Nava Marcela, Cañizares Monica, Earl James, Patel Hemali, Ren Lucy
School of Social Work, The University of Texas at Arlington, Arlington, TX, USA.
Cancer Care Services, Fort Worth, TX, USA.
Community Health Equity Res Policy. 2025 Jul 2:2752535X251352995. doi: 10.1177/2752535X251352995.
BackgroundCervical cancer disproportionally burdens Hispanic immigrant communities in the United States, despite its preventable nature and curability when detected early. These persistent disparities represent a "wicked problem," characterized by contested evidence, fragmented data, and a politicized health policy environment.MethodsThis study uses Tarrant County, Texas-a high-disparity urban region-as a case study to explore how multilevel governance structures shape immigrant health inequities. Drawing on the concept of wicked problems and the political determinants of health (PDoH) framework, we analyze archival data through a policy science lens to examine how electoral, legal, and institutional forces perpetuate barriers to life-saving care for immigrant women.ResultsFour key themes emerged from our analysis: (1) a reactive political environment that amplifies exclusion, (2) decision-making shaped by legal ambiguity, (3) passive enforcement of immigration policies through institutional design, and (4) blame-shifting between public and private healthcare systems. These dynamics collectively sustain health disparities by limiting access to preventive care and delaying treatment among immigrant populations.ConclusionFindings demonstrate that cervical cancer disparities are not solely the result of individual health behaviors but are produced and sustained by structural and political forces. Addressing these disparities requires interdisciplinary partnerships and place-based strategies that confront the institutional barriers embedded in local governance. We call for strategic alliances among researchers, community stakeholders, and policymakers to foster shared accountability and develop responsive, equity-driven policies for addressing cervical cancer and other preventable conditions in immigrant communities.
背景
宫颈癌给美国的西班牙裔移民社区带来了不成比例的负担，尽管它具有可预防性，且早期发现时可治愈。这些持续存在的差异代表了一个“棘手问题”，其特点是证据存在争议、数据零散以及卫生政策环境政治化。
方法
本研究以得克萨斯州塔兰特县（一个高差异的城市地区）为案例研究，探讨多层次治理结构如何塑造移民健康不平等。借鉴棘手问题的概念和健康的政治决定因素（PDoH）框架，我们通过政策科学的视角分析档案数据，以研究选举、法律和制度力量如何使移民妇女获得救命护理的障碍长期存在。
结果
（1）加剧排斥的被动政治环境；（2）由法律模糊性塑造的决策；（3）通过制度设计对移民政策的被动执行；（4）公共和私营医疗系统之间的责任推诿。这些动态因素共同限制了移民群体获得预防性护理的机会并延迟治疗，从而维持了健康差异。
结论
研究结果表明，宫颈癌差异不仅仅是个人健康行为的结果，而是由结构和政治力量产生并维持的。解决这些差异需要跨学科的伙伴关系和基于地点的策略，以应对地方治理中存在的制度障碍。我们呼吁研究人员、社区利益相关者和政策制定者建立战略联盟，以促进共同问责，并制定响应迅速、以公平为导向的政策，以解决移民社区的宫颈癌和其他可预防疾病。
