Marissa Raymond-Flesch, MD, MPH, assistant professor of pediatrics, grew up in New Mexico, a minority-majority state with tremendous health challenges for youth. Her high school class started with about 1,000 students but graduated with just under 500. Students were lost to gang violence, poverty, and pregnancy. This experience fostered a sense that something was broken and needed to be fixed; she became deeply interested in how she could improve the lives of Latino youth. Since then, she has focused her career on understanding the challenges that Latino and immigrant communities face.
Dr. Raymond-Flesch’s research focuses on access to care for adolescents and young adults, with particular attention on improving reproductive health access for minority and border communities. Her current research examines the relationship between mental health, community violence, and unintended teen pregnancies in Salinas, California - a small, predominantly Latino community on California’s rural central coast. Preliminary results from that investigation highlight the critical role that family plays in positive youth development and youths’ health knowledge. This work, and the community engagement associated with it, also revealed widespread concern about the mental health of Salinas youth. This data-informed the later phases of "A Crecer: The Salinas Teen Health Study," an ongoing longitudinal survey of 600 early adolescents in Salinas.
“When we began the study, we were looking at typical indicators, but what we started hearing was that the political environment was having a major impact on the health and well-being of youth,” Dr. Raymond-Flesch explains. “This includes significant impacts on mental health and other important indicators, like educational achievement. Latino students are worried about their parents getting deported while taking them to school, and worried about utilizing public resources.” As a result, she found that study participants were less likely to interact with health care practitioners or law enforcement. Structural racism effectively cuts entire communities out of the safety system in the US.
As she found in her earlier work, the newer research suggested that many of children in affected communities rely on large extended families. Not only is losing a grandparent or cousin to deportation emotionally distressing, it is also often financially disruptive.
Dr. Raymond-Flesch believes we need to focus on state- and local-level immigration policy. While the federal government is creating harmful environments for children, policies at lower levels can help mitigate the damage. For example, school systems in California are beginning to educate families about the fact that they don’t report to immigration bodies. At the state level, lawmakers are working on policy interventions to address potential citizenship questions on the 2020 census. Even policies within the UC system can move the needle: a commitment to the safe education of dreamers is one example.
“It’s important to remember that, as physicians, we have a lot of privilege and expertise and a moral imperative to protect the health and well-being of children,” said Dr. Raymond-Flesch. “We have to continuously ask how we can act on that. For some it’s doing the research, for others, it’s completing the asylum exams so those who need asylum can seek it. For many it’s just understanding the physical and mental places our patients are coming from.”
As a Watson Scholar, Dr. Raymond-Flesch has been able to open up space in her work to continue examining health policy and risk factors, and mentoring others with similar interests. She also spends time thinking about how we might better track how diversity, equity, and inclusion is being worked on across UCSF.
Indeed, the global and national policy environment is revealing the issue to be a pressing health crisis. A recent position paper, published by the Society of Adolescent Health with Dr. Raymond-Flesch as a coauthor, asserts that racism exerts adverse effects on self-concept, health and well-being, and life trajectories of both minority youth and youth-serving providers. The paper lays it out quite plainly: “in the face of growing nationalism, ethnocentrism, and xenophobia, there is an urgency in guiding how to address the health consequences of these social forces.”
“We have an obligation as health care providers to talk about this. We must work with students to obtain quality feedback to foster change,” says Dr. Raymond-Flesch. “These are not soft health issues – they’re of integral importance to the quality of care we provide.”
