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이주민의 건강권 증진을 위한 지역보건의료사업 : 미국 캘리포니아와 LA 사례를 중심으로

A Study of Community Healthcare Programs Promoting the Right to Health of Migrants : the Case of California and Los Angeles, USA

신지원
다문화사회정책연구소 (Center for Multiculturalism and Social Policy, Daegu University)|2023.08|현대사회와 다문화 (Contemporary Society and Multiculture)|제13권 제3호|pp. 145-170|DOI http://dx.doi.org/10.35281/cms.2023.08.13.3.145

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참고문헌

키워드

이주Migration건강권Right to Health성역도시메디칼마이헬스엘에이Sanctuary CityMedi-CalMy Health LA(MHLA)
주제분류사회과학일반

초록

이 연구는 최근 코로나19 팬데믹을 통해 드러난 건강불평등에 주목하여 이주가 어떻게 건강불평등의 사회적 요인 되는지 살펴보고, 미국의 캘리포니아주(州)와 LA시의 도시 거주권에 기반한 지역보건의료사업 사례를 통해 이주민의 건강권을 증진하는 방안에 대해 고찰한다. 미국사례는 이주민의 층화된 법적지위가 건강의 구조적 결정요인으로 작동하며 건강불평등의 원인이 됨을 선명하게 보여준다. 연방정부의 공공부조규정과 통제적 이민정책은 미국 내 이주민의 보건의료서비스에 대한 접근성을 제약하는 기제로 작동되었다. 이 연구에서는 이러한 문제에 대한 대안으로 보편적 건강권 실현을 위한 지역적 접근의 필요성을 조명한다. 도시의 성원으로 인정받고 권리를 갖는 데에 있어 국가에 의해 부여된 법적(de jure) 시민권이 아닌 거주지주의(jus domicile)에 근거하는 성역 도시 사례는 중요한 시사점을 안겨준다. 특히 지역차원의 ‘방화벽정책’은 이주민의 빈곤감소와 의료접근성을 높이는 데에 긍정적인 영향을 미친다. 여기서는 캘리포니아주 건강보험제도인 메디칼(Medi-Cal)과 LA에서 시행하고 있는 마이헬스엘에이(MHLA)프로그램을 중심으로 지역보건의료사업의 실제적인 운영과 한계점 및 시사점을 논의한다.

Abstract

This study examines the ways in which migration is one of social determinants of health inequalities, and considers ways to promote the right to health of migrants through local healthcare initiatives based on urban residency in the state of California and Los Angeles County, USA. The US case illustrates that the stratified legal status of migrants is intersected with a structural determinant of health, escalating health inequalities. It highlights the need for a local approach to realizing the universal right to health as an alternative to these problems. The case of sanctuary cities, which are based on jus domicile rather than de jure citizenship has important implications for recognition and rights as a member of the city. ‘Firewall policies’ at the local level can have a positive impact on increasing access to healthcare for migrants. This study looks into the ways in which local healthcare programs work in practice, focusing on California’s Medi- Cal and My Health LA (MHLA), and discuss their limitations and implications.

참고문헌 (62)

