Susan Clifford

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Susan Clifford discusses her extensive experience with the Latino community through her academic work, professional career, and personal life. Her husband is from Celaya in Guanajuato, Mexico, where scant job opportunities pushed him to seek work in North Carolina. Today, Susan works at the Orange County Health Department as the Immigrant and Refugee Health Program Manager, a profession that stems from her passion in international public health and social justice. She discusses the widespread physical and mental health issues that Latino immigrants experience, as well as the social stressors and inadequate policies that may have largely induced their negative health outcomes. However, Susan also finds light in the situation by pointing out the positive health behaviors and outcomes of the Latino community, as well as well-intentioned immigration policies.



Tammy Chen: Hi, this is Tammy Chen. I am here interviewing Susan Clifford. We’re at her office at Orange County Health Department, located in the Southern Human Services Center on Homestead Road in Chapel Hill, North Carolina. It is 3:04 pm on March 16, 2015. Thank you so much for meeting with me today. So I guess it would be great to go ahead and start and introduce yourself and your background a little bit.
Susan Clifford: Okay, thanks. I appreciate this opportunity. I am Susan Clifford. I grew up in Orange County, North Carolina. I grew up in Chapel Hill. This is where I was born and went to school. I did study in Virginia for undergrad and then did AmeriCorps up in New York and then came back for graduate school to UNC, where I studied public health and social work. And along the way, had some different kind of study abroad travel international experiences, and really found my passion was in international public health and social work, international development, and social change. And after I met my husband--who’s originally from Mexico--met him here in Chapel Hill. He really liked it here and so we decided to stay here since I still have family. And then we sort of kind of changed my job into something being able to stay at home but make it an international job still.
[00:01:47] TC: How did you initially get involved with the Orange County Health department?
SC: It was my first main job out of undergraduate school. I applied for a job as a senior public health educator, and it was focused on children’s health. But like I said, I had a passion working with immigrant and refugee types of communities. So I helped to kind of steer the project towards working with that kind of community. This was back in ninety-nine--the end of ninety-nine--and was able to kind of chart a course for myself in terms of my career, of really focusing on immigrant and refugee health. So I did about eight years as a health educator, doing different health promoter programs in the community, with women, men, family health promoters. I did a Latino leadership training and designed all the curricula myself, and trained people in Carrboro-Chapel Hill areas, as well as the Hillsborough areas since we cover the whole county. Then, about seven years ago, eight years ago, then we kind of--I spoke with the directors and we decided to kind of change my position some as we were having an increase in our number of community members, and saw we had a bigger need for language services. So we created my position, which is Immigrant and Refugee Health Program Manager. And so now I have a cadre of contract interpreters who work for me who cover many different languages, and then I have two full-time staff Spanish interpreter translators. So I coordinate all the language services, interpretation and translation for the department. And then I also oversee a couple of coalitions--the Latino Health Coalition and Refugee Health Coalition, which are inner-agency coalitions and have the opportunity to collaborate and communicate together about projects.
TC: So you said originally your passion stemmed from--you said that you worked for AmeriCorps and you had a lot of experience with public health. But is there anything that started--that fueled that passion in high school or in college that made you go into AmeriCorps and all those other opportunities.
SC: Well, I mean actually since a young age, I volunteered a lot. So when I was twelve, I loved the elderly community so I’m kind of interested in getting into that with the immigrant elder community as well at some point. But I started volunteering when I was twelve just working with older adults, and then got into Spanish. Started taking Spanish all through junior high and high school. And in high school, I went on a trip to Costa Rica and lived with a family for a couple of weeks, and I just absolutely loved it, and came back. And then in undergrad, I studied abroad in Spain as well and lived with a family there. I came back and after I graduated, I did some research but felt kind of disconnected from the community. And so I left that position and did AmeriCorps where I really felt, when I was doing it, like this is what I’m supposed to do. I was at a community-based health center, really out in the community working with people, helping to bring out their strengths and help them to work on projects that they were interested in. So then I came back to grad school and--actually before that, I went to volunteer in Guatemala for a summer and I got trained as a doula, a childbirth kind of social support person. And so I helped with births at a rural clinic--an indigenous rural clinic--in Guatemala up in the highlands. And again, felt like this is kind of more of where I am supposed to be, and had plans to go back there, but when I came back and met my husband while I was studying, like I said he liked it here and my family is still here so we ended up staying here.
