Giving Compass' Take:

• Kathy Ko Chin argues that historically exclusionary immigration policies have created a reality in which immigration status is a determinant of health, which funders should work to rectify. 

• How can funders work to make immigration irrelevant in determining health outcomes? 

• Learn how undocumented immigrants struggle to access healthcare. 

The bedrock of our immigration policy is exclusion. The Chinese Exclusion Act of 1882 was the first-ever federal legislation to ban an entire population solely on the basis of race or national origin and was not repealed until the 1940s. Anti-immigrant sentiment continues to run through our laws, from the rise of anti-immigrant policies of the 1990s to the overwhelmingly anti-immigrant rhetoric permeating our society today.

For the two-thirds of Asian Americans and Pacific Islanders (AAPIs) who are immigrants, their status determines almost every facet of daily life. There are many different immigration statuses: young DREAMers, documented and undocumented, green card holders, and those who live in the United States under a special agreement known as the Compact of Free Association (COFA).

For many immigrants, federal law serves as the gatekeeper to their health, with policies blocking coverage options that they financially support through taxes. Prior to 1996, immigrants of various statuses were included in public programs like Medicaid. The “welfare reform” of 1996 came with a cost: the arbitrary classifications of “qualified” or “non-qualified” status. Now, immigrants must wait five years to become “qualified” before they are eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

If we intend to create a truly equitable society, immigration status should not be a social determinant of health. Funders can support proactive strategies to improve care by supporting research on immigrant health needs, reshaping the narrative of who deserves health care, and directly influencing decision makers on the allocation of health resources. To do this, they will need to pay close attention to demographics and data, and help to ensure immigrants’ access to health coverage and care.

Read the full article about immigration as a social determinant of health by Kathy Ko Chin at Grantmakers In Health.