditions, screening is highly recommended for intestinal parasites and schistosomiasis, tuberculosis, hepatitis B, particularly in prenatal patients, leprosy tests in immigrants from high risk areas, yearly Papanicolau smears, gastric malignancies, dental problems, and hypertension

16. AVAILABILITY AND ACCESS TO HEALTH CARE AND MENTAL HEALTH SERVICES • While the actual percentage of Spanish speaking mental health professionals is not known, only about 1% of licensed psychologists who are also members of the American Psychological Association identify themselves as Latin or Hispanic. Furthermore, there are 29 Spanish speaking mental health professionals for every 100,000 Latinos in the United States. Nationally, 37% of Latinos are uninsured. This high number is driven primarily by lack of employer based coverage for this ethnic group. Among Latin Americans residing in the U.S. fewer than 1 in 11 contact mental health specialists whiled fewer than 1 in 5 contact general care providers. Among Latin American with diagnosed psychiatric disorders fewer than 1 in 20 receive mental health services while fewer than 1 in 10 use services from health care providers.

17. NEED FOR ADDITIONAL RESEARCH STUDIES • Unfortunately, few studies on the response of Latinos to mental health care are available. One study found that low-income Latinos were more likely to suffer from exacerbated symptoms of psychosis. Several studies found that bilingual patients are evaluated differently when interviewed in English as opposed to in Spanish. Another small study found that Latin Americans diagnosed with Bipolar Disorder are more likely to be misdiagnosed with schizophrenia than are whites. One national study found that only 24% of Latinos with depression and anxiety received appropriate care, compared to whites. Yet another study found that Latinos who visited a general practitioner were less than half as likely to receive either a diagnosis of depression or being prescribed antidepressants. Clearly, a lot more needs to be done to ensure the mental and medical care of our rapidly growing immigrant communities

18. SUGGESTED SOLUTIONS FOR A HEALTHIER MORE INTEGRATED MULTICULTURAL SOCIETY • -Joint efforts to promote economic equality. • -Joint efforts to condemned discrimination and protect individual rights on the basis of their sexual or religious orientation, ethnicity, age, and/or mental/physical disability. • -Embrace diversity in all its aspects • -Implement programs to encourage ethnic minority students to remain in school. • -Promote bilingual education • -Urge congress to pass laws to protect minority employees from exploitation and discrimination • -Strengthening partnerships with Latin America • -Promote affordable access to culturally competent health care for Latinos (i.e., access to pre-natal care, immunizations, prescriptions, mental health services). • -Affordable housing • -Collaborative efforts to change immigration laws • -Welfare reforms for those individuals in need of specialized assistance (i.e., bilingual training, child care funding, increased minimum wage.)

19. LETS WORK TOGETHER TOWARDS A BRIGHTER FUTURE

20. HAPPIER FAMILIES

21. HIGHER EDUCATION

22. ART AND CULTURE

23. DANCE

24. UNIFICATION

25. PROFESSIONALS

26. ACCESS TO EDUCATION

27. COLLABORATION

28. ACCESS TO HEALTH CARE

29. HAPPIER CHILDREN

30. REFERENCES • “At Home in the Nations Capital: Immigrants in Metropolitan Washington, D.C. “ • Singer, A. 2003. Washington, D.C. : The Brookings Institution. • Division of General Internal Medicine and Health Services Research, Department of Medicine and Department of Family Medicine, University of California, Los Angeles; and Health Sciences Program, RAND, Santa Monica, CA. • “Edge Gateways: Immigrants, Suburbs and the Politics of reception in Metropolitan Washington,” Chapter 6 in Singer, A., Hardwick, S. W. & Brettel C. B. (eds). Forthcoming, Twenty-First Century Gateways: Immigrant Incorporation of Suburban America, Washington D.C.: Brookings Institution Press. • Effects of Terror and Violence Vary by Culture • JWatch Psychiatry 2003; 2003:5-5. • Factors Associated With Poor Mental Health Among Guatemalan Refugees Living in Mexico 20 Years After Civil Conflict • Sabin M., Lopes Cardozo, B., Nackerud, L., Kaiser, R. & Varese, L. JAMA. 2003; 290 (5): 635-642. • Haney Lopez, I. 2006. White By Law: The Legal Construction of Race (10th ann. Ed.) New York: NYU Press. • Huntington, S. P. Who are we? The Challenges to America’s National Identity, New York: Simon & Schuster. • Johnson, K. R. 2004 The “Huddled Masses” Myth: Immigration and Civil Rights. Philadelphia: Temple University Press. • Massey, D. S. & Denton, N. A. 1993. American Apartheid: Segregation and The Making of the Underclasss. Cambridge: Harvard University Press. • Portes, A. & Rumbaut R. G. 2006. Immigrant America: A Portrait. Berkeley. University of California Press (3d ed.) • Post Traumatic Symptoms and the Complexity Responses to Trauma • Kroll. JAMA 2003; 290:667-670. • Premigration Exposure to Political Violence and Perpetration of Intimate Partner Violence Among Immigrant Men in Boston • Gupta. et al. Am. J. Public Health 2009; 99:462-469 • “The Latino Community: Creating an Identity in the Nation’s Capital.”

31. Questions?