Department of Family & Community Medicine and Office for Community Health, University of New Mexico, Albuquerque, NM, USA.
Office for Community Health, University of New Mexico, Albuquerque, NM, USA.
Curr Diab Rep. 2022 Mar;22(3):137-145. doi: 10.1007/s11892-022-01450-7. Epub 2022 Feb 25.
The purpose of this review is to explore using theoretical frameworks of structural violence and syndemics to understand Latinx health disparities with a focus on type 2 diabetes (T2D). We propose that combining these frameworks is a valuable approach for revealing complex root-cause dynamics and explaining the nuances of how and why health disparities exist. We discuss the importance of the relationship between T2D, fear, and stigma.
Immigration policy creates structural conditions that invite unauthorized immigration while simultaneously excluding undocumented immigrants from access to healthcare resources. Structural exclusion then breeds fear of immigration status disclosure and deportation and, in the highly politicized immigration context that has emerged over the past two decades, also assigns social sigma to immigration status. Undocumented immigrants lack access to healthcare and health insurance; they cannot afford state-of-the-art drugs, they tend to be socially isolated and lack social capital to navigate systems; they are financially limited by poverty and lack of resources, emotionally taxed by the experience of discrimination, humiliation, and language-related challenges; and they have a toxic immigration stress load in the form of multidimensional fear. Potential areas for policy change are identified. Type 2 diabetes (T2D) follows racial, ethnic, and class fault lines that reflect unequal social and structural dynamics. Latinx immigrants are at disproportionate risk and explaining immigrant T2D social geography requires a holistic lens.
综述目的：本综述旨在探讨利用结构性暴力和综合征理论框架来理解拉丁裔健康差异，重点关注 2 型糖尿病（T2D）。我们提出，结合这些框架是揭示复杂根本原因动态和解释健康差异存在的方式和原因的有价值的方法。我们讨论了 T2D、恐惧和污名之间关系的重要性。
最新发现：移民政策创造了结构性条件，一方面邀请非授权移民入境，另一方面又使无证移民无法获得医疗资源。结构性排斥继而滋生对移民身份披露和驱逐的恐惧，并且在过去二十年来出现的高度政治化的移民背景下，还将移民身份赋予社会耻辱。无证移民无法获得医疗保健和医疗保险；他们负担不起最先进的药物，往往处于社会孤立状态，缺乏社会资本来应对系统；他们受到贫困和资源匮乏的经济限制，受到歧视、羞辱和语言相关挑战的情感压力；他们面临多维恐惧形式的毒性移民压力。确定了潜在的政策改革领域。2 型糖尿病（T2D）遵循种族、族裔和阶级的断层线，反映了不平等的社会和结构动态。拉丁裔移民面临不成比例的风险，要解释移民 T2D 的社会地理状况需要采用整体视角。
