Immigration status must be treated as a health determinant. Being an immigrant limits behavioral choices and often directly impacts or alters the effects of other social positioning, such as race, ethnicity, gender, or socioeconomic status (Castaneda et al., 2014). Like other immigrants, Arab Americans have experienced challenges related to acculturation, adjustment, and prejudice (Anisa et al., 2014). In addition, the sociopolitical events in the past twenty years as well as the events of September 11th have led to increased negative perceptions and acts of discrimination toward the Arab American community (Anisa et al., 2014).
The mental health of an immigrant population is greatly affected as a result of leaving their home countries and relocating to a new and unfamiliar land with customs and traditions very different from their own (Dow, 2011). Arab American immigrants, like others, face a multitude of stressors which are further exasperated by mainstream prejudice. The immigrant experience can be depicted within a behavioral, cultural, or structural framework.
The behavioral framework is the most frequently used approach and focuses on the individual as the primary unit of analysis. This focus tends to consist of behavioral choices and typically includes health service utilization, cancer risk behaviors and screening, chronic disease, and mental health (Castaneda et al., 2014). As an immigrant, individuals are placed in ambiguous and often hostile relationships to the state and its institutions, and health services (Castaneda et al., 2014). Often, due to mistrust, both documented and undocumented immigrants will not seek out healthcare in order to avoid deportation or separation from their family. In a report by the Council of American-Islamic Relations (2006), 135 cases of hate crimes occurred in 2007 (Goforth et al., 2014). Additionally, approximately one in four Americans believe that Islam is associated with hatred and violence (Goforth et al., 2014) (Council on American-Islamic Relations, 2006). These underlying attitudes and hate crimes toward Muslims instill distrust within the communities, serving as a behavioral barrier to healthcare. The behavioral framework has several limitations. It places responsibility entirely on the individual while failing to acknowledge larger contextual factors and place accountability within social systems that drive poor health outcomes (Castaneda et al., 2014). In the case of immigrants, individual responsibility for behaviors is not always entirely fair.
The cultural framework is the second most common approach to understanding immigration and health in the public health literature (Castaneda et al., 2014). Articles in this framework emphasize the role of assumed group traits, shared beliefs, values, customary practices, or traditions, which are often linked explicitly to race, ethnicity, or national origin (Castaneda et al., 2014). The cultural framework is used in relation to topics and outcomes such as acculturation, mental health, chronic disease, health care access, maternal and child health, substance use, physical activity and obesity, and social capital (Castaneda et al., 2014). There remains a lack of culturally competent services and the failure to serve ethnic and racial minority groups despite the demographic growth. For example, studies with Arabic women have found that the stigma associated with psychiatric treatment among Arab unmarried women has marked negative consequences for marital prospects (Dow, 2011). In Arab culture, marriage is essential and receiving medical attention for mental illness is simply not culturally acceptable. Not only is mental illness a stigma in Arab culture which leads to isolation, rejection, and gossip within the community, but it is believed to be cured through measures not used in the United States healthcare system. Arabic parents believe that children who are unhappy or suffer from psychological problems can simply be cured by getting married (Dow, 2011). Acculturative stress is the behavioral response to intercultural contact and is a way to understand how the interaction between cultures affects an individual psychologically (Goforth et al., 2014). Typically, the process of acculturation is found to impact health negatively with level of acculturation directly corresponding with individual-level health risk behaviors, especially diet, smoking, and use of health services (Castaneda et al., 2014). Difficulties at home and the community may be associated with how Arab American adolescents have been socialized within a collectivist culture (Goforth et al., 2014). A strong association has been shown be- tween socio-cultural adversities (e.g., religious coping and support), discrimination, acculturative stress, and psychological distress among Arab American (Goforth et al., 2014). It should also be considered that the pervasiveness of “anti-Arabism†in the current sociopolitical environment is an important to understanding acculturative stress in this population (Goforth et al., 2014). The overreliance on cultural explanations for immigrant health outcomes obscures the impact of contributing structural factors, such as poor access to transportation, elevated health care costs, changing access to healthy foods, or differences in labor practices factors that affect immigrant communities disproportionately regardless of their cultural, racial, or ethnic background (Castaneda et al., 2014).
The third but least common framework employed on immigration and health is the structural framework (Castaneda et al., 2014). This framework interprets health outcomes through understanding and accounting for the large-scale social forces that impact health such as access to health care, health outcomes associated with immigration status, living and working conditions, and the impact of deportation and detention (Castaneda et al., 2014). Under our current administration, discrimination toward Arab Americans has been perpetuated and enforced through deportation policies. It is evident how today’s political climate is extremely taxing on the structural framework for immigrant populations, especially Muslims or Arabs. The additional burden that immigrants face by choosing not to interact with government services that could provide some relief to their situations out of fear that the interaction could lead to deportation or family separation is an enormous health barrier (Castaneda et al., 2014).
Although immigrant populations have been increasing, a social determinant of health approach has seldom been applied to this area (Castaneda et al., 2014). In recent news, instead of progressing toward a more culturally appropriate and accepting country, we have only been met with new policy which perpetuates prejudice. While each of the three frameworks discussed play a role in health outcomes of Arab and immigrant populations, the most detrimental frameworks to today’s immigrant populations are the cultural and structural frameworks due to the pervasiveness of systemic and social prejudice.