  1. 코로나19 취약계층의 건강불평등 연구, "공공보건의료재단", 공공보건의료재단, ~ (2022)
  2. 미국의 복지개혁, "박대식", 한국농촌경제연구원, ~ (2018)
  3. 이서영, "코로나19 시기 이주민 건강권의 위기와 시사점", 의료와사회, 11, pp.83~95 (2022)
  4. Aboii, Sheyda M., "Undocumented immigrants and the inclusive health policies of sanctuary cities", Harvard Publ. Health Rev, 9, pp.1~10 (2016)
  5. Ali, Shirin, "Changing America" (2022), THE HILL
  6. Asad L., "Racialized legal status as a social determinant of health", Social Science & Medicine, 199, pp.19~28 (2018)
  7. Bambra, Clare, "The COVID-19 pandemic and health inequalities", J Epidemiol Community Health, 74(11), pp.964~968 (2020)
  8. Bauder, Harald, "Sanctuary cities and urban struggle: rescaling migration, citizenship and rights", pp.1~24 (2019), Manchester University Press
  9. Brenes, Francisco, "Immigrants and the right to health care in the era of COVID-19", Hisp Health Care Int, 18(4), pp.178~179 (2020)
  10. "How to Expand Health Care Coverage to Undocumented Immigrants: A Policy Toolkit For State and Local Governments" (2020)[URL]
  11. Immigrants and Health in California, "Cha, Paulette", Public Policy Institute of California, ~ (2021)
  12. Chen, Jarvis T., "Revealing the unequal burden of COVID-19 by income, race", ethnicity, and household crowding: US county vs ZIP code analyses, 2021, pp.27(1), 43~56
  13. Correll, Robyn, "What Are Food Deserts?" (2022), Public Health, Verywellhealth
  14. Cruz, Esefania, "The Spectrum of sanctuary cities in the United States: Contrasting the genesis and practices of proimmigrant local policies", Estudios Fronterizos, 20, pp.1~22 (2019)
  15. De Genova, Nicholas, "Constructing Immigrant ‘illegality’: Critiques, Experiences, and Responses", pp.37~62 (2014), Cambridge University Press
  16. De Trinidad Young, Maria-Elena, "More inclusive states, less poverty among immigrants? An examination of poverty, citizenship stratification, and state immigrant policies", Popul. Res. Pol. Rev, 37(2), pp.205~228 (2018)
  17. California’s Uninsured in 2024: Medi-Cal expands to all lowincome adults, but half a million undocumented Californians lack affordable coverage options, "Dietz, Miranda", UC Berkeley Labor Center and Education UCLA Center for Health Policy Research, ~ (2024)
  18. Fragomen, Austin T., "The illegal immigration reform and immigrant responsibility Act of 1996: an overview", International Migration Review, 31(2), pp.438~460 (1997)
  19. Garthwaite, Craig, "Hospitals as insurers of last resort", Am Econ J-Appl Econ, 10(1), pp.1~39 (2018)
  20. Gonzalez, Benjamin, "The Politics of Refuge: Sanctuary Cities, Crime, and Undocumented Immigration", Urban Affairs Review, 55(1), pp.3~40 (2017)
  21. Guerrero, Alma, "Foregoing healthcare in a global pandemic: the chilling effects of the public charge rule on health access among children in California" (2021), UCLA Latino Policy & Politics Initiative
  22. "Recent legislation: California Trust Act" (2013)[URL]
  23. Harvard Law Review, "Recent legislation : California Trust Act", Harvard Law Review, 127(8), pp.2593~2600 (2014)
  24. Hooper, Monica Webb, "Viewpoint: COVID-19 and racial", ethnic disparities, 2020, pp.323(24), 2466~2467
  25. Horton, Richard, "Offline: COVID-19 is not a pandemic", Lancet, 396(10255), pp.874~ (2020)
  26. Houston, Ashley, "Challenging federal exclusion: Immigrant safety, health, and healthcare access in sanctuary cities", Health and Place, 75, pp.1~9 (2022)
  27. Karmakar, Monita, "Association of Social and Demographic Factors With COVID-19 Incidence and Death Rates in the US", JAMA Netw Open, 41(1), pp.e203646241~ (2021)
  28. Kayitsinga, Jean, "Social and Structural Inequalities and COVID-19 in the United States", NEXO, 26(1) (2020)
  29. Kuge, Janika, "Sanctuary cities and urban struggle: rescaling migration, citizenship and rights", pp.50~76 (2019), Manchester University Press
  30. Lasch, Christopher, "Understanding “Sanctuary Cities”", Boston College Law Review, 59, pp.1703~1774 (2018)
  31. LeBrón, Alana, M. W, "Restrictive ID Policies: Implications for Health Equity", J Immigrant Minority Health, 20, pp.255~260 (2018)
  32. Towards Universal Health Coverage: Expanding Medi-Cal low-Income Undocumented Adults, "Lucia, Laurel", Center for Labor Research and Education, University of California, ~ (2019)
  33. Macias, Raul Gil, "COVID-19 pandemic: disparate health impact on the Hispanic", Latinx population in the United States, 2020, pp.222(10), 1592~1595
