Before I begin I would like to say thank you for this study, although I am aware of the challenges that undocumented immigrants face, this article brings to light a whole different aspect of difficulties I did not consider. I am ashamed to admit that I have never thought about it from this perspective, much learned here.

The relationship between fear and its affect on health is very apparent as outlined in this study. Although fear can do many things, to include being a motivator, in the case of undocumented immigrants identified in this study it is paralyzing and results in higher levels of stress.

Stress in turn results in significant and cumulative influences on health and health disparities (Reference study here). The three main sources of fear and how it relates to health are:

Cost: The population identified in this study, due in large part to being undocumented, had a high rate of poverty, lower educational level, and high levels of transience. As expected this equates to an income level the precludes having health insurance in most cases.

Fear experienced by these individuals was rooted not only in the cost that would be incurred from medical care, participants in the study also feared being identified by INS while being hunted down by bill collectors. Adding to the stress of healthcare cost, individuals were forced to choose between paying bills and buying food over paying for healthcare. Sadly, participants in this study looked at their diabetes and knew it would eventually kill them, just not today.

Language Barriers, Discrimination, and Immigration Status: Participants in this study felt they were being discriminated against because many could not speak English, some recalled clinic/ER staff blatantly calling out and berating the participants for not speaking English and being in the country illegally.

I find this particularly disgusting based on morality alone, medical professionals are charged with providing care to the needy, sick, and injured regardless of who they are.

To further the participants stress level, communicating with physicians was difficult and often scary. Participants spoke of being made to feel guilty for needing an interpreter, and when they did have an interpreter, critical parts of the conversation were incorrect potentially causing serious medical issues with the patient.

Cultural Disconnect: Participants described having difficulty speaking with medical staff about traditional remedies for the treatment of medical problems, some of the remedies (not all) were very effective in managing health issues with little side effects to the participants, including diabetes.

Some individuals were embarrassed about what they had paid for the traditional medicine and that it ended up not working. Cultural disconnect made the participants fearful of what the provider might say about traditional remedies, negative feedback from the provider could potentially "spoil the normal identity of the patient" regarding his/her culture. (Page-Reeves, et al., 2011)

I absolutely agree structural violence perpetuates health disparity, this study is a prime example of that fact. Unfortunately, the scenario outlined in this study is not an isolated issue with regards to a particular class of people not having adequate medical care. Along with undocumented immigrants, the lower income, undereducated, and mentally impaired often go uninsured and only receive medical care in times of emergency.