Q&A with KQED's Scott Shafer: Immigration Reform and Health

Each month, the San Francisco public radio station KQED airs an hour-long program called Health Dialogues that delves deeply into such topics as food safety, asthma, swine flu and environmental health. Its latest program focused on an unusual combination of issues: immigration reform and health, with the goal of examining how undocumented and seasonal workers get health care under our current system and how immigration reform could change their situation.

Program host Scott Shafer and I talked last week how he and his KQED colleagues put together the program, which was partly funded by The California Endowment. Our interview has been edited for space and clarity.

Q: At a time when national health reform is dominating the news, why did Health Dialogues choose to report on immigration reform and public health?

A: We have done a lot of reporting on health care reform as well. The mission is to report on underserved communities in California and different aspects of health and health care as it relates to them. So, we decided to focus on immigration reform. The President mentioned that it would be on the front burner for 2010, so we try to get ahead of these things.

It's very hard to separate immigration reform from health reform. They're just inseparable. Immigrants have unique health issues, some of which are related to their immigration status. We've seen reports that migrant workers who come from Mexico were healthier south of the border than after they came to the United States. Some of that is due to nutrition, some is access to healthcare. Immigration status was part of that equation. I've done reporting on migrant workers and HIV, where there are complex issues related to men going back and forth between counties, having unsafe sex or using intravenous drugs, then going back to their families. There's just a complex set of issues that interrelate between health and immigration status.

Q: This is a big topic. How did you break it down into manageable stories?

A: Health Dialogues is a monthly program, where a team of people meet in advance and then coordinate with local (public radio) stations. Basically what we do is try to give a 360-degree degree view of an issue. We wanted to look at it from legislative perspective and the immigrant perspective including people who were here legally and not legally. We wanted to look at the whole issue of amnesty and the path to citizenship. We wanted to get an overview of legislation back in Washington, so we contacted Dena Bunis, Washington bureau chief of the Orange County Register. She'd written about this before, so she had an understanding of how immigration reform relates to California.

One of the challenges of a topic like this is finding people or providers who are willing to talk about the fact that they're serving undocumented immigrants or who are undocumented themselves. We don't want to just talk to experts, we want to talk to real folks. What voices can we bring into this hour that reflect on-the-ground experiences? One question that popped up was swine flu - there's a huge debate over whether undocumented immigrants will be eligible for subsidized health insurance. With swine flu, there's no question that everyone's going get vaccinations irrespective of their immigration status. We thought, why is that? If it's important to protect everyone from H1N1, why not from depression or other diseases that affect public health?

We also did a three-way conversation with David Hayes Bautista from UCLA and Gail Wilensky of Project Hope, who's a Republican. We had a lively discussion what people should be entitled to and what taxpayers should be asked to pay for.

Q: How did you choose the places you went?

A: It had to be a place we could get to in a day. That limited it to the greater Bay Area, nine or 10 counties. Our senior producer, Polly Stryker, started calling to clinics in different counties. Some were not willing to talk to us because they were protective of their patients and their clinics. But we went to a clinic in Napa and talked about outreach and promotoras to spread the word about H1N1 and other health issues. The clinic in Napa was very open. We got lucky. Most counties didn't have the H1N1 vaccine at that time, we just got lucky, but the Napa clinic happened to have a vaccine clinic - it was perfect. Ira Glass says a lot of public radio is luck. We got lucky and everything worked. It was the right clinic and the right timing.

With the woman in the shelter segment, we were looking to find a personal story. Polly called around in San Francisco and got permission to come in and talk to people with understanding that they'd be anonymous or first name only. She found this young women who had this very compelling story.

Then there was also the piece that came out of the Central Valley, at the Mexican consulate. We've done a number of series with Radio Bilingue, and Radio Bilingue reporter Zaidee Stavely did that segment.

Q: How did you deal with the immigration status of your subjects, in particular the woman who was the victim of a crime? Is radio different than television or newspapers, where you have photos of your subjects? Did you worry about "outing" them as undocumented?

A: We do take pictures and we have a very active website. For example, at the clinic in Napa, we took some pictures of of a row of mothers talking to intake workers. We took the picture from behind, so you couldn't see their faces. I don't know if they were legal immigrants. We didn't ask. With the woman in the shelter, we really frown upon using unnamed sources or fictitious names, but this was one case where we all understand that if you want to use the source, you have to identify them in a way they're comfortable with. If that means using first name or fictitious name only, we're certainly willing to do that.

Q: What surprised you as you reported these segments? Did you have any preconceptions that were challenged by what you found?

A: I don't think we totally appreciated how inseparable immigration is from health care reform. California is more generous, or maybe the best word is inclusive, in benefits for the undocumented. California does make a lot of services available to immigrants regardless of their immigration status. There may be reluctance on part of immigrants to access those benefits.

One of the things that was surprising in talking with outreach workers at Clinic Ole in Napa is that there were immigrants who thought the government was deliberately exaggerating the risk (of swine flu) to discourage workers from crossing the border. The outreach workers also had to overcome street rumors about Immigration and Customs Enforcement agents being at the clinics and checking papers .

The more you delve into it, the more you see your immigration affecting the way you think about your health, the willingness to access health when it is available and the obstacles that clinics need to overcome in terms of trust. For example, workplace safety. Farmworkers are critical part of our economy. More than half of farmworkers are undocumented in California, yet they are in one of the most dangerous occupations in calfiornia. They have exposure to pesticides, they have physical injuries, they have poor housing that makes them more susceptible to things like H1N1. Until their status is clarified, they're going to continue to live in the shadows and not have full access to health care that they need.

Q: What else would you like to see reporters cover in this area?

A: California's a big state and being an immigrant in Humboldt County is very different than one in Imperial or San Diego counties. There are big differences between inland and coastal areas, urban and rural areas. There are issues of outreach, including promotoras, cultural competence and how well the system serves these communities. There's lots to explore in mental health: many immigrants have mental health issues and there are often taboos in talking about mental health issues. It's endlessly interesting, I think.