But--and yeah, like I said with the health department, I got this position and it wasn’t exactly what I was looking for but I always had great support here at the health department and was able to kind of gear projects toward serving this community since it’s a community that wasn’t as well served definitely at that time. It was still a new community back in the late nineties and early 2000.
TC: So before you were talking about how your husband is originally from Mexico. [00:06:29] What brought your husband to North Carolina from Mexico or to the U.S. in general?
SC: So he came mainly for [phone vibrates]—

[Recorder is turned off and back on again]

TC: Okay, we had a brief interruption but go ahead with what you were saying.
SC: Yeah, so my husband came to North Carolina mainly looking for work. He was having trouble finding jobs in Guanajuato, where his family was from in Celaya, as were many of his friends. So some of his friends came first and then told him about the types of jobs that they had been able to find here, what a nice place it was to live. So I often joke with folks that my husband has more high school friends here than I do even [laughs] though I grew up here. So it’s a family transient community. So a lot of people after high school left, although some people are still here. But yeah, he has several friends from high school who are still here. So he found jobs. He didn’t know he was going to be great at cooking and that is something that he sort of fell into and has ended up being great at, and has continued to do for many years. So again like I said, he’s got friends here. He’s got one cousin who also came for the same reasons, looking for work, and now works for the county.
TC: Are you knowledgeable of what life is like in Guanajuato, like maybe the public health system, education, job opportunities, environment and government? Do you know--has he ever told you what life is like there compared to here, and just really anything about the province?
SC: Yeah, I mean we’ve been there several times. We tend to go every couple of years. And so I’ve stayed with his family and visited other family members in different parts of Mexico as well. And, you know, it’s difficult. I see from his sisters and other family members that finding work is really difficult. I mean, we’re not that old [laughs], you know like forties, in our early forties. And for people our age there, it’s really hard to get or keep a job because anybody working in offices and stuff, they’re preferring younger people who are less expensive or who will work harder or don’t have children, or that sort of thing. And so it’s really hard for people kind of our age, in terms of finding jobs and keeping jobs. And yeah, I mean it’s a great place, but at the same time there are difficulties, some in terms of it’s become a little bit more dangerous in some areas than when he was younger. He grew up in Mexico City, but--which also had its own crime issues--but then kind of went around during adolescence, moved to Celaya. But since then, it’s become a little bit more dangerous than it was before. His parents are lucky. His dad has, like, a pension, where they can get some access to health care but other family members, unless you have sort of a connection through work, it’s more difficult to get some health care access and quality care.
TC: So it’s not a universal health insurance?
SC: They have--you know, I don’t know all of the details so I don’t want to get that part wrong--but I know that his parents have sort of a higher level somewhat than what basic services would be available. So they’re able to get in kind of quicker to be seen by somebody than the average person. But they’re not high earning or high income necessarily either, so I’m sure that there are other options where people may have private insurance options. But it is sort of a kind of governmental program, but it’s a higher level than a basic.
TC: Do you know why your husband chose specifically--well, you said that he had friends that knew of how it was like in North Carolina--but why exactly North Carolina? Why the Southeast? Why not in the West? You know, elsewhere. Why exactly here?
SC: Yep, I would say it’s just the people. It’s because of the people. That’s the main reason. And I think initially, we can sort of trace through who told who, and all that ( ). It’s kind of funny when we’ve talked about all the connections and who kind of came here first, we think. But it was because there are jobs available, and it’s a nice safe place to live. And I’ve heard that over and over as I’ve worked with Latino families here, is that those are the things that they appreciate. It’s a relatively small town but with exciting things kind of going on because the university is around here so--and it’s good schools for the kids, and there are some job opportunities in the area, and they feel--it’s safe in terms of immigration status, as well as safe in terms of crime and violence.
TC: Moving forward, as the Immigrant and Refugee Health Program Manager, I assume that you have substantial knowledge of the issues faced by Latin American immigrants in North Carolina, or elsewhere. [00:12:13] Can you tell me about any health disparities that you’ve seen the Latin American community experience? Any health issues concentrated among groups of Latino immigrants that come from a particular country? Or just widespread health issues among the immigrant community in general? You know, barriers to health care access, lifestyle behavioral choices, any of that?
