One in four American children is an immigrant or the child of immigrants. The integration of these new arrivals into the United States health system has important implications for the health and well-being of all Americans. We were part of a group of academics, policy makers and public health practitioners brought together by the University of California Global Health Institute and the Health Initiative of the Americas to examine the relationships between migration and health. Our group recently curated and edited a special issue of International Migration devoted to the topic of immigrant children and children of immigrants. We offer insights from two of these articles here.
In the first study, Ethan Evans and Caren Arbeit analyzed data from the 2007 and 2011-2012 waves of the National Survey of Children’s Health to examine racial and ethnic disparities in access to health care among first, second, and higher-generation American children. The study considered two measures of access to care, insurance coverage and ‘access to services,’ which was defined as having a usual place to go when sick, a personal doctor or nurse, and not experiencing delays in accessing needed health care. Overall, the study found low levels of insurance coverage and access to care among immigrant children, particularly Hispanic children. It also found that these disparities diminished across generations. The vast majority of native-born children of native-born parents had insurance coverage and high-level access to services.
Strikingly, analysis revealed that insurance coverage and high-level access to services did not always coincide.
Strikingly, analysis revealed that insurance coverage and high-level access to services did not always coincide. For example, while the proportion of children with insurance increased over time, the proportion of children with high-level access to services decreased. The relationship between the two measures varied across groups as well. Among Asian immigrant children, a greater portion were insured than had high-level access to services. But, among Hispanic immigrant children, the opposite was true as a higher proportion of children had high-level access to services than were insured. This implies that increasing access to insurance coverage does not guarantee access to health care, and lack of insurance coverage is not necessarily preventing a high level of access to services.
The second study, by Krissia Martinez and colleagues, sheds light on the latter finding, that lack of insurance is not always a barrier to high-level care. Focus group discussions were conducted with English-speaking children in Hispanic immigrant families in Los Angeles who act as “language brokers” for family members seeking care. Many children reported that they and their parents avoid filling out health “paper work,” including applications for insurance coverage, out of fear of exposing their immigration status. This may lead to families obtaining care through county-run programs and clinics rather than financing the cost of private health care through a public or private insurer.
Aggressive detention and deportation by immigration authorities combined with an increasingly complex and chaotic heath system has substantially increased the risks faced by immigrant families and especially immigrant children when they seek health care. But vulnerability is only part of the story. These two articles and the others in our collection also highlight resilience and opportunities for public health interventions to support the health of immigrant children and their families.
Feature image: ‘WASHINGTON, DC, USA – MAY 1, 2009: Nelson Navidad of Hyattsville, MD, holds his son Nelson Jose, 4, at a White House rally of immigrants and supporters calling for legal reforms and an end to workplace raids.’ Photo rrodrickbeiler/iStock, used for illustrative purposes only.