Immigrants and Undocumented People Face Significant Health Challenges in the United States | 2024 ATS

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For many immigrants, the challenges do not stop after they arrive in the United States. A panel of experts moderated by Fernando Holguin, M.D., MPH, at the 2024 American Thoracic Society (ATS) conference in San Diego today discussed specific health issues in immigrant and undocumented populations, situations that increase vulnerability, the logistical issues by state and what can be done to fix them.

Access to mental health services is one of the most overlooked health issues for this population, according to Denisse Rojas Marquez, M.D., MPP, an emergency room resident physician at Boston Medical Center. She is also the co-founder of Pre-Health Dreamers, an organization that supports immigrants interested in working in healthcare. Marquez grew up in California as an undocumented immigrant.

“Having focus groups with immigrants, and honestly, from my own personal experiences, one thing that was so salient was the amount of trauma that they faced, from their home country to their journey to the United States to the stigma of being a new immigrant or undocumented or even a long-term immigrant and still having to face discrimination,” she said.

There are many reasons why immigrants are discriminated against, one being the misconception that they bring diseases from their home country, Marquez said.

“It's easy to document the increased burden of occupational diseases and fatalities among immigrants,” according to Marc B. Schenker, M.D., MPH, professor emeritus of Public Health Sciences and Medicine at the UC Davis School of Medicine, another guest speaker. “If you look at the Bureau of Labor Statistics Census of fatal occupational injury, the rate for immigrant workers is 25%.”

“The idea of these infectious exposures is not that people are bringing this with them, but actually the conditions of migrations to which they're exposed because of the structures and systems that we have, are actually worsening these risks,” Julie M. Linton, M.D., FAAP, immediate past chair of the AAP Council on Immigrant Child Health, said during the discussion.

Many undocumented people take unsafe jobs to make ends meet and may find it difficult to advocate for safer working conditions. The top three jobs held by immigrants are jobs in construction, transportation and agriculture, all of which pose health risks.

“I think they consider it a part of the work,” Schenker said. “They're not provided respirators; they're not provided training safety - they're not aware of the risk.”

Undocumented immigrants are not currently able to purchase healthcare through the Affordable Care Act and are ineligible for Medicaid. If someone has certain forms of lawful status such as refugee status or asylum status, they may be eligible but may be subject to a five-year waiting period, depending on the state. Twelve states including California, Utah and Illinois cover children, regardless of immigration status through state funding. For these reasons, Linton said providers must be aware of state policies.

“What we need is immigration reform and more humane policies at the federal level, which could easily make [inequalities] go away,” Marquez said. “I think the solution to how to improve the health of immigrants is right here, literally right here in this room. That, for me, has been empowering.”