New England Journal of Medicine, March 23, 2017 Vol. 376 No. 12

New England Journal of Medicine
March 23, 2017  Vol. 376 No. 12
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families
K.R. Page and S. Polk
Excerpt
…Today, the ACA’s fate is unclear, with implications for millions of Americans.5 We cannot predict how health care access will be reshaped, yet it’s all but certain that undocumented immigrants who were never eligible for ACA benefits will not have better access to care. Access may be significantly reduced if financial penalties are applied to states or cities that refuse to cooperate with ICE. Overt restrictions on basic public services, such as schools or public health clinics, are unlikely, given that such measures were ruled unconstitutional in the 1990s (California Proposition 187), but access could be restricted by requiring government-issued identification cards or Social Security numbers at federally qualified health centers or health department clinics. In addition, as our pregnant patient showed us, a climate of deportation may dampen the use of existing resources, even among eligible people.5

To reduce barriers to care for immigrant families, the medical and public health community can engage in local and national politics and promote a welcoming, inclusive environment in our practices. Clinicians have access to powerful stories of human suffering and strength. The current climate presents a renewed opportunity to partner with advocacy groups and media to share stories of human experience that counter the Trump administration’s negative narrative about immigrants. The sharing of personal stories about the impact of the temporary immigrant ban through social and mainstream media has energized millions of people to express opposition to the ban. Portraits of scientists and doctors affected by the ban highlighted its unintended consequences for science and health care. Telling human stories is an effective rapid-response tool that we can use to advocate for our patients.

Clinicians and public health practitioners can also join forces to harness the power of data. We can monitor and measure health care utilization and health outcomes. Clinicians can pay attention to patterns in health care utilization among their immigrant patients and communicate worrisome trends to public health professionals. Some markers of child well-being — such as Medicaid enrollment rates among eligible children of foreign-born parents, teen pregnancy rates, uptake of supplemental nutrition assistance programs, school attendance, and bullying reports — are already monitored, allowing comparison of the pre- and post-election periods.

The election’s implications for undocumented adults may be more complicated to evaluate, since these adults are often invisible in conventional databases because of barriers to care and insufficient collection of relevant sociodemographic data (i.e., ethnic background, country of origin, and language preference). It’s important to develop inclusive methods that account for the unique needs of hidden populations. Some existing measures, however, can provide indications of a chilling effect, including utilization of safety-net clinics for sexual and reproductive health care, timeliness of prenatal care, domestic violence reports, and hate crimes (especially assaults resulting in emergency department visits)…

There are many reasons to support equitable access to care for all, regardless of nationality. Objective and scientifically rigorous data analysis will be essential in elucidating the interconnection between immigrants’ health and the public health and health care costs of the United States.

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Editorial
Rotavirus Vaccines — A New Hope
Mathuram Santosham, M.D., M.P.H., and Duncan Steele, Ph.D.
N Engl J Med 2017; 376:1170-1172 March 23, 2017 DOI: 10.1056/NEJMe1701347
[See full text in Milestones section above]

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Original Article
Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger
Sheila Isanaka, Sc.D., Ousmane Guindo, M.D., Celine Langendorf, Pharm.D., M.P.H., Amadou Matar Seck, M.D., Brian D. Plikaytis, M.Sc., Nathan Sayinzoga-Makombe, M.P.H., Monica M. McNeal, M.Sc., Nicole Meyer, M.Sc., Eric Adehossi, M.D., Ali Djibo, M.D., Bruno Jochum, M.S., and Rebecca F. Grais, Ph.D.
N Engl J Med 2017; 376:1121-1130 March 23, 2017 DOI: 10.1056/NEJMoa1609462
Abstract
[See full abstract in Milestones section above]