SC: Yeah, so since I’ve mainly worked in Orange County. I did work for an extended period of time right before I graduated with the Migrant Farmworker Association. So I did interviews across the state, like eleven different--I think it was eleven--different focus groups with my migrant male farmworkers. So I did get some sense in terms of that population about a lot of mental health needs. That was what my focus was, and I came out with a report and data on the issues around mental health and how it’s not talked about as much and there aren’t that many opportunities for them. And so that’s somewhat similar, although it’s a very different population to what we have in Orange County. We don’t have as many farmworkers here but I constantly hear about mental health issues, regardless if folks are from Mexico, Central America, South America, came from a lower income family or came from a higher income family. Just a lot of stress and a lot of that stemming from--for those who face immigration and documentation issues, that being an additional stress--as well as just kind of being an immigrant in a different country without as much as social support. So, mental health is definitely something that I see across the board, and access to care. So, lack of health insurance, the high cost of health care being a barrier, not always having a regular doctor that they go to--although I think that that’s improved at least here locally, within the last five years or so. So I think most people kind of have a little bit more of a medical home as opposed to in the past. But there are some issues around HIV incidents, higher teen pregnancy, higher obesity, diabetes, kids less likely to be in active play, and motor vehicle injuries as well.
But there are a lot of positive things too, and that was something that when I was in school before that I always tried to look for [laughs]. Of this sort of healthy migrant effect--that a lot of the Latino birth outcomes are actually better with the first generation who’s here, but then in subsequent generations that worsens probably due to our poor diet here in the United States. And then also Latino women are more likely to breastfeed, less likely to smoke when they’re pregnant. So there are a lot of positive things too. They’re a resilient population.
TC: So going off of the healthy migrant effect, that’s something that I’m really interested in looking more into. That’s kind of one of the major drivers of my research. Can you expound on that more? [00:15:45] Why you think the longer an immigrant stays in the U.S., the worse their health outcomes get? Do you think it’s only nutrition and dietary factors, or do you think that there’s more to it than that?
SC: I think that there might be more to it than that. It’s complicated as most things are. It’s not--it’s probably multiple factors. Some less social support. More sense in feeling of discrimination issues. I went to a racial equity institute training--I don’t know if you’ve heard about that before or not--but there are lots of different kinds of ones around here dismantling racism and stuff. But this one is called racial equity institute, and they had one specifically on Latino challenges. We met for like two days. It was sort of a mixed group of folks. And a lot of what we were talking about and sharing and exploring together was this sort of impact of discrimination and racism and how that can affect all areas of one’s life. And specifically focusing on Latinos, and looking at the history of that.
So I think that everything from the fact that with documentation, if you can’t get a driver’s license, you can’t--you’re worried about driving your child somewhere because you might get caught because there might be a checkpoint or something about watching out for that. That kind of stress can affect you later. The child who maybe is the second generation but you grew up in a mixed status family, where some kids were citizens and others weren’t, and maybe you weren’t, and so your siblings get to have access to Medicaid and going to school and better options in terms of university and jobs and others maybe don’t and have had a different kind of experience--have had to hide while coming back and forth over the border. All those sorts of things I’ve heard have been stressors, and as you go through different generations ( ) feeling that difference can be difficult.
TC: So mental stress--or mental health problems--seem to be a huge disparity in the community. [00:18:09] So how do Latino immigrants cope with stress and anxiety and those other mental issues? How do they cope with those things?
SC: Well, I’m not a therapist but I’ll say when I had my health promoter programs, that was not necessarily one of my outcomes because I picked people who were community leaders, but I almost always on the evaluation got that this almost felt like a support group for them. That they felt linked to other people. So I think that a lot of the coping comes from different group settings, different social situations, the church, faith organizations for people. And I think also something that’s different, kind of in reflecting back with the migrant farmworkers before--back when I did that research, there wasn’t much in terms of social media and now there is. And so I do hear more people feeling connected to family or friends back home through Facebook, and even more recently through Facetime sometimes or Skype with other people. So that’s been a wonderful opportunity for people to be able to communicate better. Although Wi-Fi connections and stuff like that is not--we’ve only, in our family, been able to recently do that because it costs a lot of money and isn’t accessible to everybody.
TC: So have you seen any--or spoken to--any immigrants who have undergone any substance or alcohol abuse from--is that one of the ways they cope with anxiety or stress too, or is that a widespread issue in the community as well?
