The social determinants of health are complex, multifaceted concepts that involve more than just simple access to medical care. While having access to quality and affordable care is, arguably, one of the most essential factors in maintaining adequate health, research indicates that various factors ranging from education, economic stability, and resource insecurities are just as important when it comes to determining overall health (Artiga & Hinton, 2018). This is most evident in the case of Naomi and her daughter. Naomi is a single, undocumented immigrant mother living in Memphis, TN. As an immigrant, regardless of her zip code, she will already be facing difficulties with marginalization, acculturation, and, in her case, risk and fear of deportation (Chang, 2019).
In turn, her lack of a documented status, work visa, assumingly higher education and a potential language barrier leads to complications finding a job that provides her with both a livable wage and benefits such as health insurance. Research supports this by reporting that over half of undocumented immigrants, such as Naomi, live below the US poverty line and are more likely to receive lower wages and less benefits than their documented counterparts (Chang, 2019). Therefore, not only do her employers not provide her with insurance, but her wage further impedes her ability to afford her cost of living let alone self-financed health insurance. Further, after expenses, Naomi is left with a surplus of only $125/month to be used to provide for her family and, unfortunately, without insurance the cost of seeking medical care and subsequent treatment would far exceed that amount. In addition, even if treatment was sought, the potential of having a language barrier that could impede communication with medical staff would prove to be a significant obstacle for Naomi. This could then lead to inadequate care, miscommunications, and even medical errors. In the end, determinants such as immigration status, education level, and speaking appropriate English will all affect Naomi’s abilities to seek out medical care.
One resource that is available to Naomi in terms of healthcare is the Church Health (2020) organization located in Midtown. They are a local non-profit that caters to the uninsured by providing services such as a medical clinic, an emergency walk-in clinic, a pharmacy, a dental clinic, physical rehabilitation, eye care, as well as behavior health treatment. Naomi is able to utilize their walk-in clinic as a non-established patient (for a small fee) if she deems her daughter requires immediate medical attention or she can take the time to register as an established patient in order to seek more of a primary care setting. She would simply need to provide proof that she is an uninsured resident of Shelby County and that she works at least 20 hours/week to complete this process. Church Health (2020) also has access to Spanish resources, as this would assumingly apply to Naomi, that would allow her to more effectively communicate with her daughter’s providers and them with her. Finally, there is a pharmacy that would provide Naomi with significant discounts on the medications her daughter might require.
One additional resource that could be at Naomi’s disposal is the Mid-South Food Bank (2020) (MSFB), a continuum of the larger Feeding America organization. Through their programs such as Mobile Pantry, Kids Cafe, Food for Kids BackPack Program, and Healthy School Pantries, MSFB is capable of providing a variety of fresh produce, meat/dairy products, as well as non-perishable food items to the multiple impoverished and underserved Memphis populations. This could prove useful for Naomi in ensuring that her family has access to healthier food options that do not exceed her budget and could simultaneously aid in decreasing their risk for further health complications.
Naomi’s situation is one that is very applicable to a multitude of individuals living in the US today. She is an undocumented, female, immigrant that is essentially forced into working low-wage, menial jobs that often offer no benefits and little to no opportunity to climb the cooperate and social ladders. As a healthcare provider, it is imperative that conversations are had to aid in decreasing these determinants of health as well as the stigma and marginalization that surround these individuals.
In addition, it can be argued that it is our ethical duty to treat these individuals regardless of immigration status and to aid in removing the obstacles they experience when seeking healthcare. People are unnecessarily dying simply because of how cooperate healthcare has decided to monetize health. When taking the Hippocratic oath there is no addendum stating ‘I will only treat those who can afford to be treated’. It is remembering that these are not just illnesses that are being treated, but rather human beings that are worthy of being treated simply because they are alive.
Finally, it is not the responsibility of these marginalized groups to make the effort but rather us, the ones that have the capability to promote positive, systemic change from within. As providers, collaborating with various disciplines of various expertise is essential when expecting to provide holistic care. Treating just the presenting symptoms is not enough. It will be by collaborating as a team that we can provide patient-centered care that aids in improving all aspects of their life, albeit social work, local food pantries, shelters, etc. In the end, it needs to be the healthcare providers that change healthcare.
