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The Making of Modern Immigration: An Introduction | xix through them. We must not be discouraged by the presence of these objectively grotesque hindrances, but we must name them where they exist, and we must take legitimate measures to address them—root and branch. Racism is hardly a new or unique scourge, but it is tenacious. We have a number of other occasions, fre- quently enumerated here in these pages, that supply hard lessons in the history of immigration and immigration reform. Many of these cross borders and political lines and time periods. For instance, when we think of racism manifesting itself in the contemporary world, there is much that is tied up with it and immigration as well: notions of bi-racialism, the superiority of one race over another, eugen- ics, nationalism, pluralism. In a place like the United States, all of these ideolo- gies take on a unique and sometimes unsettling character. One could compare them to a place like Sierra Leone, West Africa—where I happen to be writing these lines as an immigrant from the United States on a short-term work visa— where they take on an entirely different meaning. Frequently the children in the town where I live yell out to me, “opoto” (white man, a truncated reference to “O! Portuguese-o!” after the first European explorers to visit Sierra Leone). They want the attention of the stranger who is very different from them, and they want to see what I will do. Mixed with their greeting to me is a certain postcolonial angst over my presence here. They are fascinated by me even while they, rightly or wrongly, dread me. Such is the cross-fertilization of culture, which we are be- ginning to see analyzed with greater frequency in the sociological and anthropo- logical literature. 28 In addition to the various conceptualizations and attitudes of rights and status, there is the more practical element in the global village of how we care for one another in a world of limited resources. Nowhere is this more delicate than in the field of health care. Immigrants have a special difficulty in gaining access, and it is largely a matter now of regulating them out of the system, leaving them to fend for themselves or rely on the kindness of others, principally religious groups. Immi- grants and their U.S.-born children accounted for 71 percent of the increase in the medically uninsured population between 1989 and 2007. In all, 34 percent of im- migrant households lack basic health insurance, compared with 13 percent of the native-born population. 29 Important new studies are emerging that this issue affects the overall question of health care for all Americans and that it has yet to be suffi- ciently addressed. Princeton University’s Center for Migration and Development, for instance, has brought about significant new data using in-depth interviews and field observation of hospitals and clinics in three research sites in Florida, South- ern California, and central New Jersey to measure delivery of services and examine the challenges encountered in each of 40 institutions located in these places. 30 It is to be hoped that legislative efforts will follow on sound research, though that is a great hope indeed. Already the signs are not good. Due to the economic downturn in 2009–2010, certain state legislative efforts that would have given some relief to