SC: Yeah, I think that’s probably related to some of the motor vehicle injury incidents and ( ) incidents that we’ve seen as well. Yeah, definitely. I’ve worked with men some. And again, when I did the migrant farmworker, that was one of the findings from that group, is that, yeah, alcohol and substance use was part of their way of coping. More recently, I’ve mostly worked with women so I haven’t heard it as much directly other than indirectly through some of their spouses, but yeah. I think that that is definitely--continues to be an issue. But it really does with a lot of our community in general and it’s a topic that and domestic violence have also come up a lot with our refugee community from Burma. We’ve really been trying to work on trying to improve our services for them, information, education, as well as treatment options.
[00:21:11] TC: Could you talk a little bit more about health care access for Latino immigrants? What do they--most of them rely on Medicaid or other insurance affordability programs, or do they not even have insurance and just pay out of pocket? Do they take up preventive care, or do they just go to the hospital whenever it’s an emergency and they know they have something and really have to go? What is it like for them to access health care?
SC: I think it’s varied, but since my answer would have been different like ten years ago because things have kind of changed. There’s more of an established community. There’s less migration than there was back in the late nineties, early 2000s. So some people feel a little bit more confident and know where to go in terms of sliding scale fee places like the Carrboro Community Health Center, here at the health department, where it’s based on their income and household size, where we don’t ask for immigration status information. And then some individuals do qualify for Medicaid or Health Choice, their kids if they’re born here, and then if they’re pregnant and they deliver, they get emergency Medicaid to cover their labor and delivery. And then we’ve got Charity Care through UNC Hospital. People need assistance with that. But we also do have some people who do have some private insurance. It’s not the vast majority at all, but there are some people. So we have to be careful to not lump everybody together to the same group because each family may be a little bit different. And then some people do payment plans and that sort of thing too.
TC: Going off of the Charity Care comment that you made, so I’ve heard that that’s a problem in the UNC Hospital that not many people know about really. Do Latino immigrants--is that something they know of, or do you have to publicize it to them and get the word out that it’s there and it’s available to them if they really do need it? How exactly do people find out about that?
SC: I think it tends to mainly be through a referral. So like, if somebody is being sent to something like if, for example, we’re sending somebody to UNC from the health department to go for a certain service, we may tell them they need to contact Charity Care and go ahead and get started on an application. And they do have that information in Spanish in an application, and some workers who speak Spanish. Inside UNC--I don’t really know--but I assume if they’re going in for a service somebody may tell them about their different financial options and Charity Care being one of those. But things are always changing, and so that’s been something too that we’ve talked about at our Latino Health Coalition. That we all feel like we need to learn more about too. We can read some stuff online about it but what really happens, how long does it take to qualify, that sort of thing. Yeah, it’s not a quick turnaround.
TC: This might not be something you’re too knowledgeable about because this might not be in the specific field that you work in, but [00:24:28] do you know about any common labor-related issues among Latin American immigrants such as managerial abuse, wage theft, discrimination, etcetera? And what are some of the most prevalent jobs that you’ve seen Latin American immigrants work here in North Carolina?
SC: So again, it’s statewide, a lot of farmworkers. But here in Orange County, I would say sort of construction and some service jobs like in restaurants. A lot of the women I’ve worked with do cleaning of other people’s houses. Some have established businesses of cleaning new construction and have a really good experience with that. Several of the ladies that I’ve worked with, two in the past, do childcare. Either went through and got a certificate to be a childcare provider in a licensed facility, and then many others who are kind of like a nanny to young families around this area. And then more recently, I’ve heard more of some elder care, so some even who are elderly themselves taking care of other elders [laughs] in the community. I thought that was really interesting, because like I’ve said, I’ve been interested in finding out about older immigrants and immigrant elders. We don’t have a huge population but it is growing and wasn’t really here as much before. So seeing older immigrants take care of older adults who live here is kind of interesting.
TC: Can you share some good experiences people have had and some bad experiences? Some issues that they may have encountered, and some good things that they may have encountered?
