Unserved and Underserved Populations

Preface

This book describes the plight of unserved and underserved populations across the globe. These populations consist of migrants, refugees, asylum seekers, and native-born residents of many countries who lack equitable access to services due to war, political instability, poverty, racial discrimination, and economic disparities. These populations suffer poor access to or the absence of health care, education, employment, and other basic human needs. The planning of this book began after a conference in Taiwan in 2019, where speakers from many different countries presented information on the situations and needs of these populations. We realized that there was a need for a book that would inform readers in the helping professions as well as those throughout the broader society. We agreed that we would share our knowledge by describing the situations in different countries to alert readers to the dire challenges facing marginalized populations.

Introduction

Underserved and unserved populations are those who lack basic services, especially facing difficulty in access to adequate health care. They include a growing number of migrants, refugees, asylum seekers, and those among native-born populations who lack equal access to basic health and education services, nutrition, clean water, and adequate living situations. Across the globe, millions have been displaced due to warfare, ethnic bias, violence, poor economic opportunities, and climate change, which affects agriculture and living conditions in coastal regions. These inequalities result from the power deficit experienced by these marginalized populations, which, in turn, derives from structural or systematic racism. Critical reflection can be used to better understand the systemic exercise of power by dominant groups that support a racial or ethnic hierarchy that has a negative impact on the living standards of the underserved and unserved. This hierarchy establishes a ranking of groups under the control of a dominant group that leads to inequalities in education, health care, income, and wealth. Critical reflection allows us to recognize how systems of privilege and oppression have influenced our thinking and actions. Studies conducted in the United States and South Africa showed that marginalized groups reported receiving poor quality of health care, facing discrimination because of their race or ethnicity, being unable to pay for services offered, and experiencing communication/language barriers. The chapters in this book examine the inequalities faced by the underserved and unserved populations in several countries across the globe, with a focus on access to health care.

“To deny people their human rights, is to challenge their very humanity”

Nelson Mandela

1.The Plight of Unserved and Underserved Populations across the Globe

Sandra Levey and Li-Rong Lilly Cheng

Populations lacking health care, educational opportunities, and other services to meet basic human needs are defined as the unserved or underserved. These populations include migrants, refugees, asylum seekers, or individuals living in their native countries. Migrants are individuals who seek to establish a better life in a new location or country. Refugees are those forced to leave a country because of war, persecution, political instability, or poverty (Gönültas & Mulvey, 2019; International Organization for Migration, 2018). Asylum seekers are those who have fled their home country because of conflict, war, or other factors that bring danger to them or their families. Forced displacement occurs when individuals are compelled to escape persecution, conflict, unemployment, or climate disasters that affect the environment (Grech, 2019). These conditions create vulnerability to mental health disorders (Sheath, Flahault, Seybold, & Saso, 2020).

At the end of 2018, 70 million individuals across the globe had suffered forced displacement (United Nations Refugee Agency, 2018a). Many migrants, refugees, and asylum seekers are stateless, meaning that they are not considered citizens under the laws of any country. Consequently, they often lack access to health care, adequate housing, educational opportunities, and other basic services (United Nations Human Rights, 2020). In addition, the unserved or underserved face abuse, famine, disease, and loss of life.

Immigrants, Refugees, and Asylum Seekers

The number of international migrants in 2019 totaled 272 million individuals (World Migration Report, 2020). The numbers of male and female ←1 | 2→migrants were relatively equal, and three-quarters were 20 to 64 years of age. India is the largest country of origin (17.5 million), followed by Mexico (11.8 million) and China (10.7 million). Violence and conflict accounted for 41.3 million displaced migrants. The Syrian Arab Republic, Colombia, and the Democratic Republic of the Congo accounted for the highest number of displaced persons. 6.7 million migrants left the Syrian Arab Republic, and 3.7 million of these migrants entered Turkey. In the middle of 2019, 4 million people left Venezuela, which was the largest source of asylum seekers in 2018 (340,000).

Unauthorized resident immigrants are foreign-born non-citizens who are not legal residents (Center for Immigration Studies, 2020). It is estimated that at least 3.9 to 4.8 million unauthorized immigrants resided in Europe in 2017 (Connor & Passel, 2019). The number of unauthorized immigrants accounted for less than 1% of the population of the 32 states comprising the European Union and the European Free Trade Association (Iceland, Liechtenstein, Norway, and Switzerland). Those whose applications were ←2 | 3→rejected, and then appealed, have continued to remain in these countries waiting for approval. In the United States, there were roughly 10 million illegal immigrants in 2017 (Nowrasteh, 2019b). Border crossing from Mexico into the United States presents less difficulty than traveling to Europe from Afghanistan, Iraq, or Nigeria. Differences in the size of these populations across countries are based on the difficulties and costs associated with crossing the Mediterranean Sea compared with crossing borders into a country.

In Canada, it is reported that bias against skilled immigrant job applicants leads to discrimination (Dietz, Joshi, Esses, Hamilton, & Gabarrot, ←3 | 4→2015). For two groups in Canada with university degrees, employment rates are 90.9% for native workers and 61.9% for immigrants. These events occur because many individuals are wired for tribalism (Greene, 2013). This means that these individuals have a reaction to others not part of their tribe or group, differing from them in race, language, and behavior. This explains some individuals’ response to migrants, refugees, and asylum seekers. Discrimination also appears in health care, with language differences creating a barrier to accessing care, with better health-care outcomes associated with the presence of interpreters (Flores, 2005; Mukherjee, 2018). It is essential that health practitioners and others who work with migrants and refugees familiarize themselves with the languages and cultures of these individuals, with the use of interpreters to bridge gaps in communication.