Department of Anthropology, University of California Riverside USA.
Conchita Servicios de la Comunidad USA.
Soc Sci Med. 2024 Apr;347:116736. doi: 10.1016/j.socscimed.2024.116736. Epub 2024 Mar 6.
Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions.
This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information.
A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health.
This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services.
美国西南部的许多拉丁裔和墨西哥裔原住民居住在美国-墨西哥边境的未合并社区，这些社区被称为“colonias”。这些环境正义社区通常缺乏基本的基础设施，包括医疗保健服务，这促使许多人跨境寻求服务。然而，由于地缘政治因素，更脆弱的照顾者在利用美国的医疗保健服务方面受到限制。本文报告了居住在美国-墨西哥边境地区“colonias”的照顾者的经历和医疗保健决策，这些照顾者照顾患有呼吸系统疾病的儿童。
本研究于 2020 年 9 月至 12 月进行。对患有哮喘或呼吸窘迫症的儿童的拉丁裔和墨西哥裔原住民照顾者进行了焦点小组和访谈。定性访谈引出了照顾者对影响儿童慢性健康状况的环境因素以及对医疗保健服务的使用的看法。分析采用了结构脆弱性的概念，将地理作为照顾者在为患有呼吸系统疾病的儿童做出医疗保健决策时面临的结构性健康决定因素进行理论化。还进行了一项调查以收集基本的社会人口统计学信息。
共有 36 名照顾者参与了研究。结构因素，包括未合并社区地位和政府不作为，与健康的社会决定因素相交织，促使照顾者跨境前往墨西哥为其子女获取医疗保健服务。然而，更脆弱的照顾者（即在美国没有文件身份的人）及其子女，在美国获取医疗保健服务不是一个选择，限制了照顾者满足子女医疗保健需求的能力。在这种情况下，地理是健康的结构性决定因素。
本研究表明了地理在健康中的重要性。位于边境地区的农村未合并的“colonias”地理位置不稳定，缺乏基本的关键基础设施，包括医疗保健服务。在这些地方，历史上和社会上处于边缘地位的人群变得看不见，受到环境危害的健康影响，并且根据他们的地位和因此的脆弱性受到医疗保健服务的限制。
