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Immigration Status as a Barrier to Healthcare and Well-being: Migrant Stories in the Rural South

 

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The United States foreign-born population totals 46 million people, the largest globally. While 53% are naturalized citizens, the other nearly 47% hold a migrant status (1). While this number is the highest it has ever been, migration to the United States is not new and has long been the source of economic and population growth nationally. Several US presidents have stated that this is a nation of immigrants. Even former president Donald Trump, who has campaigned on tightening immigration laws, is married to an immigrant. However, as the 2024 presidential elections near, immigration continues to be hotly debated on the public stage, and hostilities toward and fear among immigrants continue to rise. In addition to the sociopolitical environment that immigrants must navigate in the US, there exists a complicated and often inaccessible system that must also be navigated: healthcare. Immigration status in the US serves as a barrier to health and well-being since it often exacerbates preexisting structural barriers such as language of services and materials, insurance access, costs and payment methods, and proximity to care.

Access to Social Programs and Childhood Healthcare

Andrea Williams-Morales grew up as the immigrant daughter of migrant farm workers who moved from state to state to follow crop seasons. In her interview for the Southern Oral History Project (SOHP) she recounts that when she asked, her mother did not recall having health insurance or taking her daughters to yearly checkups or the dentist when they were young. Williams-Morales herself states: “As far as medical, I think the only time we went to go see a doctor/provider was if we actually were, I mean, sick, sick, sick, sick, sick” (2). Consistent preventive care and checkups are critical to early detection of health problems, updating vaccinations, and health literacy. Ms. Williams-Morales’ story is not an anomaly though. In a 2017 study using the Los Angeles County family and neighborhood survey data to observe the relationship between parent and child immigration status and healthcare coverage and use, findings showed that children of immigrant parents had higher uninsurance rates than citizen children of citizen parents. This statistic was highest among unauthorized children of unauthorized mothers. Additionally, the same subgroup was less likely to have had a dental visit than children in the other categories within the last year (3). Williams-Morales, who now works as an administrative assistant at CommWell Health in Dunn NC, attributes uninsurance to the fact that many minorities do not know how to access healthcare and social programs related to healthcare.

“Unfortunately, even to this day, there are a lot of minorities that don’t know how to get access to healthcare, and the opportunities that are out there for access to healthcare, like Medicaid, WIC, slide-fee scale, kind of like what community health centers like us do, so it’s a lot of that education, that awareness. My parents, unfortunately, didn’t have the education. They were not aware.”

Many of these programs, however, only apply to immigrants with documentation, and out-of-pocket healthcare costs are incredibly high. Even with sliding-scale fees, low-income patients may not prioritize regular healthcare unless they are noticeably sick due to other monetary obligations, even if preventative care may save long-term healthcare costs.

Access to Consistent Care

Similarly, Claudia Garrett is the daughter of migrant farm workers (though she was born in the US) who moved between North Carolina and Florida to follow crop seasons. While she discusses having an overall positive experience with the healthcare system, she does not remember her parents going to the doctor for their care (4). However, an important aspect of her childhood healthcare is rooted in her identity. As a migrant farm-working family, constant movement between states meant constantly changing primary care. Garret states:

“It affected greatly, because going back and forth, you always saw a different doctor, so you didn’t really have that contact with that one particular doctor that knew your history and that knew what was wrong with you three months ago.”

Constant mobility severely limits access to health services partially because, upon arrival to  the new state, migrants may lack sufficient knowledge about available services. Moreover, within a larger community of seasonal farm workers, there are very few long-term residents to guide newcomers to available services. The public health review echoes Garret’s sentiments regarding the strain of internal migration on the doctor-patient interaction by explaining that it “makes follow-up care (e.g., from a cancer screening) and long-term care (e.g., for tuberculosis or diabetes) difficult to provide” (5)

Access to Reliable Language Interpretation

However, even after accessing care, many immigrants face an additional barrier: language. Ysaura Rodriguez, another interviewee in the SOHP discusses how while living in Florida, despite the state having a large Hispanic and immigrant population, there were rarely interpreters at the hospital. When her son got sick she struggled to communicate with the doctors or understand what was happening since she did not speak much English at the time.