SC: Yeah. So different kind of just anecdotal experiences that I’ve heard about in jobs have been--you do hear some people feeling like they are treated well, and those tend to stay in the jobs for a long period of time because it’s somebody who supports them--especially if they don’t have documentation, it doesn’t make them feel scared in any way--and is maybe aware of that situation and is okay with it. And everybody feels like they can be honest with each other, which is really nice. Then there are other situations where I’ve heard some people feel kind of threatened, like somebody knows that they don’t have documentation so they could just easily get rid--fire them. Or just almost ask them to work harder or not pay them. I had heard of that in the past, of some people not being paid, or being told they are going to be paid later and then they weren’t. I think people are just more scared to complain or report things in general for fear of being reported or something like that. Again, I think compared to some other parts of the state, Orange County is a little bit more relaxed in terms of that. Some of our surrounding counties, I think it’s more difficult. But there are difficulties here, too, as I mentioned before with just driving. We have a very welcoming police department--law enforcement in general. But I had a health fair, as this was a year or so ago, where one of the health promoters was coming to the health fair on a Sunday to a church, and got stopped for driving without a license and her car was taken. And so you’re thinking, my goodness [laughs], this is somebody who is volunteering her time driving on a Sunday just to come to a health fair to help other people, and it’s heartbreaking because she is a very safe driver, very--wants to follow all the rules, but doesn’t have the opportunity to get a driver’s license.
TC: Are there any specific jobs that employees have had really good experiences with, but then specific jobs that employees have had bad experiences with?
SC: Again, I think it’s because I started out a lot working on children’s health issues. I’ve just heard so much about ladies who were taking care of other people’s children, and many who have just had great experiences. Getting to know the families, feeling respected, families wanting them to speak Spanish to teach their kids how to speak Spanish. So that’s been nice. I think that some of the ladies that I work with cannot be health professionals here. So some were maybe nurses back in their home countries, or worked for the Red Cross. But because of their documentation status, can’t do that here. So they would work for med students who had their young kids and who needed a nanny. So they felt respected because they were like, I was a nurse in my home country, they knew some CPR, they took those courses, and their employers respected them as professionals as well. And then I think in some--you know, it just depends--but in some restaurants, again I know lots of friends who work in restaurants as well and many felt supported and that they were treated well. But then some haven’t [laughs]. Just kind of depends on the situation. Yeah, I think sometimes people didn’t get the full training that they needed and then other types of complaints I’ve heard in that situation has been some sort of racism as well, in terms of tensions with other races or ethnicities too.
[00:30:21] TC: How do you think labor issues may have impacted the health of these people?
SC: I think it’s hard in general if you don’t have any kind of sick leave to get off period because you don’t get paid for your time off. It’s very stressful. You don’t want a mess for yourself, for your child. You don’t want to get your employer mad for asking for time off. That in general is stressful for anybody regardless if you’re an immigrant. And then, just again, on top of it, I think it’s stressful for them not wanting to complain. And so it could be that some people might be more reluctant to ask, “What are these cleaning products that I’m supposed to be using--or that I’m using at your house to clean? Is that safe for me if I’m pregnant?” Or saying, “I don’t feel like I can do this while I’m pregnant.” Or maybe they don’t want to tell people that they’re pregnant [laughs]. So I think people are just even less likely to complain, plus some of our [door closes] population is what you call humilde. Just humble people. So they don’t necessarily want to complain in general. That’s not a part of their culture to complain, as well as sort of feeling worried about it.
[00:31:53] TC: Are there any other glaring social issues that you think may have also played a large role in the health outcomes of this population besides labor issues specifically? Or the stress that comes with being undocumented? Anything else that stands out to you?
SC: Well, I mean, again, I think--I know you just alluded to it--but again, we’ve talked recently about public health--immigration as a public health issue. I do really think that there’s some links there. There have been some studies that have been done at Wake Forest looking at access to health care and immigration policies in different areas. I do think that that is something that hasn’t been paid enough attention to on a larger scale. And again, it’s sort of the racism. I feel like it’s starting to come up more than it used to, but in general, some of the racism discrimination issues, in addition to sort of separate from the immigration part as well. And we still find with the DACA and the DAPA that they don’t get access to the health exchange. So there’s just--even though they’re sort of considered here legally for this temporary time, they don’t get the benefits of some of the access. So again, that has an impact not only tangibly because they can’t go to the services, but another feeling of, okay, I’m kind of here but I’m not really accepted. I don’t have access to the same things. And those are young individuals who may not be having a lot of health issues, but if they have an accident or something, what’s their option? So there are different policies definitely that are affecting--.
