Program in Health Disparities Research, Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
Xenophobia encompasses negative attitudes and behaviors to exclude and vilify others pertaining to a particular ethnic or national group. Xenophobia is expressed as a defensive act by persons in groups that perceive a threat to their dominance. There is evidence that perceived disease threat predicts xenophobic attitudes. Negative consequences stemming from xenophobia include related acts of violence and bullying, a formation of negative ethnic identity in children, inhibited acculturation processes, and a general discord between ethnic and national groups. Xenophobia reflects structural violence or how history and political economy perpetuate social inequalities.
As a concept xenophobia is closely linked to stigma and discrimination. Stigma, a negative set of beliefs based on group belonging, is socially constructed through interactions but most often measured through perceived discrimination at the individual level. Growing more prominent in European countries, xenophobia is disproportionately directed at unauthorized migrants than legal or refugee migrants. Xenophobia contributes to the health burdens shouldered by immigrant populations around the globe, shaping experiences inside and external to the health system.
Health Consequences of Xenophobia
Violence motivated by xenophobia results in deaths, injuries, disabilities, trauma, and displaced persons. Violence against foreigners can cause movement of persons to displaced persons camps lacking infrastructure. Displaced persons are exposed to increased health risks due to unhygienic living conditions, poor clinical services, food insecurity, unsafe water sources, and greater exposure to infectious diseases. Further, bullying related to xenophobia places immigrants at greater risk for injury and harm.
Xenophobia determines the types of employment available to migrants. Often jobs open to migrants include hazardous working conditions and low pay. Workplace experiences may be shaped by xenophobia-related discrimination. Labor intensive jobs conducted without basic employment rights or entitlements to sick leave, health care, or convalescence time generate work-related accidents. Job insecurity and the discrimination perceived within the work sphere may cause stress and anxiety. By relation, loss of concentration places immigrant laborers at further risk of injury and peril to their health.
The prolonged stress of xenophobia leads to a physiological state of fear or hyper arousal. This state leads to increased allostatic load, a bodily stress response, which places migrants at greater risk for chronic illness. Perceived discrimination has been associated with increased incidence of chronic illness. Reports of discrimination have been linked to high blood pressure, respiratory problems, somatic complaints, negative self-rated health, and chronic health conditions.
Xenophobia-related discrimination has been associated with poor mental health. Anxieties related to experiencing xenophobia caused an increased need for mental health services. Among migrant groups such services have often been unavailable due to eligibility constraints based in legal status.
Health Care Seeking
Xenophobia provides an overarching context to the health care seeking activities of migrants. Contexts of xenophobia may compound rights-based limits on immigrant health care access such as lack of health care insurance or work-related limits on sick leave. Fear-based experiences of xenophobia may lead to
Sana Loue & Martha Sajatovic (eds.), Encyclopedia of Immigrant Health, DOI 10.1007/978-1-4419-5659-0,
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avoidance of or delayed health care seeking. Migrants have avoided seeking health care services for a range of issues from prenatal care during pregnancy, broken bones, and abscesses. Aside from avoidance, delayed health care seeking results from xenophobia. Migrants delay prenatal and perinatal service seeking which likely leads to higher rates of perinatal mortality observed in many migrant groups. Migrants delay seeking health care for job-related injuries. The delay in seeking health care ensures that such injuries develop into longer term chronic problems.
Xenophobia shapes national legislation and thus influences health care access. Further, concern over limited health care resources can exacerbate xenophobia. In the United States, the federal welfare reform act of 1996, titled Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), foreclosed eligibility for Medicaid to most legally authorized immigrants for the first 5 years of residence. The law required that state governments providing benefits to undocumented affirm migrants' eligibility. Intended to save costs, the legislation inadvertently created categories of eligibility within migrant groups, thereby increasing xenophobia toward illegal immigrants.
In certain contexts, health care staff are obligated by law to denounce undocumented migrants seeking health care services. Providing adequate care is further compromised by an inability to adequately supply medications to clinics serving migrants. Immigrants experience frustratingly longer wait times. Immigrants are more likely to report discrimination of health care compared with US-born counterpart populations.
Xenophobia shapes immigrant health risks, outcomes, behaviors, and health care seeking. By generating violence, xenophobia places persons of particular national or ethnic identity at greater risk of injury, disability, and death. Discriminatory experiences in the workplace may generate poor health outcomes. Xenophobia results in avoidance and delayed health care seeking, thus intensifying and worsening conditions. Fears of deportation and legal obligations for health care providers to report unauthorized immigrants result from contexts of xenophobia. Stress and anxiety related to xenophobia generate mental health needs which may be stigmatized in certain immigrant groups. Availability of mental health services is often limited to authorized immigrants. Health care services within contexts of xenophobia may be characterized by discrimination, long wait times, and poor supplies of medication. As protective factors against harms of xenophobia, immigrant groups may organize to claim their rights, receive social and economic support from nongovernmental organizations, labor unions, or other institutions.
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