Abstract
For decades, traditional consular services have assisted nationals who live or travel abroad, using a wide network of Consulates and Embassies. Consular officials offer a wide array of services related to issuing passports and other travel documents, emergency assistance, and offer their citizens help navigating foreign laws and legal systems. More recently, the Mexican government has worked to expand its efforts beyond customary consular functions in an attempt to better integrate its diaspora in the United States. This shift coincides with the increasing concentration and geographical proximity of its migrant population. With nearly 12 million Mexican migrants living in the United States, both countries have a shared interest in promoting their social and economic integration. Resource limitations, language barriers, eligibility restrictions, and other cultural gaps in the U.S. social welfare system necessitate service delivery and advocacy roles from alternative sources.
The Mexican government established the Institute of Mexicans Abroad (abbreviated IME for its Spanish translation) as a means to formally collaborate with nonprofits and migrant voluntary organizations who are dedicated to serving the U.S.-based Mexican migrant population. By linking Mexican migrant communities to Mexican government initiatives in the area of education, health, civic engagement, financial literacy, and consular protection, the IME aims to integrate and build the social and human capital of Mexican migrants in the United States. As the IME continues to broaden its scope of integration initiatives and service delivery programs in the U.S., unique challenges and opportunities associated with governing from abroad are revealed. For instance, the most vulnerable Mexican migrant populations residing in the U.S. are often those with undocumented legal status. These groups tend to resist organized methods of service delivery for fear of deportation. This makes efforts to assess a program’s effectiveness nearly impossible when the target population chooses to remain hidden. Furthermore, the transnational flow of people, resources and ideas between Mexico and the United States can make it difficult for public-private partnership organizations to establish legitimacy.
Nonetheless, other migrant sending and receiving nations have started to use Mexico’s unique diaspora policy and outreach efforts as a model to inform their own immigration policies. This paper provides an overview of the IME’s model health promotion program, Ventanillas de Salud (VDS). The VDS program staff collaborate with local community health departments to provide health care assistance, education, and outreach materials to low-income Mexican migrants who are unfamiliar with the U.S. health system. IME partners with local migrant voluntary groups and/or non-profit organizations to establish a Ventanilla for the community. The partnering nonprofit sponsors the Ventanilla, manages its day-to-day operations, and offers community-level services based on the needs of the local population.
In light of the recent U.S. health care reform policies, this collaborative effort between Mexico and U.S. based nonprofits, local health community centers, and IME project staff is of particular importance. Migrant communities living in the U.S. tend to face unique challenges when it comes addressing their health needs. Barriers to health care access such as cost, lack of knowledge regarding available services, and differences in culture, language and beliefs about health contribute to the poor health status of many migrant groups. The U.S. health care system reform certainly has helped reduce disparities in health outcomes among many traditionally underserved populations. However, the nearly 7 million undocumented Mexican migrants currently living and working in this country remain ineligible for health care reform benefits. This same population earns the lowest wages, is at the highest risk of work-related injury and death, and has the least access to health insurance and health care among any other group in the U.S. labor force. Over time, the use of immigration status as a health care exclusionary mechanism will likely exacerbate existing health disparities among Mexican migrant groups, thus perpetuating their marginalization. Moreover, by 2050 the Latino origin population is estimated to account for 30% of the total U.S. population. Thus, excluding over half of the current U.S. based Mexican migrant population from crucial health care reform benefits will undoubtedly impact future population health.
Because health status knows no borders, the U.S. and Mexico have an equal stake in promoting the social and human capital of their shared migrant population, regardless of legal status. Therefore, the goal of this study is to provide an updated assessment of the methods by which both countries engage in the health promotion of an increasingly binational migrant population. Of particular emphasis is the organizational structure, regulatory framework, provision of services, and major funding sources of the Ventanillas de Salud programs. As health care reform measures continue to be implemented, social welfare programs such as VDS have the potential to improve migrants’ health and limit the marginalizing effects of an exclusionary health care system.