Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
The "DACAmented Voices in Healthcare" project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These "DACAmented" youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family's health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.
Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments.
Arizona's state-level policies restricting undocumented immigrants' access to public benefits continue to have implications on mixed-status households' accessibility to care. More notably, the effects of prolonged stress, anxiety and trauma remain unaddressed whilst mental health services continue to be absent. This article examines the healthcare experiences of mixed-status households after Arizona's SB1070 (“Support Our Law Enforcement and Safe Neighborhoods Act”) was passed. Arizona Senate Bill 1070 (SB1070) was state legislation empowering police to detain individuals unable to prove their citizenship upon request. Of particular interest is how households navigate accessibility to care when members have varied immigration statuses, hence, varied healthcare availability. Interviews with 43 households in Tucson, Arizona, 81% of which had at least one undocumented member, reveal barriers and promoters to care. Barriers include complexity of applications, fear and trepidation in seeking care. Promoters include discount care programs that are a vital source of care as well as discretionary practices exercised by front-line staff. Findings have implications beyond Arizona as immigrants settle in new destination states while the current Trump administration borrows from Arizona's anti-immigrant policies.
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