“I don’t remember that there were many people that could interpret. Sometimes a nurse or — I don’t remember any doctors that were able to speak Spanish” (6).

Even in hospitals with doctors who speak the necessary language, without professionally trained interpreters, the quality of care is inferior and contains more errors (7). Ysaura’s story brings to light another significant concern: if this disparity is still occurring in places where the language requested is widely spoken, what must it be like in locations where it is not? Moreover, Spanish is the second most spoken language in the United States, yet Latinx immigrants still face complications. What must it be like for immigrants who speak less common languages?

Broader Implications

The stories recounted by Andrea Williams-Morales, Claudia Garett, and Ysaura Rodriguez explore the realities of Latinx migrants in rural North Carolina. However, they also offer a glimpse into a much broader issue, that failure to address the healthcare needs of all people is a critical human rights concern. Beyond the humanitarian concerns there also exist economic and public health consequences. Agriculture is the most important industry in North Carolina, and foreign-born farm workers (mostly from Mexico) constitute 68% of the agricultural workforce (8). The USDA found that “roughly half of hired crop farm workers lack legal immigration status”(9). The very people who build the state’s economy cannot reap its benefits, having been disqualified from Medicaid and other public welfare services. Thus, by failing to prioritize the health of immigrants, the US food system is also placed at risk. Pressingly, the COVID-19 pandemic not only widened existing disparities but also highlighted the importance of “essential workers” to the fabric of society. Immigrants are more likely to be “essential workers” in the US economy demonstrating that they are both more at risk of being exposed to health hazards while also being crucial to the insurance of public health (10). Healthcare for only a portion of society jeopardizes well-being of all of society.

References

  1. Bureau, US Census. “New Report on the Nation’s Foreign-Born Population.” Census.Gov, 16 Apr. 2024, www.census.gov/newsroom/press-releases/2024/foreign-born-population.html#:~:text=According%20to%20a%20new%20report,the%20total%20population.
  2. Williams-Morales, Andrea. Interview with Katz, Madelaine. 23 July 2019 (Y-0137). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
  3. Ybarra, Marci, et al. “Health insurance coverage and routine health care use among children by family immigration status.” Children and Youth Services Review, vol. 79, Aug. 2017, pp. 97–106, https://doi.org/10.1016/j.childyouth.2017.05.027.
  4. Garett, Claudia. Interview with Ramirez, Joanna. 25 June 2018 (Y-0023). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
  5. Arcury, Thomas A., and Sara A. Quandt. “Delivery of health services to migrant and seasonal farmworkers.” Annual Review of Public Health, vol. 28, no. 1, 1 Apr. 2007, pp. 345–363, https://doi.org/10.1146/annurev.publhealth.27.021405.102106.
  6. Rodriguez, Ysaura. Interview with Ramirez, Joanna. 29 June 2018 (Y-0044). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
  7. Flores, Glenn. “The impact of medical interpreter services on the quality of Health Care: A Systematic Review.” Medical Care Research and Review, vol. 62, no. 3, June 2005, pp. 255–299, https://doi.org/10.1177/1077558705275416.
  8. “National Agricultural Workers Survey 2019-2020 Selected Statistics.” Farmworker Justice Fact Sheet, Farmworker Justice, June 2022, www.farmworkerjustice.org/wp-content/uploads/2022/06/NAWS-data-fact-sheet-FINAL.docx-3.pdf.
  9. USDA. “Farm Labor.” USDA Economic Research Service, US Department of Agriculture, 7 Aug. 2023, www.ers.usda.gov/topics/farm-economy/farm-labor/#:~:text=Roughly%20Half%20of%20Hired%20Crop,declined%20to%20about%2040%20percent.
  10. United States, Congress, Joint Economic Committee, and Don Beyer. Immigrants Are Vital to the U.S. Economy, 2022.

 

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