Structural racism embedded in U.S. health care systems not only affects people of low income and minoritized populations who have lived in the country over time, but also immigrants.  Furthermore, immigrants must navigate a myriad of health insurance or direct payment options as well as other social safety net programs for themselves and their children often while speaking languages other than English and facing fears of anti-immigrant sentiment including concerns over their rights to remain in the country. As a leader of a philanthropic organization recently explained, “It’s hard enough to access health and human services for the U.S. born-English speaking communities. The burden placed on our immigrant neighbors is unnecessary and inhumane.”[1]

As Community Science seeks to accelerate equity, we want to recognize that immigrants are diverse in terms of their migration journeys as well as their experiences in the U.S. Therefore, to enable environments where everyone has fair and just opportunities to attain their highest levels of health, we must meet people where they are and work together with communities to harness data to inform improvements. We approach this with the understanding that everyone has the right to good health, people should not have to earn or demonstrate their worthiness to achieve good health, and structural challenges that create inequities can and should be dismantled. As the U.S. is home to more international migrants than any other country in the world,[2] it is important to move beyond sensational headlines and stereotypes and dig into the needs of specific immigrant communities to create conditions where everyone can thrive together.

As part of our behavioral and health equity practice area, Community Science was pleased to host the webinar Promoting Immigrant Health on November 15, 2023. Framed around our newly released Tips for Using Data to End Health Disparities and Strengthen Communities, this webinar highlighted new survey data from the 2023 KFF/LA Times Survey of Immigrants and lessons from the engagement of researchers in Protecting Immigrant Families’ health advocacy. This blog offers some background on immigrant health and highlights from the webinar.

During the webinar, KFF’s Samantha Artiga, Vice President of the Racial Equity and Health Policy Program, and Drishti Pillai, Director of Immigrant Policy, presented new data that disaggregates information about immigrants based on key characteristics such as length of time in the U.S., country or region of origin, citizenship and immigration status, English language proficiency, geographic residence, insurance status, age, education, income, and race and ethnicity. Their findings were based on the Survey of Immigrants, the largest and most representative nongovernmental survey of immigrants living in the U.S. to date. KFF and the LA Times sponsored the survey and fielded it in 10 languages between April and June 2023. They found that while most immigrants feel they are better off in the U.S., many face substantial challenges, including the cost of living, job discrimination and anti-immigrant harassment, lack of health insurance and culturally and linguistically competent health care, and immigration-related fears. This was consistently true for Black and Hispanic immigrants, immigrants with limited English Proficiency, and undocumented immigrants (which was inferred when a foreign-born respondent recruited on the web, by phone, or through the mail said they do not have citizenship, green card, or work or student visa).

KFF’s survey found immigration status plays an important role in access to health insurance, with half of likely undocumented immigrants saying they are uninsured compared to 1 in 5 lawfully present immigrants and less than 1 in 10 U.S.-born citizens. They also found that 1 in 4 (27%) likely undocumented immigrants, and 1 in 10 (8%) lawfully present immigrants say they avoided applying for government assistance with food, housing, or health care in the past year due to immigrant-related concerns. This is despite recent government guidance policy stating that these services will not affect immigrants’ applications for citizenship.[1] KFF’s rich and nuanced survey data help to center the voices of immigrants and make disparities within this vast and diverse group more visible. In partnership with the LA Times Immigrant Dreams series, they also help dispel polarizing and threatening stereotypes about immigrants. KFF plans to make this survey data available to the public for further analysis.

On the issue of advocacy for the right to use public benefits, the webinar featured Cheasty Anderson, Deputy Director of the Protecting Immigrant Families Coalition (PIF). PIF was formed in 2017 to stop aggressive, anti-immigrant policies pursued by the Trump Administration. This included a 2018 revision of the 1999 Public Charge ruling that would have used common food, housing, and health care benefits, causing the U.S. to refuse citizenship to immigrant users.[2] Anderson explained that one of the initial activities of PIF was to form a Research Working Group to connect data and advocacy. Primarily, they were interested in knowing how the proposed rule affected immigrants’ use of public benefits, and working group members were able to deliver timely findings on this topic.[3],[4] By creating a space where researchers and advocates communicated monthly, PIF found it could overcome misalignment between researchers, who need time to collect and analyze data then publish in professional journals, and advocates, who need information immediately. Despite the Biden Administration’s reversal of the Public Charge rule and engagement of immigrant advocates and the public in the release of a new and final rule in 2022, there is evidence of ongoing misinformation and avoidance of public benefits (such as that found in the recent KFF survey). This threat to public health at large and immigrant health is explicitly in addition to other pre-existing and emergent issues designed to systematically exclude and discriminate against people due to their birth in a country other than the U.S. PIF has grown to include 650 organizations — including Community Science — in 43 states and produces resources for communities and advocates to assure all families have access to the care and services they need to thrive.[5]

We thank KFF and PIF for participating in our webinar and demonstrating key Tips for Using Data to End Health Disparities and Strengthen Communities. Their work not only helps refine questions about disparities among immigrants but also shows how immigration status is a social determinant of health that affects disparities. Along with other sources, such as the Migration Data Hub by the Migration Policy Institute, they help fill gaps in the data about immigrants and tell substantive stories that deepen our understanding of immigrant experiences. Finally, the data help with coalition building and advocating for policy changes in the public interest. We look forward to ongoing collaborations to dispel myths and stereotypes, advocate for just distribution of resources, and create positive outcomes for all members of our communities.

[1] U.S. Citizenship and Immigration Services. Public Charge Resource.,term%20institutionalization%20at%20government%20expense.

[2] Protecting Immigrant Families. Public Charge.

[3] Bernstein H, Gonzalez D, Karpman M, Zuckerman S. Amid confusion over the public charge rule, immigrant families continued avoiding public benefits in 2019 [Internet]. Washington (DC): Urban Institute; 2020 May. Available from: Google Scholar

[4] Barofsky, J., Vargas, A., Rodriguez, D., & Barrows, A. (2020). Spreading Fear: The Announcement Of The Public Charge Rule Reduced Enrollment In Child Safety-Net Programs. Health affairs (Project Hope), 39(10), 1752–1761.

[5] Protecting Immigrant Families. Find Resources.

[1] Denise Herrera Executive Director of the Con Alma Health Foundation.  Health Affairs Virtual Event on Immigrant Health. July 20, 2021.

[2] Ward N, Batalova J. Frequently Requested Statistics on Immigrants and Immigration in the United States.  Migration Information Source. March 14, 2023.

About the Author

Mayson Friej

Maysoun Freij
Senior Associate for Health Equity
Community Science

Maysoun Freij, Ph.D., MPH, has extensive expertise in health and racial equity, specifically around health care coalitions, health and language access, immigrant health, social determinants of health, and intersectoral approaches to health and well-being. Recently, she’s focused on COVID-19 related disparities and equity-focused mitigation efforts, and health informatics. Maysoun has a background in cultural anthropology and has been engaged in evaluation research on local, state, and national initiatives for more than 14 years.

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