Higher Education Access and Health Outcomes Among Undocumented Immigrants

There are over 427,000 undocumented immigrants enrolled in higher education in the U.S., and nearly 90% of them attend college as opposed to vocational school [1]. However, it is estimated that almost 1.6 of the 11 million undocumented immigrants in the U.S. are between ages of 16 to 24 years old [2]. In addition to greater socioeconomic opportunities, higher education is especially critical because many studies have found it to be a strong predictor of health outcomes.

Documentation status has been identified as a social driver of health and risk factor: those without legal documentation status are more likely to have worsened health [3]. Among non-senior adults that are noncitizens in the U.S., 42% were uninsured in 2020 [4]. This lack of healthcare coverage for undocumented adults leaves many of them only able to access healthcare through Emergency Departments (EDs), Federally Qualified Health Centers (FQHCs), and local volunteer-run clinics [5]. Another way undocumented immigrants receive care is through clinics on college campuses. Most colleges in the U.S. require students to have health insurance and likely provide subsidized plans, so higher education is a great mechanism in which undocumented immigrants may achieve better health outcomes in the short and long term.

DACA is instrumental in providing undocumented students access to higher education since attendance in higher education is a major qualifying factor for DACA recipients [5]. DACA provides a mechanism in which undocumented children may reach higher education and improve their social drivers of health. The program also relieves stressors that are generated from fear of being deported. However, those who are DACA recipients are not qualified for health insurance through the ACA, meaning they are ineligible for Medicaid and CHIP [5]. Another program that is key for young adults to achieve citizenship is the DREAM act, which permits those who have grown up in the U.S. to apply for temporary legal status and eventually become eligible for citizenship if they go to college or serve in the military. Studies have found that having a protected legal framework like DACA and DREAM leads directly to better health outcomes by bettering economic stability, increasing educational opportunities, and increasing healthcare access [6].

It is imperative that undocumented immigrants be provided the opportunity to get higher education for both immediate access to clinical care and improved long-run health outcomes. However, more can be done to support college students without legal documentation status.

Undocumented immigrants in college face a myriad of challenges and stressors, leading them to be at a higher risk for behavioral health issues. These stressors include, but are not limited to, inability to finance required textbooks, fear of performing poorly academically and being removed from the DREAM act, and concerns for one’s future and financial stability [3]. A study found that COVID-19 had a profound impact on dreamers’ mental health, more so than documented students [7]. It was identified that out of those in the study, “47% of the dreamers met the clinical cutoff for anxiety, 63% met the cutoff for depression, and 67% (2 in 3) met the cutoff for anxiety and/or depression.” Id.

Programs such as DACA and DREAM need to be protected to continue access to higher education and healthcare, but it is also important that on-campus care for undocumented immigrants includes mental health resources and financial support systems.

Edited by: Sam Shi

Graphic Designed by: Shanzeh Sheikh

References

1. National Data on Immigrant Students. Higher Ed Immigration Portal. (2022, November 4). Retrieved November 9, 2022, from https://www.higheredimmigrationportal.org/national/national-data/

2. Profile of the unauthorized population - US. Migration Policy Institute. (2022, October 1). Retrieved November 9, 2022, from https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/US

3. Enriquez, L.E., Morales Hernandez, M. & Ro, A. Deconstructing Immigrant Illegality: A Mixed-Methods Investigation of Stress and Health Among Undocumented College Students. Race Soc Probl 10, 193–208 (2018). https://doi.org/10.1007/s12552-018-9242-4

4. Published: Apr 06, 2022. (2022, April 6). Health Coverage of Immigrants. KFF. Retrieved November 9, 2022, from https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/

5. Adams, C. (2018, December 13). How Increased Access To Higher-Ed Improves Health Outcomes for Undocumented Immigrants. University of Michigan School of Public Health. Retrieved November 7, 2022, from https://sph.umich.edu/pursuit/2018posts/higher_ed_undocumented_immigrants.html#:~:text=Bachelor's%20Student%2C%20Public%20Health%20Sciences&text=Additionally%2C%20undocumented%20immigrants%20can%20typically,education%20strongly%20influence%20these%20barriers.

