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As one of the editors of this book I feel concerned with the
presentation of this book as somehow jingoist. Dr. Rossignol is correct
that this book is "incomplete" and we went to great lengths to state
explicitly that this was not meant to be a definitive treatise on
immigrant health or even immigrant women's health. Rather, it was directed
primarily at clinicians who need information and training about how to
care for the rapidly diversifying population in the United States. It
relates predominantly to health care delivered in the US. It was not meant
to be a public health manual, so topics that we may have an interest in,
such as designing prevention strategies aimed at "populations" rather than
individuals, did not get covered in this volume.
While we worked hard to incorporate the philosophy, shared by all of
the editors and authors, that Western allopathic medicine is not a panacea
nor are traditional medicines "primitive or incorrect", we acknowledge the
bias that this book targets primarily western-trained clinicians who must
themselves struggle to find a compromise between philosophies that often
play out in the clinic, office or hospital. I do not believe that Western
style medicine is anywhere in this volume described as superior. However,
Dr. Rossignol's perception that focusing on access to Western medical care
is a problem shows me that she has little appreciation for the barriers
that nearly all recent immigrants face in the US when attempting to access
care within the US health system. As an emergency physician, I have seen
this play out over and over again across many ethnic and language groups
and regardless of education, if the common feature is lack of health
insurance. Yes, our country benefits from the best and the brightest
immigrants, physicians, engineers, and philosophers. Ask any of those
people how to access medical care for their mother's chest pain when she
is visiting the US; you will hear many distressing stories of the barriers
faced by even the most educated.
While the chapter on health services utilization (Chapter 4) was
meant to demonstrate differences in use of health services, little data
exists which parses utilization by immigration status. Thus Dr.
Rossignol's plea for more information on the use of health services
comparing immigrants to non-immigrants is very nearly impossible on any
other than case study or anecdotal levels as the US national databases do
not categorize persons by immigration status. Thus race and ethnicity
often become proxies for immigrant specific data, just as race and
ethnicity have often served as proxies for socioeconomic status. Is this
the way we would want it to be? Certainly not. But we do not create the
data and the US is currently stuck with the social construct of "race-
ethnicity" as it plays out in our national health databases. We are
caught in our own creation!
I hope no other reader will take away from the background section
that we perceive of all immigrants (including our own family members for
those of us writing who ARE recent immigrants) as "poor, disease laden,
and wretched with parasites". We consider the wave of immigration to the
US as a huge source of wealth to our country, now more than ever.
Immigrants often BRING good health with them, and are made ill by Western
society. On the other hand, it would be naive, at best, not to consider
that the current US medical system is poorly equipped to handle the
spectrum of needs for immigrant women. It was our attempt to deliver
information that would help to prepare providers for this challenge.
It is my great hope that others, Dr. Rossignol among them, will take
up that challenge in many other fields: public health, health care policy,
health services research, and medical sociology and anthropology.
Susan L. Ivey, MD, MHSA
Assistant Clinical Professor, Joint Medical Program
Center for Family and Community Health,
UC-Berkeley,
School of Public Health,
Berkeley, CA 94720-7360
Competing interests:
No competing interests
28 April 2001
Susan L Ivey
Assistant Clinical Professor, Joint Medical Program
University of California, Berkeley, School of Public Health
U.S. benefits greatly from immigrants but physicians need direction
In response to Dr. Rossignol's critique:
As one of the editors of this book I feel concerned with the
presentation of this book as somehow jingoist. Dr. Rossignol is correct
that this book is "incomplete" and we went to great lengths to state
explicitly that this was not meant to be a definitive treatise on
immigrant health or even immigrant women's health. Rather, it was directed
primarily at clinicians who need information and training about how to
care for the rapidly diversifying population in the United States. It
relates predominantly to health care delivered in the US. It was not meant
to be a public health manual, so topics that we may have an interest in,
such as designing prevention strategies aimed at "populations" rather than
individuals, did not get covered in this volume.
While we worked hard to incorporate the philosophy, shared by all of
the editors and authors, that Western allopathic medicine is not a panacea
nor are traditional medicines "primitive or incorrect", we acknowledge the
bias that this book targets primarily western-trained clinicians who must
themselves struggle to find a compromise between philosophies that often
play out in the clinic, office or hospital. I do not believe that Western
style medicine is anywhere in this volume described as superior. However,
Dr. Rossignol's perception that focusing on access to Western medical care
is a problem shows me that she has little appreciation for the barriers
that nearly all recent immigrants face in the US when attempting to access
care within the US health system. As an emergency physician, I have seen
this play out over and over again across many ethnic and language groups
and regardless of education, if the common feature is lack of health
insurance. Yes, our country benefits from the best and the brightest
immigrants, physicians, engineers, and philosophers. Ask any of those
people how to access medical care for their mother's chest pain when she
is visiting the US; you will hear many distressing stories of the barriers
faced by even the most educated.
While the chapter on health services utilization (Chapter 4) was
meant to demonstrate differences in use of health services, little data
exists which parses utilization by immigration status. Thus Dr.
Rossignol's plea for more information on the use of health services
comparing immigrants to non-immigrants is very nearly impossible on any
other than case study or anecdotal levels as the US national databases do
not categorize persons by immigration status. Thus race and ethnicity
often become proxies for immigrant specific data, just as race and
ethnicity have often served as proxies for socioeconomic status. Is this
the way we would want it to be? Certainly not. But we do not create the
data and the US is currently stuck with the social construct of "race-
ethnicity" as it plays out in our national health databases. We are
caught in our own creation!
I hope no other reader will take away from the background section
that we perceive of all immigrants (including our own family members for
those of us writing who ARE recent immigrants) as "poor, disease laden,
and wretched with parasites". We consider the wave of immigration to the
US as a huge source of wealth to our country, now more than ever.
Immigrants often BRING good health with them, and are made ill by Western
society. On the other hand, it would be naive, at best, not to consider
that the current US medical system is poorly equipped to handle the
spectrum of needs for immigrant women. It was our attempt to deliver
information that would help to prepare providers for this challenge.
It is my great hope that others, Dr. Rossignol among them, will take
up that challenge in many other fields: public health, health care policy,
health services research, and medical sociology and anthropology.
Susan L. Ivey, MD, MHSA
Assistant Clinical Professor, Joint Medical Program
Center for Family and Community Health,
UC-Berkeley,
School of Public Health,
Berkeley, CA 94720-7360
Competing interests: No competing interests