In America we have some of the best medical care in the world, but the same high quality care isn't available to everyone. Government programs insure the elderly and the poor. For the rest, it's usually either private health insurance through their jobs, or no health insurance at all. An estimated 47 million people in the United States have no health insurance, and many of them are immigrants.
Health policy experts classify immigrants as a "vulnerable" group — at increased risk for heath problems and inadequate health care.
The health vulnerability of immigrants is the subject of a paper in the current issue of Health Affairs, a journal that examines health policy issues. Lead author Kathryn Derose of the Rand Corporation in California says some factors — like low income or limited education — can make anyone vulnerable. But immigrants, she said, have some special risks.
"Things like their immigration status — whether they're a citizen or not, naturalized citizen or legal permanent resident versus an undocumented [immigrant]; when they came to this country, because policies have been changing; where they live in this country can also seem to affect how good their access to care and quality of care is," Derose said.
There is evidence that immigrants, at least the young ones who come here to work, actually are healthier than their American-born counterparts, at least when the arrive. Over time, however, their health deteriorates. Study co-author Nicole Lurie saw that first-hand when she lived in Minneapolis, Minnesota, in the American Midwest.
"Minneapolis has had a lot of different immigrant populations over the years," she said. "First, lots of southeast Asians — Vietnamese and Hmong communities — and then, more recently, a huge Somali influx. When I first started taking care of Somali patients, you never saw a Somali person who was diabetic. Now, something like half of Somalis in that community are diabetic because they've adopted really crummy American, western health habits."
Immigrants are a pretty diverse group that includes naturalized citizens and both legal and undocumented non-citizens. Their legal status, in fact, plays a big role in their health status, say the authors, because their legal status may limit their access to various government services, or to jobs with health-related benefits. The recent increase in anti-immigrant sentiment, the authors suggest, may result in more limitations.
In their jobs, immigrants may be engineers or childcare providers or farm workers, and they come from almost every country on Earth. Their socioeconomic status, too, is an important factor in how healthy they are and in how well they are treated when they get sick. Income, education and English proficiency are also part of the mix. For example, Spanish-speakers are more likely to find a Spanish-speaking doctor in Los Angeles or Dallas than in a small town in Idaho or Maine, far from the Mexican border.
Among these various risk factors, one seems missing: the country of origin. In fact, co-author Nicole Lurie stresses that their diversity make it hard to generalize about the health vulnerability of immigrants from any one country.
"But I also suspect that what we're going to find is that where immigrants go is also going to have a lot to do with how they do. So if people, regardless of where they come from, end up in places where there are good school systems and their kids can get educated and can learn English and there are job opportunities, they're going to do better than people who aren't [doing that]," Lurie said.
One recommendation the authors make is to expand access to health insurance, whether through private providers or through government programs. That recommendation could also apply to everyone who is uninsured. But lead author Kathryn Derose says immigrants have certain unique needs that go beyond the medical care itself.
"There are things having to do with the limited English proficiency," says Dr. Derose. "There are laws that hospitals and clinics that receive federal funding are obligated to provide care in their language assistance, but there's often little enforcement of that. And then things like expanding and strengthening the medical safety net: hospitals and clinics that care for a large portion of the uninsured in communities and often for immigrants."
Kathryn Derose and her colleagues note that in a political environment where many Americans believe the country is being overrun by illegal immigrants, actions to curtail illegal immigration may have serious health consequences for all immigrants, regardless of their legal status.