But there have been some good policies too. Title six of the Civil Rights Act [laughs], helping to bring up language access issues. The Executive Order back in 2000 from the President. Those are part of the reasons I even have my job. We write our policies in terms of the fact that we are mandated for receiving federal funds to provide linguistically accessible services, which is a wonderful thing. And many other agencies are supposed to do that too. Some are smaller and it’s hard for them cost-wise to do that but that’s a good law and a good way to start a conversation about how can we make all places accessible since we do have some laws and policies to help us back up our arguments.
TC: You briefly touched in the beginning on what the Orange County Health Department does, and how you provide services to immigrants and refugees, but [00:34:50] can you go a little bit more in-depth with what kinds of services that you offer, or that you provide, or your department provides to support these populations?
SC: I mean really all of our services are open to everybody, and so we make a point of--like on our website and stuff--saying that we don’t ask for immigration status. Interpreter services are free of charge to everybody. We’ve got some bilingual, bicultural staff. We’ve got I think more than twenty now. And back when I started, there were just a few of us. So it’s been a huge change in terms of that. We’ve definitely seen more people coming for services, all kinds of services. Everything from STD testing and treatment to family planning to dental to immunizations, well child check-ups, the care coordination that we do for pregnant women and children, and some of the restaurant inspections as well. We haven’t been doing this as much recently but like bed bugs, our environmental health that have gone out with folks to help them with that, and people feeling comfortable. So we’ve reached out as there’s been the need. We have a community health assessment that we do every four years as part of Healthy Carolinians. So we’re getting ready to do that again this year. But four years ago, we did a focus group--I did a focus group with Latino community leaders hearing about what their needs are and how we can provide better services for them. And so we’ve used that information to try to expand our materials, our outreach, our services so that everybody is aware of what we’re providing.
TC: And these are free services you said, right? Like the health services, specifically?
SC: No, I mean, it depends. So, it depends. We have some free services like the STD testing and treatment. But let’s say prenatal services or something like that, it would depend. It’s a sliding scale fee. So it would depend. If you don’t have insurance, then we would look at your household income and your household size, and then determine. And it could be that it ends up being zero percent, which means you don’t pay. But some services do have a minimum, like our nutrition services or our dental services. Our dental has a minimum of thirty dollars. But again, if you were at zero percent and you had a thirty-dollar dental appointment, that’s pretty amazing compared to other options in the community. So we serve adults there, kids there.
TC: So basically the Orange County Health Department is kind of like a community health center in a way?
SC: Yeah, it’s similar. We’re not just the same as Piedmont Health Services or Carrboro Community Health Center in that we have certain types of programs like preventive health programs. If you’re a part of that, then we can see you for primary care. At their location, they kind of have, I believe, primary care for anybody, but if you’re not a part of one of our--if you’re not a prenatal patient or you’re not a well child patient, a family planning patient, then we can’t see them for primary care. So we kind of have these silos depending on our funding sources.
TC: Do you work with--do you communicate with other health departments in other states in the nation? Do you all work collaboratively, or do you all work separately because you all have your own specific demographics and specific geographic regions, so it’s different for everyone?
SC: I’ve tried some across the state, although health departments vary from county to county as well. So there’s some that will provide--they may not have a community health center nearby and they maybe have more primary care services and be more like a regular type of clinic, and then others that are even more limited than our services. So in terms of the state, I got a fellowship a few years ago when I went across the state meeting with different health departments, and looking at refugee immigrant issues and language issues. And there wasn’t anybody really in my same position so it wasn’t always as much coordinated in terms of their services for immigrants and refugees. It was kind of like we have our refugee nurse, and we maybe have some bilingual staff, or staff that we think are bilingual. We, here, have really established a program in terms of language assessment, approval, different levels, who is allowed to speak to a client without an interpreter, and who needs to call an interpreter due to their level of Spanish. And then our refugee population, our program we’ve worked on a lot as well. So there have been some other--some states that I’ve contacted. But mainly it’s been through listservs. So I’m on a lot of different language listservs, as well as refugee and Latino health types of listservs where we communicate about different types of programs that are going on or services or questions for each other. I found that to be helpful.