6. Sudhinaraset, M., To, T. M., Ling, I., Melo, J., & Chavarin, J. (2017). The Influence of Deferred Action for Childhood Arrivals on Undocumented Asian and Pacific Islander Young Adults: Through a Social Determinants of Health Lens. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 60(6), 741–746. https://doi.org/10.1016/j.jadohealth.2017.01.008

7. Goodman, J., Wang, S. X., Ornelas, R. A. G., & Santana, M. H. (2020, January 1). Mental health of undocumented college students during the COVID-19 pandemic. medRxiv. Retrieved November 9, 2022, from https://www.medrxiv.org/content/10.1101/2020.09.28.20203489v1.full

Limitations of Hope: Lessons Learned from the Aducanumab Controversy

A year ago, the FDA fast-tracked a brilliant new therapy for Alzherimer’s disease. Alzheimer’s is a devastating neurological illness which causes slow cognitive decline over time, characterized by beta-amyloid plaques which surround neurons in the brain. This new drug, known as aducanumab, removed the plaques linked to the neurological devastation caused by Alzheimer’s disease. The only problem? There was no proof that aducanumab actually treated Alzheimer’s.

Aducanumab looked promising at first. After all, it had been shown to remove beta amyloid plaques, a key hallmark of Alzheimer’s disease. However, in clinical trials, Aducanumab hadn’t been shown to reduce the symptoms of Alzheimer’s, nor slow down the progression of the disease significantly. In other words, the FDA had fast-tracked a therapy that wasn’t actually proven to treat Alzheimer’s.

How did this happen? Pharmaceutical companies, Alzheimer’s patients, and advocates began a lobbying process for the approval of the drug, regardless of its efficacy, and once on the market, Aducanumab was marketed for $56,000 a year. After public outrage, the price was cut down to $28,000 annually. So was the other $28,000 just an upcharge by pharmaceutical companies because they could? For a therapy that wasn’t even proven to be effective? As demonstrated by the motivation of patients to approve the drug, hope must’ve been the factor they were taxing.

And yet, what would’ve happened had the FDA chosen not to approve Aducanumab, one of the more promising therapies in recent years? The lack of significant progress in the realm of Alzheimer’s therapies is causing funding for research in the field to dry up, a problem made worse by the FDA’s refusal to approve or fast-track drugs for Alzheimer’s due to lack of data demonstrating efficacy. This is a pressing problem for Alzheimer’s patients as well, many of whom see their hopes for a better future disappearing just like the potential for new treatments.

While the final approval decision for aducanumab lies squarely on the FDA, it’s also true that the drug likely would not have been approved at all had it not been for the Alzheimer’s advocates pushing for more potential treatments. It’s easy to push blame onto patients, their families, and their caregivers, or wonder why they would push for approval for a therapy that likely wouldn’t succeed anyways. But when you’ve been fighting for so long and the road ahead just keeps getting darker, it’s difficult not to reach for that tiny spark of light, no matter how faint it is. The approval of aducanumab is a lesson both on the limitations of science and the limitations of hope.

Edited by: Olivia Ares

Graphic Designed by: Sofia DiFulvio

References

1. https://www.dukehealth.org/blog/what-you-need-know-about-aducanumab

2. https://n.neurology.org/content/98/9/e968

3. https://investors.biogen.com/news-releases/news-release-details/biogen-announces-reduced-price-aduhelmr-improve-access-patients

Black Women and Maternal Mortality

Black women are three times more likely to die from a pregnancy-related cause than white women, as reported by the Center for Disease Control. Preeclampsia and eclampsia, which are both terms for high blood pressure at different times during pregnancy, is a leading cause of death for black mothers, yet if diagnosed early, is easily manageable. According to the Population Reference Bureau, “Black women are five times more likely to die from pregnancy-related cardiomyopathy and blood pressure disorders than white women.” Why is a treatable condition causing disproportionate deaths of black mothers? Evidently, a gap exists in communication between patients in the doctors, in which a lack of an adequate diagnosis and/or treatment leads to increased rates of black maternal mortality. The following are potential factors that can contribute to higher rates of black maternal mortality.

