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Health Affairs Briefings on Border Health and Immigrant Health

The July 2021 issue of Health Affairs, supported by the California Health Care Foundation, The California Endowment, and Con Alma Health Foundation, covers the intersection of borders, immigrants, and health.

Articles describe the coverage gaps remaining among US immigrants, the impacts of immigration policy on health care use, sanctuary policies as social determinants of health, and much more.

“The COVID-19 pandemic showed us that disease knows no borders, and that the health of our neighbors is inextricably linked to our own health,” said Sandra R. Hernández, MD, president and CEO of CHCF. “As California works to rebuild and recover, we must prioritize health care that transcends immigration status and language barriers. The articles in this thematic issue of Health Affairs highlight important research and inclusive solutions to care for immigrants, the backbone of California’s economy and culture.”

Two virtual briefings will highlight the content of the issue: 

  • Border Health: Evidence & Policy Issues — July 12, from 10:30 AM—noon (PT)

  • Immigrant Health: Evidence & Policy Issues — July 20, from 10:30 AM—noon (PT) 

The events will feature key papers and authors, and Dr. Hernández will give remarks at each event.

You must register for each event individually. Register here.

Borders, Immigrants, And Health

About one in seven residents of the US is an immigrant, and about fifteen million people live within 100 kilometers of the US-Mexico border. Disparities in health status exist between people born in the US and those who have immigrated. Immigration policy has been contentious throughout US history, and current policies in the US and Mexico have significant effects on the health and well-being of tens of millions of people. This thematic issue of Health Affairs focuses on immigrants and borders. The overview article by Arturo Vargas Bustamante and coauthors describes a range of health policy issues raised by the continuously shifting demography of US immigrants.

Along The Border

Keith Gennuso and colleagues calculate life expectancy for counties on the US side of the US-Mexico border. They find that Black, White, and Asian residents of border counties experience longer lives than their counterparts elsewhere in the US, but Hispanic and American Indian/Alaska Native residents in those counties have lower life expectancy than in the rest of the US.

Rodrigo Dominguez-Villegas and Bustamante examine the health insurance coverage of people born in Mexico who left that country and returned either voluntarily or because they were deported. During the first two years after their return, both groups have lower health insurance coverage rates than Mexican-born residents who never left, with deportees faring worse than other returnees.

Sharon Borja and coauthors find that 53.6 percent of US citizen migrant children living in Mexico lack health insurance. Underinsurance rates are 80.4 percent in urban areas and 65.2 percent among those who live in Mexican states near the US border.

Reaching The US Border

The US has agreements with El Salvador, Guatemala, and Honduras permitting the expedited removal of asylum seekers from the US, claiming that these countries provide protection against persecution. C. Nicholas Cuneo and coauthors examine data from people from this region who were seeking asylum in the US and who presented to a medical clinic in Boston, Massachusetts. Among them, 91.2 percent of people reported repeated trauma exposures, most often threats of violence, sexual assault, and violence perpetrated against family or friends.

Ietza Bojorquez-Chapela and coauthors analyze official health policy documents in Mexico to study the extent to which the country considers the needs of in-transit migrants and asylum seekers in its response to the COVID-19 pandemic. The authors find major gaps regarding who can access care and who is mandated to provide care, suggesting the need for more attention to these highly vulnerable groups.

Meghan Benton and Demetrios Papademetriou consider how COVID-19 is reshaping border and immigration management in the US and draw parallels with policy changes made after September 11, 2001. They analyze the pandemic’s impact on migrants, migration flows, and migration policies and argue that COVID-19 offers both risks and opportunities for future safe travel and migration policy.

Immigrants In The US

Abigail Friedman and Atheendar Venkataramani find that increased enforcement of deportation policies is negatively correlated with having a regular health care provider and an annual checkup among Hispanic adults. This negative relationship holds “even among diabetic respondents, for whom biannual check-ups are the standard of care.”

In 2018 a change to the “public charge” rule was proposed that threatened the ability of noncitizens who use some public programs to become citizens. Sharon Touw and coauthors estimate that 25 percent of all at-risk immigrant essential workers and their household members avoided in public programs because of the proposed rule change, resulting in about 1.3 million and 2.1 million of them forgoing SNAP and Medicaid, respectively.

About sixteen million people live in mixed-status families where only some members are legally present in the US. Mariellen Jewers and Leighton Ku report that when living in the same household, 42 percent of noncitizen children are uninsured compared with 12 percent of citizen children, primarily because of Medicaid and CHIP.

Dolores Acevedo-Garcia and coauthors discuss legal status as a social determinant of health, review how immigrant exclusions affect US citizen children in mixed-status families by focusing on access to safety-net programs, and outline policy recommendations to decrease restrictions that harm children.


Health Affairs thanks Arturo Vargas Bustamante, UCLA Fielding School of Public Health, our theme issue adviser. We were terribly saddened to learn of the death in November 2020 of Leah Zallman, from Harvard Medical School and Cambridge Health Alliance, who participated in our issue planning meeting and is a coauthor of two articles. We thank the California Health Care Foundation, The California Endowment, and Con Alma Health Foundation for their financial support of this issue.

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