Caribbean Immigrants in the United States--Health and Health Care: The Need for a Social Agenda

Abstract

Immigration is a cornerstone of the American experience. From the founding fathers and mothers to the political asylum seekers today, America has been a beacon to many from around the globe. However, the immigrant experience in America has been uneven with regard to which groups are readily incorporated into the mainstream social order and which are, as Brace (1872/1973) wrote in the late 19th century, among the dangerous classes for which special vehicles for social integration are needed. Among the recommendations made by Brace were to prevent additional population growth among the dangerous classes and, most notably, to throw the influences of education and discipline and religion about the abandoned and destitute youth of our large towns (p. ii). The groups for whom Brace made these recommendations were largely European (that is, Irish, Southern, and Eastern European). Today, America's ethnic kaleidoscope is vastly different from that referenced in Brace's assessment, with a major presence of nonwhite and non-European immigrants. Among the many groups immigrating to the United States are Caribbean-born people representing many different countries of origin (for example, Bahamas, Barbados, Jamaica, Guyana, Haiti, and Trinidad and Tobago). According to the Center for Immigration Studies, a Washington, DC-based nongovernmental organization, at least 6 percent of the immigrants coming to the United States between 2000 and 2005 were from the Caribbean (see http://www.cis.org). The sheer number of people from Caribbean countries suggests that American health, social, educational, and human service systems should consider the need for the immediate development of programs capable of meeting the unique needs of these emigrating groups. An agenda in social work that seeks to understand the needs of this growing population and the development of culturally specific models of intervention is critically important and relevant to the profession's core mission of social and economic justice. Such an agenda would certainly include advancing our knowledge about the myriad forces that contribute to the disparate health and mental health conditions among Caribbean immigrants. However, such a social work agenda would also include policy and structural interventions that address immigration laws, locally and nationally, that give preference to some racial and ethnic groups over others. Emigration has always been an integral component of the Caribbean experience. The search for a better life for themselves and their children has taken Caribbean peoples all over the globe to countries within their own region, as well as to metropolitan countries such as Britain, Canada, and the United States. The United States has, however, been a favorite destination because of its close proximity to the Caribbean region and its long-held reputation as a country with a burgeoning economy that promises an improved quality of life for skilled and unskilled, documented and undocumented people who are willing to work hard in pursuit of their dreams. The status of Caribbean immigrants in the United States is not monolithic, but clearly there are Caribbean populations making great strides in their education, income, and social mobility in which they are poised to realize the American dream. On the other hand, segments of the population face a range of challenges in measures of education and other indices of well-being. Despite the undisputed benefits and vast opportunities that segments of the U. S. Caribbean population have experienced, a significant number of these immigrants face a worsening health status that is due in part to socio-structural factors that affect their access and use of health services; the unique psychosocial risk factors faced by immigrants from the region; and their distinctly different clinical and social needs are often misunderstood (Jackson et al. 2007; Mohan et al., 2006; Molokhia & McKeigue, 2006; Williams et al. …