Immigration

The DC metropolitan area has the seventh highest number of foreign-born residents among all metropolitan areas in the U.S.; nearly one in every four residents is an immigrant (24%), compared to 13% nationwide. Immigration status is complex, and not all immigrants have the same backgrounds, experiences, opportunities, or pathways to citizenship. Residents who entered the country without documentation, or those who remained after their status expired, do not hold legal status. Immigrants who entered the country legally have documentation granting them permanent or temporary status. Residents holding refugee status, asylum, and other protected statuses were granted legal admission due to violence, war, persecution, or extraordinary conditions in their home countries, and may be eligible for certain services through the Office of Refugee Resettlement. Some immigration categories enable individuals to work and/or permanently reside in the U.S. and apply for a green card. Although green cards provide a pathway to citizenship, even green card holders do not have the same access to public benefits as U.S. citizens, and unlike citizens, may become deportable under certain circumstances. As immigration statuses vary widely within communities and even families, it is a mistake to make assumptions or generalize about immigrant populations.

 

Immigration is a lived experience that can directly impact health due to the complex interplay of conditions in a country of origin, during migration, and in the destination country. Exposure to trauma in a home country and during travel, family separation and reunification, and adjustment to a new language, culture, and environment are a few examples of the many major stressors that immigrants living within the region may experience. Once in the United States, immigrants are more likely to experience unsuitable or unsafe housing conditions, exploitation or discrimination in the workplace, poverty, and malnutrition than native-born citizens. Social and emotional isolation and upticks in public displays of anti-immigrant sentiments may directly impact health, in addition to creating reluctance to seek assistance. Undocumented and mixed-status families may experience these and additional stressors, such as fear of deportation.

 

In the United States, immigration status also determines access to publicly funded health coverage, income support and other entitlement programs. Undocumented immigrants are not eligible for Medicaid, the Children’s Health Insurance Program or federally subsidized health insurance under the ACA. Undocumented immigrants are additionally barred from purchasing insurance plans available through the state and federal health care exchanges. Proof of income, state residency  and immigration status are requirements for Medicaid and CHIP eligibility. Even many lawfully present immigrants must have established residency in the US at least 5 years before becoming eligible for entitlement programs or subsidized health insurance.

 

To learn more about immigration as a determinant of health in this region, check out the resources below.

Immigration Status as a Social Determinant of Health

The Brookings Institute has identified the Washington metropolitan area as a new immigrant gateway. Immigration status is a key determinant for mental and physical health, leading to inequities between documented and undocumented immigrants, as well as between immigrant and non-immigrant populations. It is important to understand the characteristics of the region’s immigrant communities in order to better address their needs. In this briefing paper, the Consumer Health Foundation and La Clínica del Pueblo offer a profile of immigrant health in DC, Maryland, and Virginia, including:

  • State-level immigrant demographics, workforce, income and poverty data, and data on the undocumented immigrant population.
  • A case for integrating the experience and needs of immigrants into a community-based service delivery model.
  • A description of local, state, and national policies affecting immigrant health in the region.
  • Policy gaps affecting access to health care and immigrant health outcomes.

DMV Youth Summit Report

As outlined in a 2015 report by the Migration Policy Institute, unaccompanied youth fleeing violence in the Northern Triangle have been arriving to the United States in greater numbers. At least 9,000 children seeking refuge were resettled with family members in the DC metropolitan area between 2014 and 2016. In April of 2016, the DMV Coalition for Youth Seeking Refuge hosted a regional convening of newcomer immigrant youth from Central America and Mexico to address issues related to education, employment, discrimination, bullying and gangs, as well as family and community support systems. The report includes:

  • Social and political context of Central American youth migration
  • Highlights from youth discussions
  • Programmatic recommendations for schools, educators and providers who work directly with immigrant youth and families
  • Systemic recommendations for government officials and advocates who influence policy, particularly at the local and state levels
DMV Youth Summit REPORT_Our Voices Our Future-1 copy