  34. Turning the Golden State into a Sanctuary State, A Report on the Impact and Implementation of the California Value Act (SB 54), "Mancina, Peter", ADVANCING JUSTICE, ~ (2019)
  35. Manfredi-Sánchez, Juan Luis, "Sanctuary Cities: What Global Migration Means for Local Governments", Social Sciences, 9(8), pp.1~16 (2020)
  36. Marrow, Helen. B., "The power of local autonomy: expanding health care to unauthorized immigrants in San Francisco", Ethn. Racial Stud, 35(1), pp.72~87 (2012)
  37. World Migration Report 2022, "McAuliffe, Marie", International Organization for Migration, ~ (2021)
  38. The Medi-Cal Program, "McConville, Shannon", Public Policy Institute of California, ~ (2019)
  39. Health Care Reform in California, "McConville, Shannon", Public Policy Institute of California, ~ (2021)
  40. Menjívar, Cecilia, "Legal violence: immigration law and the lives of Central American Immigrants", American Journal of Sociology, 117(5), pp.1380~1421 (2012)
  41. Annual Report Fiscal Year 2020-21, "MHLA", Health Services, ~ (2021)
  42. "Annual Report Fiscal Year 2021-22" (2022)[URL]
  43. Neelon, Brian, "Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States", PLoS ONE, 16(3), pp.e0248702~ (2021)
  44. What has been the impact of the COVID-19 pandemic on immigrants? An update on recent evidence, "OECD", ~ (2022)
  45. Ogedegbe, Gbenga, "Assessment of racial", ethnic disparities in hospitalization and mortality in patients with COVID-19 in New York City, 2020, pp.3(12), ~
  46. Ortiz, Robin, "A content analysis of US sanctuary immigration policies: implications for research in social determinants of health", Health Aff, 40(7), pp.1145~1153 (2021)
  47. Paik, Naomi A., "Abolitionist futures and the U.S. Sanctuary movement", Race Class, 59(2), pp.3~25 (2017)
  48. Pérez-Escamilla, Rafael, "Health care access among Hispanic immigrants: Alguin Está Escuchando?", NAPA Bull, 34(1), pp.47~67 (2010)
  49. 2023 Update on Key Federal Immigration Policies and Implications for Health, "Pillai, Drishti", Kaiser Family Foundation, ~ (2023)
  50. Potochnick, Stephanie, "How states can reduce the dropout rate for undocumented immigrant youth: the effects of in-state resident tuition policies", Soc. Sci. Res, 45, pp.18~32 (2014)
  51. Rodriguez-Diaz, Carlos E, "Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics", Ann Epidemiol, 52, pp.46~53 (2020)
  52. Providing Health Care to Undocumented Residents: Program details and lessons learned from three California county health programs, "Rojas, Denisse", Center for Labor Research and Education, ~ (2016)
  53. Roy, Ananya, "The city in the age of Trumpism: from sanctuary to abolition", Environ. Plann. Soc. Space, 37(5), pp.761~778 (2019)
  54. Singer, Merrill, "Generations of Suffering: Experiences of a Treatment Program for Substance Abuse During Pregnancy", Journal of health care for the poor and underserved, 3(1), pp.222~234 (1992)
  55. Singer, Merrill, "Introduction to Syndemics: A Critical Systems Approach to Public and Community Health" (2009), Jossey-Bass
  56. Solis, Jamie, "Structural vulnerability in the U.S. revealed in three waves of COVID-19", Am J Trop Med Hyg, 103(1), pp.25~27 (2020)
  57. Impact of Shifting Immigration Policy on Medical Enrollment and Utilization of Care among Health Center Patients, "Tolbert, Jennifer", Kaiser Family Foundation, ~ (2019)
  58. Van Natta, Meredith, "Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net", Social Science & Medicine, 220, pp.49~55 (2019)
  59. Vilar-Compte, Mireya, "Pre-COVID-19 Social Determinants of Health Among Mexican Migrants in Los Angeles and New York City and Their Increased Vulnerability to Unfavorable Health Outcomes During the COVID-19 Pandemic", Journal of Immigrant and Minority Health, 24(1), pp.65~77 (2022)
  60. Viruell-Fuentes, Edna A, "More than culture: Structural racism, intersectionality theory, and immigrant health", Social Science & Medicine, 75(12), pp.2099~2106 (2012)
  61. Yu, Matthew, "Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County", Health Equity, 4(1), pp.366~374 (2020)
  62. Zhang, Xiaohan, "Immigrants’ access to care under the Affordable Care Act: An examination of California", International Journal of Healthcare Management, 14(2), pp.335~344 (2021)

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