The pervasiveness of COVID-19 has exposed the structural failures of the healthcare system for immigrant populations, who have consistently been at risk during the pandemic. With over 244 million migrants living around the world – and more migrants expected due to the intensifying climate crises – it’s imperative that we understand the intersection between migration and health to create solutions that address everyone’s unique needs.

Public health researchers suggest that migration is a social determinant of health. Migration can often lead to positive health outcomes for families if they are able to escape persecution or have increased access to education, healthcare, and opportunity in the destination country. However, for particularly vulnerable groups such as young children, the elderly, female heads of households, unaccompanied minors,  and those fleeing war, the migration process itself can pose even more severe health risks. Poor nutrition, lack of healthcare, violence, trafficking, harsh living, disease exposure, and psychosocial trauma can have long-term effects on the mental and physical health of migrants. 

Upon arrival in the destination country, migrants still may not have access to proper healthcare. Accessibility barriers such as understanding the insurance application process, eligibility rules, cultural, language, and literacy obstacles as well as logistics and transportation issues are common. Additionally, hostile immigration policies coupled with social exclusion fueled by xenophobia further exacerbate negative health outcomes in immigrant communities. Chronic illnesses within migrant populations often go undiagnosed and many immigrants wait to seek medical services until there is an emergency. A holistic policy approach that addresses all of the healthcare barriers for immigrant communities is needed. 

Recent Events Adversely Affecting Immigrants and Their Health

In 2019, United States Citizenship and Immigration Services (USCIS) restricted pathways to citizenship for immigrants who were receiving public assistance through government programs such as Medicaid, public housing, and Supplemental Insurance Income. The public charge ruling made it such that if an immigrant parent, on the path to citizenship, enrolled in a program such as the Children’s Health Insurance Program for a citizen child, that parent would be ineligible for citizenship after 12 months. This rule, which lasted until March 9, 2021, disproportionately impacted immigrants with chronic illness, pregnant women, and families and was put into place at the onset of the pandemic when workplace closures and hospitalizations began.

In a survey of organizations serving immigrant communities, 70% of respondents indicated that the public charge rule deterred immigrants from seeking COVID-19 testing and treatment. The same survey indicated that, despite the pressing need for assistance, “almost everyone” or “many” immigrant families avoided public relief programs out of fear of losing their immigration status. 

By now, we’ve seen the disproportionate impacts of the pandemic on certain communities. Immigrants are 50% more likely than those born in the U.S. to contract COVID-19 because they are more likely to be essential workers. For undocumented immigrants, outcomes are projected to be far worse. They are by far the most likely group to go uninsured, including 45% of the undocumented elderly population and 33% of undocumented children. Despite various efforts to expand emergency Medicaid coverage during the pandemic, these measures vary by state leaving many immigrants left out.

As the national conversation continues surrounding the expansion of a universal healthcare option, it is imperative that we incorporate the 47 million immigrants, including undocumented immigrants, into these plans. As Ninez Ponce, Director of the UCLA Center for Health Policy Research, says, “We can’t stop the spread of disease while denying health coverage to people. It’s irresponsible public health policy.”

What Can Donors Do?

The best way to support immigrant health is to support policies and candidates that are in favor of a universal healthcare system and expanding pathways to citizenship for immigrants at a local, state, and national level. Another avenue for donors is to fund increased research on the intersection of migration and health. You can also support the following Giving Compass vetted organizations which are doing tremendous work within the immigrant community:

  • California Immigrant Policy Center promotes policies that advance the rights and health of immigrants in California and was a major advocate in rolling back the public charge rule and mitigating damage this rule has caused.    
  • OneAmerica is building power within immigrant communities by teaming up with key allies and organizing advocates for immigrant inclusive policies in Washington state. 
  • Freedom For Immigrants is dedicated to advocating for immigrants detained at the United States border, and is promoting policies that will improve the health and well-being of migrants. 

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Original contribution by Madeleine Alegria, Philanthropy and Impact Analyst at Giving Compass.