Hispanics, Immigration and the Nation’s Changing Demographics

Hispanics comprise the largest population of minority groups in the United States. While Mexicans make up the largest share of the immigrant population nationally, the largest share of the immigrant population in the DC region belongs to Salvadorans. Ana Gonzalez-Barrera, a senior researcher at the PEW Research Center, presented new statistics on Latino immigrant trends at the 2016 Regional Conference on Advancing Health Equity for Latino Youth and Families. View slides for the following data:

  • Historical immigration trends
  • Current national trends
  • A profile of the Latino electorate
  • Geographic dispersion of the US Hispanic population

Immigrant Child Health Toolkit

Since 2010, more than 30,000 children under the age of 18 have immigrated to the National Capital Region, according to the 2011-2015 American Community Survey (ACS) 5-year estimates. While individual experiences differ, recently arrived children are more likely to have experienced stressors and other social determinants that lead to unique health issues. Furthermore, immigrant children from some countries may not have undergone the same health screening or received the same immunizations as U.S.-born children. They may also have been exposed to diseases not common in the United States. The DC Chapter of the American Academy of Pediatrics has developed a toolkit for medical providers in DC, Maryland, and Virginia caring for recently arrived immigrant children. The toolkit provides valuable information on:

  • Clinical guidelines
  • Education, mental health, and social services
  • Immigration legal services, language services, and interpretation
  • Access to public benefits

The Immigrant Population in the Washington, DC Region and the Service Needs of Central American Child and Family Migrants

While the growth of the total immigrant population in the National Capital Area has slowed since 2010, the size of the population is still growing. Half of the region’s foreign-born population lives in Fairfax or Montgomery counties, and two-thirds of the region’s undocumented immigrants live in Fairfax, Montgomery, or Prince George’s counties. Furthermore, 10% of the unaccompanied children who entered the United States between FY14-FY16 were released to sponsors in the National Capital Area. Randy Capps, Director of Research for U.S. Programs at the Migration Policy Institute, presented new statistics at the 2016 Regional Conference on Advancing Health Equity for Latino Youth and Families. View slides for the following data:

  • Immigration trends in the Washington metropolitan region
  • U.S. trends in family unit and unaccompanied child apprehensions
  • Immigration court outcomes for unaccompanied children and families

Regional Conference on Advancing Health Equity for Latino Youth and Families

In 2016, RPCC partnered with the Avance Center for the Advancement of Immigrant/Refugee Health and the Metropolitan Washington Council of Governments to host the Annual Latino Health Disparities Conference. The conference addresses health disparities affecting Latino immigrant communities, with the goal of sharing emerging research, best practices, and community perspectives. Check out the Conference webpage for materials from the most recent and past conferences, including agendas, event summaries, and videos of sessions:

  • Keynote by Armando Trull, Senior Reporter for WAMU and NPR contributor; remarks from Claudia Ivette Canjura de Centeno, Ambassador of El Salvador
  • National and local immigration statistics
  • Regional perspectives on social determinants of health
  • Determinants of health including trauma, education, healthy food and beverages, safe and affordable housing, and positive youth development
  • A screening of “Living Undocumented”, introduced by filmmaker Tatyana Kleyn, PhD, MA and discussion with a local youth
  • “Unaccompanied,” a photojournalism exhibit by local artist Oliver Contreras, featuring images and voices of unaccompanied youth

How DACA Affects the Health of America's Children

Deferred Action for Childhood Arrivals (DACA) has awarded temporary work permits and protection from deportation to undocumented young adults who were brought to the United States as children. It covers nearly 800,000 immigrants, many of whom now have children of their own. The DACA program has led to dramatic improvements in the mental health of children born to immigrant parents, reducing anxiety disorders by more than half, compared to children born to DACA-ineligible parents.

Header photo credits: Katie Yaeger Rotramel/Flickr