TC: So I guess my next question is, even in a time of national health care reform there continues to be much attention surrounding the issue of health care rather than factors that lead people to need health care in the first place. Such as, for example, the Affordable Care Act, a law that basically is focused on providing insurance for everyone--which is great--but there is a lot of attention surrounding that. [00:40:36] So do you think that if Latin American immigrants had access to health care--had much more access to health care than they do today--do you think that their health condition would largely improve because they have better access, better preventive care, better interpretation at clinics, better knowledge of healthy lifestyle choices? Do you think that it would improve or do you think that it would largely maybe stay the same as it is today?
SC: I think it would improve some. Again, just taking away some of the barriers to access to care would be helpful. But yeah, I think there’s nothing that’s just the answer to all the problems. I think there’s so many multifactors. I think we’ve sort of talked about how among us here at work, how we’ve seen public health change over time and how it’s sort of moving more towards the outcomes. And we used to be in homes more doing some of the preventive environmentally based things to see really what was going on in people’s homes. And now a lot of it’s some more phone-based stuff, some more Medicaid managed care, and all that sort of thing that has changed, that we wonder if it will sort of move back. If it sort of ebbs and flows, we’ll see. But I hope that there will be the opportunity to have more funds to support preventive programs. Right now, there’s a lot of focus on sort of policy-level and environmental change. And so we got things like in Orange County, the smoke-free public places which benefits everybody, right. So there’s less second-hand smoke out there even though Latinos don’t smoke as much, but maybe they’re less likely to be sitting beside somebody at a bus stop who’s smoking. So there are some preventive things but there’s a lot of room [laughs] for a lot more improvements. Focuses on exercise, healthy eating, mental health. We’re going to be talking about that in May at our next Latino Health Coalition meeting about mental health and how the lack of funds is--El Futuro had to close their clinic in Carrboro this year, just this past month.
And so what are other options? Feels like you’re moving backwards sometimes but we need those services so that when we’re screening people or talking to people, we have somewhere to send them if they do identify a mental health need. So there’s lots of work to do but I think some folks like, we’ve got Frank Porter Graham, the magnet school--and my kids go there so I know a lot about it, personally as well as professionally--and they’ve got just a wonderful team of social workers, nurse, school guidance counselor who are trying early with the kids to work on healthy lifestyles, and they have classes for the parents, classes for the kids, Girls on the Run, all different kinds of programs that are in Spanish as well for the families, which is ideal. So that again, that ( ) works on the preventive end, but we need the support and the funds to be able to do that.
TC: So I guess my last question for you would be, how has the Orange County Health Department--as a government agency, I assume--has it played a large role in public policy, in advocating for certain policies and shaping immigrant policy, for example. And if it hasn’t really specifically done that, [00:44:28] do you think that there’s any specific policies that you think would really just be amazing if they were implemented, or they would really make a large impact on this population, like a positive impact?
SC: I mean around immigration policy issues as a government agency, we can’t lobby in our roles. We can’t be lobbying. One thing that they did allow me to do when I had my Latino leadership training was I had somebody come and talk about advocacy and we scheduled to go at that time and meet with the speaker of the house who was a representative from Orange County at that time. And met with him and just talked to him about Latino health issues, directly from community members. We took a bus, went up there, and met with him and a couple of other people just to share life experiences and raise their awareness and help to kind of make that connection. That these are your neighbors. They’re living in the same county as you. Maybe they aren’t voting members, you know, constituents, but they’re living and working in your county. And they were very receptive. Again, I think that was sort of a step towards, we couldn’t again bring up a specific policy, but that was the awareness raising to try to help people feel that personal connection. That often helps people feel like they’re able to make the next step.
Honestly, I think having a change in terms of the driver’s license would be amazing [laughs]. So, having that open to everybody without having to show immigration status or proof of legal residency would be a good public health move in terms of public safety in driving, and make sure everybody is going through the same testing and training, education for driver’s ed. It would help people to drive to work and school and health care facilities without fear. And expansion of Medicaid or our ACA, to be able to be open to at least the DACA and DAPA groups, makes sense, but I think that it’s so political, it’s hard to know where to start with that. I’m not sure if it’s even open for discussion. But hopefully with some immigration changes, there will be some trickling down of other effects that would help to reduce the stress and the mental health. And, you know, when it affects the mental health, if affects the physical health too of our community.
TC: Thank you so much for speaking with me today. I really appreciate it.
SC: Thank you. I appreciate it. [00:47:43]