Immigration and Health Disparities

Migration continues to be an important component of globalization. With global movement comes migrants’ vulnerability, and the consequent intersection with health and health disparities. The immigrant population in the United States is expected to increase to about eighty-one million by 2050. This ongoing demographic transformation suggests that the health status, health risk behaviors, and health disparities of immigrants and their offspring may play a significant role in shaping the health outcomes of the American population. Immigrants are particularly considered a vulnerable population because of insufficient access to and utilization of health care, limited English proficiency, low socioeconomic status, immigrant status, stigmatization, marginalization, and increased risk for poor physical, psychological, and social health outcomes, especially among the working poor. These factors undoubtedly have detrimental effects on the health and health disparities of immigrants and their children. These social, environmental, and behavioral occurrences or life experiences accumulate over time to improve or jeopardize an individual’s health. Similarly, immigration policies have a tremendous impact on immigrant health disparities, especially during periods of strict and intense enforcement in the United States. Nativity has become a prominent domain in health disparities research. Given that nativity, racial, and ethnic health disparities continue to be a major public health concern, social work scholars and practitioners continue to work toward eliminating health disparities among population subgroups, including immigrants. Included in these discussions are immigrant health service use, immigrant health effects, salmon bias, and determinants of immigrant health. Also important in working with immigrants are problems with accessibility to health services.

Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California

Restrictive US immigration laws and law enforcement undermine immigrant health by generating fear and stress, disrupting families and communities, and eroding social and economic wellbeing. The inequality and stress created by immigration law and law enforcement may also generate disparities in health among immigrants with different legal statuses. However, existing research does not find consistent evidence of immigrant legal status disparities in health, possibly because it does not disaggregate immigrants by generation, defined by age at migration. Immigration and life course theory suggest that the health consequences of non-citizen status may be greater among 1.5-generation immigrants, who grew up in the same society that denies them formal membership, than among the 1st generation, who immigrated as adolescents or adults. In this study, we examine whether there are legal status disparities in health within and between the 1st generation and the 1.5 generation of 23,288 Latinx immigrant adults interviewed in the 2005–2017 waves of the California Health Interview Survey. We find evidence of legal status disparities in heart disease within the 1st generation and for high blood pressure and diabetes within the 1.5 generation. Non-citizens have higher rates of poor self-rated health and distress within both generations. Socioeconomic disadvantage and limited access to care largely account for the worse health of legally disadvantaged 1st- and 1.5-generation Latinx adults in California.

Immigrant Health Inequities: Exposing Diversions and White Supremacy

Diversions occur when research disregards the inequality-generating actions of advantaged groups and instead focuses attention on the actions and behaviors of disadvantaged groups. We incorporate important insights from COVID-19 to illustrate historical and contemporary examples of diversions. This paper highlights US immigrant health inequities—a burgeoning subfield within the broader health inequalities canon—to explore: (1) if and how diversions appear in immigrant health studies; (2) how often white supremacy and intersectionality are explicitly named in grants, publicly available datasets, and published research. The data derive from: NIH R01 grants (17), publicly available datasets that focus on immigrant health (7), and research published in three health journals (14). Using a qualitative content analysis approach, we analyzed these data as evidence concerning the knowledge production cycle, and investigate whether: (a) the role of advantaged groups in generating inequalities is explicitly mentioned; (b) disadvantaged groups are asked about discriminatory actions perpetuated by advantaged groups; (c) health inequalities are placed on the conditions of disadvantaged groups; (d) if white supremacy and intersectionality are explicitly mentioned in grants, publicly available datasets, and research articles. The findings demonstrate the prevalence of diversions in immigrant health research, given an overemphasis on health behaviors and cultural explanations towards explaining immigrant health inequities. There was no mention of white supremacy across the knowledge production cycle. Intersectionality was mentioned once in a research article. We argue that understanding white supremacy’s role in the knowledge production cycle illuminates how diversions occur and prevail. We provide suggestions on moving away from diversionary research, toward adopting an intersectional approach of the study of immigrant health inequities.

