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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25204.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Immigration as a Social Determinant of Health Steve Olson and Karen M. Anderson, Rapporteurs Roundtable on the Promotion of Health Equity Board on Population Health and Public Health Practice Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation, Health Resources and Services Administration, Kaiser Foun- dation, The Kresge Foundation, Office of Health Equity, The Colorado Trust, and the U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13:  International Standard Book Number-10:  Digital Object Identifier:  https://doi.org/10.17226/25204 Additional copies of this publication are available for sale from the National Acad- emies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624- 6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Immigration as a social determinant of health: Proceedings of a workshop. Wash- ington, DC: The National Academies Press. doi: https://doi.org/10.17226/25204. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institu- tion to advise the nation on issues related to science and ­ echnology. Members t are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was estab­ished in 1970 under the charter of the National Academy of ­ ciences to l S advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, E ­ ngineering, and Medicine to provide independent, objective analysis and ad- vice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in ­ atters of science, engineering, and medicine. m Learn more about the National Academies of Sciences, Engineering, and ­ edicine M at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin- ions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

PLANNING COMMITTEE ON IMMIGRATION AS A SOCIAL DETERMINANT OF HEALTH1 FRANCISCO GARCÍA (Chair), Director and Chief Medical Officer, Pima County Department of Health GILLIAN BARCLAY, Healthcare Industry Specialist, Nevada Governor’s Office of Economic Development B. NED CALONGE, President and CEO, The Colorado Trust SAMANTHA SABO, Associate Professor, Center for Health Equity Research, Northern Arizona University MELISSA A. SIMON, Professor of Obstetrics and Gynecology/Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University UCHENNA S. UCHENDU, Executive Director, Office of Health Equity, Veterans Health Administration, U.S. Department of Veterans Affairs WINSTON F. WONG, Medical Director, Community Benefit, Kaiser Permanente 1  The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rap- porteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

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ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY1 ANTONIA VILLARRUEL (Chair), University of Pennsylvania PATRICIA BAKER, Connecticut Health Foundation JULIE A. BALDWIN, Center for Health Equity Research, Northern Arizona University GILLIAN BARCLAY, Nevada Governor’s Office of Economic Development B. NED CALONGE, The Colorado Trust KENDALL M. CAMPBELL, Brody School of Medicine, East Carolina University LUTHER T. CLARK, Merck & Co., Inc. FRANCISCO GARCÍA, Pima County Department of Health JEFFREY A. HENDERSON, Black Hills Center for American Indian Health EVE J. HIGGINBOTHAM, University of Pennsylvania CARA V. JAMES, Centers for Medicare & Medicaid Services CHRIS KABEL, The Kresge Foundation MELENIE MAGNOTTA, Aetna Foundation OCTAVIO N. MARTINEZ, Hogg Foundation for Mental Health, The University of Texas at Austin CHRISTINE RAMEY, Health Resources and Services Administration MELISSA A. SIMON, Northwestern University PATTIE TUCKER, Centers for Disease Control and Prevention UCHENNA S. UCHENDU, Office of Health Equity, Veterans Health Administration, U.S. Department of Veterans Affairs ROHIT VARMA, University of Southern California WINSTON F. WONG, Kaiser Permanente Staff KAREN ANDERSON, Director ANNA MARTIN, Senior Program Assistant HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice 1  The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs

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Reviewers This Proceedings of a Workshop was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: KENDALL M. CAMPBELL, Brody School of Medicine, East Carolina University ERIN HAGAN, University of California, San Francisco MELISSA A. SIMON, Feinberg School of Medicine, Northwestern University PATTIE TUCKER, Centers for Disease Control and Prevention Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HARRY J. HEIMAN, Georgia State University School of Public Health. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. ix PREPUBLICATION COPY—Uncorrected Proofs

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Contents 1 INTRODUCTION 1 Major Topics of the Publication, 2 2 THE PAST AND PRESENT OF U.S. IMMIGRATION POLICY 5 Advent and Decline of the Quota System, 6 1965 Immigration and Nationality Act, 7 Immigration and Reform Control Act and Subsequent Legislation, 8 Immigration Today, 10 Health and Well-Being of Immigrants, 12 Continuing Integration of Immigrants into U.S. Society, 14 Asian Americans and Pacific Islanders, 14 State-Level Policies, 16 Data Security and the Need for Disaggregated Data, 17 3 IMMIGRATION AS A SOCIAL DETERMINANT OF HEALTH 19 Linking Immigration with the Social Determinants of Health, 20 A State Survey of Health, 22 Community-Based Responses, 25 Data and Potential Policy Change, 27 4 THE VOICES OF IMMIGRANTS 29 Serving a Diverse Asian American Community, 30 The Plight of Veterans, 32 Photographs of Immigrants’ Lives, 34 From Medical School to Community, 36 xi PREPUBLICATION COPY—Uncorrected Proofs

xii CONTENTS 5 REFLECTIONS ON THE WORKSHOP 39 Grappling with the Complexities of Immigration, 39 Unmet Needs, 40 Caring for Those in the Shadows of Life, 43 REFERENCES 45 APPENDIXES A Workshop Agenda 47 B Speaker Biographical Sketches 51 C World Café Organizations 59 D Statement of Task 63 PREPUBLICATION COPY—Uncorrected Proofs

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Since 1965 the foreign-born population of the United States has swelled from 9.6 million or 5 percent of the population to 45 million or 14 percent in 2015. Today, about one-quarter of the U.S. population consists of immigrants or the children of immigrants. Given the sizable representation of immigrants in the U.S. population, their health is a major influence on the health of the population as a whole. On average, immigrants are healthier than native-born Americans. Yet, immigrants also are subject to the systematic marginalization and discrimination that often lead to the creation of health disparities. To explore the link between immigration and health disparities, the Roundtable on the Promotion of Health Equity held a workshop in Oakland, California, on November 28, 2017. This summary of that workshop highlights the presentations and discussions of the workshop.

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