Social Exclusion & Race Case Study: Maternal Mortality

Question 1

Infant & Maternal Mortality by Race

Answer 1

• US ranks 32nd out of 35th wealthiest countries in infant mortality
• Black infants in America more than twice as likely to die as white infants
• 11.3 per 1000 live births for Black babies
• 4.9 per 1000 live births for White babies
• Black women in America three to four times as likely to die from pregnancy-related causes as white women
• Gap persists when class and education are accounted for

Question 2

Maternal Mortality & Racism

Answer 2

• “weathering”: life course effects of experiencing racism
• leads to hypertension and pre-eclampsia
• discrimination and stereotyping within the medical system
• disregarding health concerns
• assumptions of having bad lifestyles
• racial stereotypes (e.g. black women are less susceptible to pain)
• Dr. Richard David: “for black women, something about growing up in America seems to be bad for your baby’s birth weight”

Question 3

Immigration as a Social Determinant of Health

Answer 3

Immigrants are affected by…

• Conditions and status in country of origin
• Conditions and status in country of arrival
• Voluntary migration vs. forced migration
• Legal status and entitlements (shaped by immigration policies)

Question 4

Classification of Admission Category (Canada)

Answer 4

• 2000-2010: 250 000 new immigrants and refugees came to Canada
• 2011: immigrants constitute 20.1% of Canada’s population (one in five Canadian residents)
• In Canada, majority of immigrants are economic or family sponsored

Question 5

Economic Immigrant

Answer 5

selected for their ability to contribute to Canada’s economy through their ability to meet labour market needs, to own and manage or to build a business, to make substantial investment, to create their own employment or to meet specific provincial or territorial labour market needs (e.g. caregiver)

Question 6

Immigrant Sponsored by Family

Answer 6

sponsored by a Canadian citizens or permanent resident and were granted permanent resident status on the basis of their relationship either as a spouse, partner, parent, grand-parent, child or other relative of this sponsor (‘family class’ or ‘family reunification’)

Question 7

Express Entry

Answer 7

• person receives ranking points based on their language ability, education, skills and experience
• every 2 weeks candidates with the highest amount of points are invited to apply for permanent residence

Question 8

Provincial Nominee Program

Answer 8

-provinces (except Quebec) nominate the immigrants they would like, based their own needs

Question 9

Quebec-Selected Skilled Workers

Answer 9

Quebec selects it’s own skilled workers

Question 10

Start-up Visa Program

Answer 10

Entrepreneurs with business ideas and the support of Canadian investors can become permanent residents and launch their businesses here

Question 11

Caregiver Program

Answer 11

individuals who have gained experience working in Canada proving in-home care to children, or people with high medical needs, can apply for permanent residence

Question 12

Economic and Family Immigration Programs

Answer 12

-through the Family Class, Canadian citizens and permanent residents can sponsor loved ones to join them in Canada. (spouses, common-law partners, dependant children, parents and grandparents)

Question 13

Refugee is…

Answer 13

someone who has been forced to flee his or her country because of persecution, war or violence; has a well founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group.

Question 14

Internally Displaced Person

Answer 14

someone who has been forced to flee their home but never cross an international border; are not protected by international law

Question 15

Asylum Seeker

Answer 15

when people flee their own country and seek sanctuary in another country, they apply for asylum – the right to be recognized as a refugee and receive legal protection and material assistance; must demonstrate that his or her fear of persecution in his or her home country is well-founded

Question 16

The “Healthy Immigrant” Effect

Answer 16

-immigrants have a health advantage upon arrival and health begins to decline over time
-contradicts the health effects associated with income
Why health declines after immigration?
-immigration process is selective
-behaviours change
-racism (stressors associated with poverty, poor access to services, unemployment etc.)
-individuals in the group may not apply to this common trend

Question 17

Immigration as a Behavioural Framework

Answer 17

• focuses on individual behaviours
• lack of engagement with the contexts that shape these behaviours
• interventions focus on education and personal responsibility (maternal nutrition and parenting)
• e..g cancer risk screening, health service utilization

Question 18

Immigration as a Cultural Framework

Answer 18

• how individual health behaviours are influenced by culture
• Acculturating: align behaviour with dominant culture (may be negative)
• “culture” attributed to immigrant/minority cultures, but not the dominant culture
• can rely on and enforce stereotypes
• maintains individual focus
• e.g. lack of engagement with culture or racism or exclusion

Question 19

Structural Framework

Answer 19

• interprets health outcomes through understanding and accounting for large-scale social forces that impact health
• access to healthcare
• immigration status
• living conditions
• working conditions
• impact of deportation and detention
• consideration of how these elements are impacted by immigration status

Question 20

Immigration and Social Exclusion

Answer 20

-Non-white immigrants may experience racism and discrimination in workplace and in daily life
Wage gap (2005)
-immigrant men .63 for every dollar
-immigrant women .53 cents per dollar
-Credentials not recognized or valued – 30% of male immigrants with university degree working in jobs
requiring less than high school diploma
-Rates of unemployment and poverty increasing for recent immigrants
-Language barriers (perceived or real) can affect employment, access to services and participation in society
-Separation from family and/or community may have mental health effects

Question 21

Still looking for a job (2-4 years later)

Answer 21

Main reasons for difficulties faced

1. Not enough Canadian Job experience
2. No connections in the job market
3. Foreign experience not accepted

Question 22

Immigration Status

Answer 22

-Legal status has a considerable impact on access to resources, particularly government provided resources
-Work, legal support, housing, healthcare etc.
-National policies outline who has entitlements to
what services
-Avoidance of interactions with government institutions due to fear of deportation or detention
-Legal status of parents or other family members impacts children who are citizens
-Legal status can be fluid – individual status may change based on policy change
-E.g. ‘dreamers’ in the US

Question 23

“Deservingness”

Answer 23

• some groups (but not others) considered worthy of attention, investment and care
• separate from formalized entitlements(may impact these entitlements through support for policies
• should immigrants be able to access welfare, healthcare, education etc.
• influenced by status, language use, race etc.
• all immigrants to Canada screened (health screenings to ensure that they do not become a ‘burden’ on Canada’s health system

Question 24

Policy Implications and Recommendations

Answer 24

• Equal access to health care for immigrants
• Canadian provinces have a wait period (up to 3 months)
• Refugee claimants may have access to temporary health insurance
• Enforcement of labour laws and protection of immigrant workers’ rights to organize
• Immigrants may lack power due to fear of deportation or retaliation  -Fair immigration reform that includes path to citizenship
• Include immigrant communities in policy and public health