Immigration as a Social Determinant of Health Proceedings of a Workshop (2018) / Chapter Skim
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2 The Past and Present of U.S. Immigration Policy
2 The Past and Present of U.S. Immigration Policy
Pages 5-18
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From page 5... ...
(Ewing) • The federal deadlock on immigration policy has led states to enact a confusing patchwork of rules and regulations related to immigration.
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These immigration acts generally did not deal with the Western Hemisphere, though a set of agreements around World War II were designed to bring primarily Mexican immigrants to the United States to meet labor shortages. As Ewing described the period after 1924, "Northern and western Europeans were in, and everybody else was effectively out -- except for Mexicans and other inhabitants of the Western Hemisphere, who were left outside of the quota system due to their usefulness as easily exploited agricultural laborers." The position of nativists gradually eroded after the 1920s for a number of reasons, Ewing said.
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This includes not only green card holders but naturalized U.S. citizens, undocumented immigrants, recipients of temporary protected status, refugees and asylum seekers, and workers on temporary visas.
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in 1986. The act granted legal status to many of the undocumented immigrants already living in the country, opened the doors to hundreds of thousands of new agricultural guest workers from Mexico, and increased border enforcement.
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During the early 1990s, the federal government began fortifying the U.S.–Mexico border against undocumented immigration with more Border Patrol agents, new technologies to detect unauthorized crossings, and hundreds of miles of fencing. "Yet, the end result wasn't fewer undocumented immigrants in the United States, but more," said Ewing, He added: True, more died while crossing the border in remote locations in an at tempt to evade the Border Patrol.
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These bills made sweeping changes to immigration law, making it easier to deport or deny federal welfare benefits even to lawfully present immigrants. "In the end, the goal of the immigration provisions of these laws was to make life as difficult as possible not only for undocumented immigrants but for green card holders as well," Ewing said.
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From NASEM, 2015. FIGURE 2-2 Since 2009 the number of Asians immigrating to the United States has exceeded the number of Latinos.
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Undocumented status does not fully impede integration, but it does have intergenerational effects on the children of undocumented immigrants, he noted.1 For example, 5.2 million children in the United States live in mixed-status families, and 4.5 million of these children were born in the United States. They are now living under "a regime of increased deportation, or at least increased fear of deportation," said Ramakrishnan, and these fears can contribute to negative health outcomes.
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While many activities do not require citizenship, such as contacting officials, boycotting products, or expressing political views online, he noted that noncitizens are less likely to participate in these activities than citizens. This is true even for volunteers, which "should be a major concern," Ramakrishnan observed, "to the extent that volunteerism affects community dynamics and the ability of localities to be resilient in the face of budget cuts and economic shocks." Ramakrishnan explained that the majority -- 85 percent -- of firstgeneration immigrants speak another language, but half report speaking English well or very well.
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Poverty rates among Asian Americans are lower than the overall U.S. rates, although Asian American senior poverty is higher than the average senior poverty rate.
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But the Asian American community also has tremendous diversity in terms of socioeconomic status, language, health, geographic ancestry, political activity, and other measures. As just one indication of this diversity, Ramakrishnan mentioned the political activity of recent Chinese immigrants using WeChat to exchange information, political messages, and rumors.
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Prince William County, Virginia, denied all county services of any kind to undocumented immigrants, and Hazleton, Pennsylvania, passed an ordinance making it a crime to rent an apartment to an undocumented immigrant. The result has been "a complete mess," Ewing observed, "a patchwork of conflicting rules and regulations on topics that should have been decided at the federal level." As did Ewing, Ramakrishnan pointed to wide variation in the states in enforcing federal immigration laws while also citing differences in areas such as adult education and workforce training, in-state tuition, financial aid, driver's licenses, professional licenses, and child health insurance.
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Similar issues arise when data are collected from immigrants in community health departments, college financial aid forms, or driver's license offices. The 2015 National Academies report recommended continuing the practice of collecting the nativity of not only the respondent but also the father and the mother, as has been done in the past.
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18 IMMIGRATION AS A SOCIAL DETERMINANT OF HEALTH Another example involves rates of uninsured people among Asian Americans, which dropped substantially after enactment of the Patient Protection and Affordable Care Act. However, the numbers differ by ethnic group, again demonstrating "why data disaggregation is so critical," Ramakrishnan said.
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