Two Keys to Advancing Health Equity for Immigrants 

I was in a California middle school when I discovered something amazing: voting matters. My awakening began when a Board of Elections booklet arrived in our family’s mailbox. I read every page, captivated by the detailed description of candidates running for City Council, local judgeships, and municipal, state and federal offices, and by the ballot initiatives that gave citizens a direct say in policies with far-reaching consequences.

None of this might have surprised my peers, but my parents had never told me they were entitled to participate in the civic life of their adopted country. Naturalized American citizens who had emigrated from Taiwan, they did not quite feel entitled to the same rights as those who had been born here. In their homeland, government is highly centralized, and policymaking happens far from the communities affected by it. They didn’t understand how democracy worked at the local level and feared that taking a political stand could lead to a backlash against the broader Asian community. Their impulse was to keep their heads down.

Why Civic Engagement Matters to Health and Wellbeing

My own personal and professional journey taught me something very different: democracy is closely tied to health and wellbeing, and we need to show up for it. Participation can take many forms. When we run for the school board, volunteer on parks and library committees, or speak out at land-use meetings, we can influence decisions that make our communities more inclusive and equitable. When we encounter racism and name it, we make it harder for our political and business leaders to look away.

As part of its own efforts to dismantle systemic racism, the Foundation has been taking a closer look at some of the issues that affect immigrant populations. Immigrants make up 15 percent of the U.S. population and one-quarter of children in this country have at least one immigrant parent. Regardless of their legal status, immigrants are more likely to live in poverty, are less likely to have health coverage or access to safety net programs, and are rarely represented adequately in decisionmaking bodies. The language and cultural barriers that discouraged people like my parents from becoming politically active persist.

But changes are underway, galvanized in part by the recent rise of anti-immigrant rhetoric and policies. Like me, many children of immigrant parents are refusing to be marginalized, choosing instead to become more visible at every level of civil society and to join in the process of shifting power. Our parents are stepping up as well, recognizing that silence makes their experiences easier to ignore. It took mine many years to recognize the value of the vote, but they finally cast their first ballots in the last presidential election. Immigrants now represent 10 percent of the nation’s electorate, and as more municipalities allow noncitizens to vote in local elections and provide access to ballots in other languages, they are becoming an increasingly potent political force.

The Foundation has been building its network of ties to advocacy groups working to bring immigrants into the civic life of their communities, such as the National Immigration Law Center (NILC) and UnidosUS. Our recent support of Protecting Immigrant Families, a coalition of more than 700 local, state, and national partners, helps to promote collaborations among immigrant rights groups and health and human service organizations. Importantly, coalition members are taking the lead in conducting formative research to understand how best to approach outreach, education, and engagement with immigrant families. At the Foundation, we are listening closely to their bottom-up conversations as they consider who should be at the table, and what kind of data should be collected, to further those aims.

Learning at a Granular Level

Our partners also have a lot to teach us about how community should be defined. Respecting intersectionality is key, because immigrant groups are multi-dimensional, shaped by race, ethnicity, language, place of origin, drivers of emigration, socioeconomic realities, disability, duration of their time in the United States, and much more. We can’t just talk about Black communities, but need to distinguish between the experiences of recent arrivals from Africa and those of African Americans whose ancestry traces back to slavery. People of Asian origin likewise hail from diverse settings and have widely varied histories in the U.S.—some are fleeing recent violence, others carry the burden of intergenerational trauma, and still others entered under special immigration policies designed to attract highly skilled labor.

When we generalize them we lose the nuance needed to inform action. Sweeping statements about the health and wellbeing of Asian American Native Hawaiian and Pacific Islanders (AANHPI) as a group, for example, offer limited insights at best. An analysis by the Pew Research Center found that Asians are disproportionately represented in both the top and bottom 10 percent of income groups, which limits the value of data that reports average incomes. To overcome a yawning deficit in the evidence base, gain a more representative picture of health, and conduct analyses informed by an equity lens, we need to disaggregate data to the right level of detail. Ensuring open public access to data is a further equity move, ensuring that the information and knowledge needed to drive change is widely shared.

RWJF has been considering these issues since establishing the first-of-its-kind National Commission to Transform Public Health Data Systems, whose recommendations reimagine how data are collected, shared, and used, and also identify the types of investments needed to advance health equity. The Commission put equity at the center of an overhauled data infrastructure and called for measures that are intentionally designed to capture structural racism. In response, the Foundation allocated $10 million to promote data disaggregation that goes beyond broad racial and ethnic categories, and an additional $40 million to catalyze other steps to modernize public health data systems.

I’m excited about that kind of work and inspired by the ferment of activities in immigrant communities. Civic engagement and open, actionable data are the seeds for building and bridging what we call social capital—the connections, resources, and values within and across communities that promote cooperation and reciprocity. By measuring what we value and applying that knowledge to help set the policymaking agenda, we can assert our power to make systems change. Immigrants are a critical link in the chain making that possible.

Explore this series that delves into the many innovative ways that states can expand healthcare coverage to immigrant communities.
 

About the Author

Christine Fu is a senior program officer in the Research-Evaluation-Learning department who brings her passion for evidence that informs policy to the mission to build a Culture of Health.