How Immigration Reform Could Impact Public Health

By: Allison Hydzik

In his State of the Union address this week, President Obama called on Congress to send him an immigration reform bill, saying, “Now let’s get this done. Send me a comprehensive immigration reform bill in the next few months, and I will sign it right away.”

At the University of Pittsburgh Graduate School of Public Health, Patricia Documet, M.D., Dr.P.H., scientific director of the Center for Health Equity, and Laura Macia, Ph.D., project coordinator for the Latino health advocacy groups Hermanas en la Salud and Latino Engagement Group for Salud, shared their professional views on how immigration reform could impact public health.
Q: Why is immigration reform important to public health?
Dr. Macia: The most obvious answer is that access to health insurance and, sometimes, certain medical services is directly impacted by the legal framework in which immigrants exist. Not having a social security number makes accessing some of these services much harder. Additionally, anxiety and depression are often reported by immigrants as resulting from the experience of migration. We also often hear from undocumented immigrants who refuse to engage in social or sporting activities due to fear about their legal status, and this becomes a barrier to living healthier lifestyles. Immigration reform could also take many of these immigrants out of the “shadows,” allowing them to claim certain rights in issues such as adequate housing and safe work conditions.

Q: What are the health experiences of immigrants, both undocumented and those that are well-qualified and educated?

Dr. Macia: In some respects they are extremely different, while in others quite similar. It is also important to note that there is no dichotomy between undocumented and well-educated immigrants – many undocumented immigrants are extremely well-educated and vice-versa. The distinction is often in how they migrate to the U.S., whether undocumented or through legal visas. Undocumented immigrants face more discrimination, and among them anxiety and depression are common. Due to their low income, many find it very hard to access adequate housing conditions. Undocumented immigrants, as well as many well-qualified and educated immigrants, can find enrolling in health insurance extremely difficult, if not impossible. For well-qualified immigrants, who are often spouses of students or professionals, the inability to legally work is commonly a trigger for depression. Many of them, facing economic pressures and feelings of inadequacy by not being able to work, decide to accept jobs “under the table,” such as housekeeping, that do not fit their educational background.
Q: How does immigration status impact a person’s mental, social and physical health?
Dr. Documet: I cannot stress enough how much social isolation affects a person’s social health. This, in turn, may bring about depression and anxiety. Regarding physical health, it makes it more difficult to find resources in the community to address any issues that emerge. Additionally, immigrants may take up unhealthy behaviors, such as smoking, and stop healthy behaviors, such as breastfeeding. Finally, they are more likely to develop health problems, such as asthma, diabetes and obesity.
Q: Based on your research experience, what do you think is the best immigration policy, both for our nation and citizens, as well as potential immigrants?
Dr. Documet: It is difficult to answer this question and I certainly have no research data on policies. From the health data I have collected, a policy that allows for people who are contributing to our economy as workers to receive health care in a non-threatening environment would be beneficial. As a private citizen, a more general answer would be that a policy that provides a path to citizenship for those who are currently in the U.S. illegally would be beneficial. I believe it is fair that individuals have to undergo a background check, pay a fine and be current in their taxes. Enforcement should concentrate on detecting and deporting criminals and discouraging employers from hiring undocumented workers.
Dr. Macia: I’m no expert on immigration legislation, and rather than directly answering this, I can offer my thoughts on what needs to be considered in crafting a good policy. Any policy that forces people to exist under the radar will have a negative impact on those people, and will create the wrong incentives for those who take advantage of them. Most immigrants come to the U.S. for work. However, many immigrants face very grim work environments, with little-to-no protections readily available to them. The mixed nature of these messages is undeniable, and a good policy needs to correct this. If immigrants are being pulled due to certain needs, such as economic force, they need to be recognized as such and not be left in the shadows.