Immigrant health care workers from developing countries in the US: antecedents, consequences and institutional responses

PurposeThe aim of this paper is to present a conceptual model on foreign-born health care workers from developing countries working in the US. The model covers their motivations for migration, the consequences in terms of the inequality and exclusion they may experience and the role of institutional responses at micro-, macro- and meso-level of intervention.Design/methodology/approachThe paper is based on: (1) in-depth review of key literature studies on the foundation theories of international migration including sociology, economics, anthropology, psychology and human resource management, (2) analysis of theoretical approaches to medical migration across disciplines, (3) analysis of the international and national documentary sources of micro-, macro- and meso-level policies on migration and (4) analysis of evidence on best practices, solutions and aspirational changes across different levels of institutions.Findings(1) Migration of international medical graduates (IMGs) from developing countries to the US can be explained from a micro-, macro- and meso-level of analysis. (2) IMGs who identify as racial/ethnic minorities may experience unfair discrimination differently than their US-born counterparts. (3) Although political/legislative remedies have had some successes, proactive initiatives will be needed alongside enforcement strategies to achieve equity and inclusion. (4) While diversity management initiatives abound in organizations, those designed for the benefit of IMGs from developing countries are rare. (5) Professional identity groups and some nonprofits may challenge structural inequities, but these have not yet achieved economies of scale.Research limitations/implicationsAlthough it is well-documented in the US health care literature how ethnic/racial minorities are unfairly disadvantaged in work and career, the studies are rarely disaggregated according to sub-groups (e.g. non-White IMGs and US-born MGs). The implication is that Black IMG immigrants have been overlooked by the predominant narratives of native-born, Black experiences. In placing the realities of native-born Blacks on the entire Black population in America, data have ignored and undermined the diverse histories, identities and experiences of this heterogeneous group.Practical implicationsAn awareness of the challenges IMGs from developing countries face have implications for managerial decisions regarding recruitment and selection. Besides their medical qualifications, IMGs from developing countries offer employers additional qualities that are critical to success in health care delivery. Considering organizations traditionally favor White immigrants from Northern and Southern Europe, IMGs from developed countries migrate to the US under relatively easier circumstances. It is important to balance the scale in the decision-making process by including an evaluation of migration antecedents in comprehensive selection criteria.Social implicationsThe unfair discrimination faced by IMGs who identify as racial/ethnic minority are multilayered and will affect them in ways that are different compared to their US-born counterparts. In effect, researchers need to make this distinction in research on racial discrimination. Since IMGs are not all uniformly impacted by unfair discrimination, organization-wide audits should be in tune with issues that are of concerns to IMGs who identify as racial/ethnic minorities. Likewise, diversity management strategies should be more inclusive and should not ignore the intersectionality of race/ethnicity, nationality, country of qualification and gender.Originality/valueImmigrant health care workers from developing countries are integral to the health care industry in the United States. They make up a significant proportion of all workers in the health care industry in the US. Although the literature is replete with studies on immigrant health care workers as a whole, research has rarely focused on immigrant health care workers from developing countries. The paper makes a valuable contribution in drawing attention to this underappreciated group, given their critical role in the ongoing pandemic and the need for the US health industry to retain their services to remain viable in the future.

Does America Make You Sick? A Critical Perspective on the Black Immigrant Paradox

The health trajectory of Black immigrants receives little attention in minority health discourse despite Black immigrants representing a notable share of the Black population. One aspect of their health that requires increased attention is the immigrant health paradox. This draws attention to the deteriorating outcomes of immigrants as they assimilate into the host country. Although a few scholars have acknowledged the role of race in this trajectory, few have examined it from a critical perspective. This article embraces critical race theory to argue that racial processes intersect with other forms of structural oppression to produce the immigrant health paradox. An understanding of this health trajectory of Black immigrants is instructive in understanding the impact of race on minority health.