地理が健康の構造的決定要因としてどのように作用するか(How geography acts as a structural determinant of health)

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2024-04-26 カリフォルニア大学リバーサイド校(UCR)

カリフォルニア大学リバーサイド校の研究チームは、米国とメキシコの国境地帯、特に南カリフォルニアの東コーチェラバレーに焦点を当て、低所得者層の健康に地理が大きく影響することを明らかにしました。この地域の非法人化されたコミュニティでは、基本的なインフラと医療アクセスが不足しており、住民は社会的にも歴史的にも疎外されがちです。調査では、地元のラテン系及び先住民系メキシコ人のケアギバー36人にインタビューし、多くが子どもの呼吸器ケアのために国境を越えてメキシコの医療を利用していることが分かりました。これは、米国の医師が言語の壁により十分な情報を提供していないためです。

<関連情報>

米国とメキシコの国境を越えてケアを求める: 喘息または呼吸困難の子どもを持つラテン系およびメキシコ先住民の介護者の経験 Seeking care across the US-Mexico border: The experiences of Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress

Gabriela Ortiz, Sophia Rodriguez, María Pozar, Ashley Moran, Ann Cheney
Social Science & Medicine  Available online:6 March 2024
DOI:https://doi.org/10.1016/j.socscimed.2024.116736

地理が健康の構造的決定要因としてどのように作用するか(How geography acts as a structural determinant of health)

Highlights

  • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands.
  • Latinx children in colonias are disproportionately exposed to environmental toxins.
  • Geography acts as a structural determinant of health for Latinx families in colonias.
  • A binational approach to health services should be prioritized for families in the borderlands.

Abstract

Background
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.

Methods
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.

Results
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.

Conclusion
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.

医療・健康
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