Historically, there is a lot of preexisting mistrust in black communities surrounding medical professionals. This may date back to when medical professionals such as J. Marion Sims, who is revered as the “father of modern gynecology,” performed repeated and painful experimental surgeries on enslaved black women without administering anesthesia, and without their consent. Not only does this raise ethical questions regarding informed consent, but such examples of doctors disregarding the pain experienced by black patients further exacerbate the mistrust some members of the black community have towards medical providers. Another example of this is Serena Williams’ childbirth experience. Serena’s doctors were aware that she had a high-risk tendency for blood clots, yet when Serena experienced symptoms of an impending blood clot during childbirth, her doctors were reluctant to believe her. When she explained to them that she needed heparin, a drug that prevents blood clots, she was told, “Well, we don’t really know if that’s what you need to be on right now.” After advocating for herself repeatedly, a CT scan showed she had multiple blood clots, and she was correct about her symptoms. This illustrates a current example of doctors disregarding the pain and symptoms reported to them by a black patient, leading to distrust of the medical community.

This is worsened by the false beliefs about biological differences in the bodies of black people that are even today, held by some members of society. In a 2016 study conducted by Dr. Kelly F Hoffman, it was found that approximately half of the medical student participants had false views about biological differences between black and white patients. This included the belief that black patients have a higher pain tolerance due to having thicker skin and less sensitive nerve endings. Implications of such biases include healthcare providers not taking their patients' reported symptoms seriously. This may lead to a failure to accurately diagnose certain conditions and prescribe the correct medication to treat patients. Beliefs about black patients' tolerance for pain can also lead to medical professionals being “rougher” and more careless when treating their patients. Long term negative effects include staggering increases in black maternal mortality rates.

Another factor that can contribute to high rates of black maternal mortality is weathering. Weathering is a term coined by Dr. Arline Geronimus, a public health researcher and professor at the University of Michigan, to describe how racism, discrimination, and other lived experiences can negatively impact the health of disadvantaged people and/or populations of color. The weathering hypothesis suggests that the accumulation of stress experienced by black mothers in their lifetime can contribute negatively to maternal health and exacerbate the higher rates of poor birth outcomes for African and African American mothers.

The effects of the weathering hypothesis combined with the devaluing of pain as well as mistrust towards the medical community, are all factors that need to be considered when discussing the high rates of black maternal mortality. This is a prominent issue today, and improving the understanding of these topics within the medical community can lead to better health outcomes for black mothers worldwide.

Edited by: Danika Dai

Graphic Designed by: Alejandra Gonzalez-Acosta

References

1. “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds,” Population Reference Bureau, https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/.

2. “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds,” Population Reference Bureau, https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/.

3. “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds,” Population Reference Bureau, https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/.

4. “A surgeon experimented on slave women without anesthesia. Now his statues are under attack,” The Washington Post, https://www.washingtonpost.com/news/retropolis/wp/2017/08/29/a-surgeon-experimented-on-slave-women-without-anesthesia-now-his-statues-are-under-attack/.

5. “Serena Williams on her near-death experience after giving birth: No one was really listening,” Today, https://www.today.com/health/womens-health/serena-williamss-essay-black-pregnancy-rcna23328.

6. “Black Maternal Mortality: ‘It is Racism, not Race,’” Johns Hopkins Bloomberg School of Public Health, https://ccp.jhu.edu/2021/05/17/maternal-mortality-black-mamas-race-momnibus/.

7. “Eliminating Racial Disparities in Maternal and Infant Mortality,” Center for American Progress Action Fund, https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality/.