School of Public Health
University of California at Berkeley
Spring Semester 2013
PH 212C: Migration and Health: A US-Mexico Binational Perspective
Units: 2 units
Time: Mondays 2-4 pm
Place: B51 Hildebrand
Course Control Number: 76102

Instructor:   Sylvia Guendelman, Ph.D.
sylviag@berkeley.edu
Office Hours: Tuesdays, 2:15-3:30pm
207-J University Hall

Co-Instructor: Xochitl Castañeda, Medical Anthropologist
Director, Health Initiative of the Americas
xochitl.castaneda@berkeley.edu

View Entire Syllabus (pdf)

OVERVIEW

Every year, millions of people leave their countries of origin to look for a better life, escape violence or natural disasters or to be reunited with other family members who emigrated before them. The United Nations estimates that nearly 200 million people- or about 3% of the world’s population- live outside their country of birth.

The U.S. constitutes the major destination country. Immigration from Mexico that began to substantially increase after 1970 and remained steadfast until 2010, has contributed by far the largest number of immigrants from any one country in US history. Of the approximately 40 million immigrants in the US in 2012, about 30% were born in Mexico. California, which was once politically a part of Latin America, boasts the largest number of Mexican-born residents. Undoubtedly, California is demographically, economically and culturally linked to Mexico and Latin America.  Whereas until recently Mexican and other Latin American immigration was concentrated in California and a few other states, immigrants are now moving into new localities throughout the U.S.

Although migration contributes to economic productivity, an entrepreneurial spirit and cultural diversity in the U.S., it poses real challenges for individuals, families, and communities of origin, transit, and destination. From a health standpoint, illnesses and health behaviors know no borders as individuals, media and goods flow back and forth across political borders. Furthermore, for communities of origin and destination, migration can negatively impact health and social disparities. A large proportion of Latino immigrants lack health insurance or are underinsured; overweight and obesity are increasing rapidly, and rates of chronic diseases such as diabetes and hypertension and levels of job-related injury are much higher compared to other demographic groups in the U.S.

Understanding the significant role that the physical and social environment plays in shaping health and health disparities is critical to a deeper understanding of immigrant health. For this class we start from the vantage point that the experience and process of im/migration is an overarching social determinant of health. We examine health, disease and death in the context of multiple social determinants implicated in im/migration such as country of birth and residence, border crossings, immigration status, income and education, access to care, ethnicity, social standing in the society of origin and destination, length of time in the US, language proficiency and acculturation to societal norms, values and behaviors.

Addressing the health needs of im/migrants in social and culturally appropriate ways is critically important for creating an inclusive, cost-effective health care system and a more equitable society. Effective public health policies, interventions and population-based preventive programs are important tools for promoting healthy behaviors and reducing risk factors for adverse health outcomes in this vulnerable population.

The goal of this course is to strengthen student’s knowledge and understanding of  im/migration, health and disease at the community and population level.  Students will explore successful policies and public health interventions targeting those populations. Beside lectures and discussions with key international experts, there will be student presentations on selected topics.

LEARNING OBJECTIVES

At the end of this course, students will be able to:

1. Describe current trends in im/migration from Mexico and Latin America and its impact on the health of populations/communities of origin and destination;
2. Recognize priority health issues for immigrants, key social determinants of health and appropriate interventions to address them;
3. Identify major sources of data on international migration and immigrant health-related issues;
4. Examine methodological approaches to the study of im/migrant populations;
5. Conduct systematic literature reviews on im/migration and health issues;
6. Organize and deliver a clear and concise oral presentation on a selected health topic and a written fact sheet summarizing the results of the literature review.

GRADING AND REQUIREMENTS
Paper Outline-   20%
Class Participation-  35%
Final presentation-  10%
Final Paper-    35%

Class time will consist of one hour of lecture by instructor or guest speaker, followed by one hour of discussion of readings assigned for the session.  Each student will sign up as a discussant for a given session and there will be 2 or 3 discussants per session who will work together to coordinate the session. The role of the discussants will be to revise the assigned readings and in no more than 15 minutes, summarize the readings and describe how the main issues addressed in the articles tie into the lecture or presentation. The discussants will also raise a couple of questions that can stimulate class discussion on how to think about critical issues, gaps in knowledge, policy/intervention implications, and recommendations for further research. The lecturer and/or the instructors will help to facilitate the overall class discussion. Students are fully expected to attend class and become familiar with the readings, and to actively participate in class discussions to prepare questions and to share comments with other students and with the guest speakers.  Sign-up sheets will monitor attendance.

On the sixth and the eighth sessions, we will hold a discussion of current events. The purpose is to reflect on the following issues: How do media report some of the main topics on migration and health? Is the reporting based on scientific evidence or is it mainly anecdotal? Is it fairly balanced or biased? To prepare for these sessions, each student will sign up to join a group in one of the following topics:

1) immigration, 2) borders and border crossings/crossers 3) chronic disease or 4) maternal, child, adolescent and family health (Session 6). AND

1) health insurance;  2) non-financial  access/barriers to health care, 3) health education 4) access to higher education, and 5) school dropout (Session 8).

For these current events discussion sessions, it is expected that each student will bring to class a short newspaper/magazine article on the chosen topic and share it with their group. The first hour of that session will be devoted to reading and discussing the articles among members of the group and compiling a brief presentation of the main points learned. The second hour will be devoted to presenting the main points followed by a brief question and answer period. The impact of the social determinants of health will guide the discussions.

For the term assignment, each student will prepare a brief oral presentation as well as a fact sheet on a health issue relevant to immigrants. By the fifth week of class (March 4th) students need to hand in a 1-2 page outline of the main components of their final presentation and paper. The outline should contain: a) proposed title b) brief formulation of the issue, c) specific objective(s), and d) specific references that will be used.

The final document , based on the oral presentation, should be a well-researched, concisely written fact sheet, 5 pages in length (double spaced), and is due on the last day of class. The last 2 weeks of class will be dedicated to a 5-10 minute student PowerPoint oral presentation, followed by a brief Q & A period per presentation. Content must include:

1) Proposed title
2) Formulation of the health issue including brief background information on the health issue and its significance
3) Methodology used: sources consulted; period covered
4) Summary of main findings from the literature review (using ample references including:
a. Description of the study population (s)
b. Main results (include tables and graphs)
c. Strengths and weaknesses of the evidence under review
5) Conclusions
6) Recommendations for research
7) Implications for public policy and public health. (For instance, what might be the best practices that could be implemented to address the issue?
8) References

Oral presentations will be graded based on: (1) Overall structure, logic, and content, (2) quality of literature review, (3) relevance of data (i.e. specific to immigrants), (4) appropriateness of research recommendations and policy/practice implications, (5) quality of slides, (6) quality of delivery, and (7) compliance with time allocation.

The final paper will be graded using the first four criteria, as for oral presentation, as well as writing quality.