The barriers obstructing immigrants and the diaspora population from adequate access to healthcare go beyond mere policy. They are a melting pot of policy restrictions, bureaucratic hurdles, systemic discrimination, and fear. And with the unprecedented international migration that has been occurring in recent years these policies and hurdles have become cumulatively more prevalent. This is extremely concerning not only on an ethical standpoint, but also in terms of general public health, social inclusion, economic impact, the policy landscape, and more.

Image Credit: George Dagerotip from Unsplash

Policy Level

There are multiple levels for the barriers to healthcare regarding undocumented immigrants, starting with the policy level, then the health care system level, and then the individual level.

On the policy level exists exclusionary eligibility criteria: this means that policies frequently restrict access to social services--housing, food assistance, health insurance, etc.--based on immigration status or length of residence. Permanent residents are frequently required to wait months / years before qualifying for public healthcare (e.g. in Canada a 3-month waiting period is imposed before immigrants can access public health insurance), discouraging immigrants from preventative care and increasing reliance on emergency services. These residency and waiting period requirements may lead to immigrants not seeking healthcare out of fear of putting their immigration process into jeopardy.

Image Credit: Jason Leung from Unsplash

This fear can similarly exist because of criminalization and enforcement policies--harsh enforcement (i.e. ICE raids, detention policies) may cause immigrants to avoid hospitals due to fear of deportation even in urgent circumstances. This fear may be amplified because in some countries healthcare providers are legally obligated to share patient information with law enforcement.

Whittled down to the core, immigrants have limited political voice, which leads to policies that are put in place but do not reflect immigrants' needs or protect them adequately. An example of this is how immigrant labor is often essential but unprotected--policies time and time again allow immigrants to be exploited by failing to enforce proper labor laws or by excluding certain categories of immigrant workers from the ones that they do impose (undocumented, guest workers, etc.).

Take the Quiz: Which KPop Demon Hunters' Huntrix Member Are You?

Are you the chaos on stage or the calm in the storm? Let’s find your Huntrix twin.

Healthcare System Level

Image Credit: Luis Melendez from Unsplash

Meanwhile on the healthcare system level, barriers obstructing immigrants and diaspora populations often arise from how care is structured, delivered, and accessed--regardless of what policies exist on paper. For instance, language and communication barriers--an immigrant patient may inevitably misunderstand dosage instructions or miss follow-up appointments due to unclear language.

Similarly, there may be cultural incompetency and/or bias wherein health professionals misunderstand or fail to respect cultural health beliefs, leading to a lack of trust on the patient's side. Navigation challenges could also exist, where refugees or recent arrivals may be unaware of how to find a primary care provider or how to guide themselves through a new healthcare system.

And, perhaps most importantly, many immigrants are ineligible for public health insurance programs. Medicaid, Affordable Care Act (ACA), Children's Health Insurance Program (CHIP)--there isn't anywhere for undocumented immigrants to turn to for insurance because they are excluded from all three. And these examples are limited only to the US--more countries including the US, European nations, Scandinavia, Canada, and Costa Rica, have all implemented a range of policies that limit access to healthcare in some form.

In the European Union, policies that limit undocumented immigrants' access to health care are also widespread and vary substantially--ranging from denying all access to providing limited access to emergency and preventive care. For example, some policies do not include a follow-up for tubercuolosis, HIV/AIDs, low immunization rates, and untreated mental health issues, leading to not only individual immigrants' health worsening but also a negative effect on general public health.

Individual Level

On the individual level, barriers root from personal, social, or psychological challenges that interact with the healthcare and policy issues.

It's the individual constraints that immigrants face--for instance, many of them work long hours, multiple jobs, or are unable to get paid leave. This leaves them unable to make doctor's appointments because they aren't in the position where they can afford to miss a shift or lose income. In this vein, even minor healthcare costs may be daunting for them--prescriptions, transportation, follow-up visits, etc.--and make it difficult for them to take necessary prescriptions and treatments. Additionally they might struggle from generational experiences of discrimination, trauma, or abuse from medical systems that can lead to mistrust.

Image Credit: Christina Victoria from Unsplash

A combination of these factors--or perhaps something else entirely--may cause immigrants to delay their own visits to the hospital and restrict their own access to healthcare. And while their reasons for this are understandable, it just leaves them all the more vulnerable to worsening health outcomes, untreated conditions, and preventable complications. Over time, this cycle of avoidance and limited access can widen preexisting disparities and contribute to that gap in health inequity.

Image Credit: Pablo Merchán Montes from Unsplash

Public Health Risks

These many barriers in place for immigrants culminate not only in risking the health of individual immigrants: they impose a potential risk to the general public health. When individual immigrants face difficulty accessing care, it can lead to delayed treatment for infectious diseases, chronic conditions, and mental health issues that could boil down to augment their spread and severity within the community. When early intervention is inaccessible untreated uncommunicable diseases can circulate more easily, and unmanaged chronic illnesses can lead to preventable emergencies that strain healthcare systems.

Mental health challenges left unaddressed can also stack on top of each other and result eventually in broader social outcomes, including increased rates of homelessness, substance use, or crisis-level care. In this way, individual barriers compound into systemic vulnerabilities--resulting in the healthcare level and policy levels.

Equitable healthcare access is not only a moral or ethical imperative: it is also a public health necessity. Addressing healthcare disparities is not just about supporting immigrant communities, which is something policy makers need to understand: closing this health equity gap will contribute to erecting a healthcare infrastructure that will eventually serve everyone more effectively and justly.