To achieve health equity, we need systemic changes that will foster greater social, economic, and civic inclusion of immigrants and their families.
A conceptual illustration of a family getting lifted up in a hand, indicating a supportive gesture. Photo Credit: MHJ/iStockPhoto
More than 46 million first-generation immigrants now live in the United States and one in four children have at least one immigrant parent. The wave of immigration that brings some one million individuals to this land every year shows no sign of cresting. With their determination, drive, and multitude of talents, immigrants and their families offer gifts that can strengthen our communities and nurture a more diverse, vibrant society.
Yet too many of our systems and structures are failing to promote the social, economic, and civic inclusion that would allow them to thrive. As a child of parents who left Taiwan to start a new life in the U.S., I have seen the challenges of being an outsider firsthand. Like so many other immigrants, my parents did not know what services, benefits, and supports were available to them, nor how to navigate the settings in which that information was housed. Their instinct was to keep their heads down and find their own way amidst the systemic barriers that stood in the way of their ability to thrive.
Health Equity is Our Focus
At RWJF, we want to dismantle the barriers that prevent everyone from having fair and just opportunities to lead the healthiest possible life. We believe that can only happen through policies that confront structural racism and advance equity and justice. Our investments take aim at the root causes of health inequities, which means putting striving populations at the center of our grantmaking. Centering immigrant families is important in our work to ensure our grantmaking is responsive to the needs and aspirations of communities most impacted by structural racism. In a society that struggles with the myth of a zero-sum game—the assumption that what is given to one must be taken from another—these populations are all too often cut out of opportunity, regardless of their legal status.
This is strikingly evident in measures of health insurance. Noncitizens are four times as likely to be uninsured compared to citizens (39.2% versus 9.8%), primarily because complex restrictions are placed on their ability to secure public benefits and employer-sponsored coverage leaves yawning gaps. An extensive body of evidence tells us that people who are uninsured have less access to care, fewer preventive services, and less timely treatment for chronic conditions.
Such inequities reflect a faulty narrative that suggests some people belong in this country while others do not. That sense of “othering,” fostered by those long accustomed to dominance, breeds contention, opens the door to explicit violence, and ultimately weakens the social fabric. Rather than celebrating the pluralistic society at the aspirational core of America, public figures are increasingly using divisive language and exclusionary policies to tighten their hold on power. By stirring up animosity against all immigrants, whatever their origin story and length of time in this country, they willfully threaten and disadvantage the health and wellbeing of large swaths of the population.
Seeking Researchers to Study Policies that Support Immigrant Families
In 2024, RWJF’s Policies for Action program is investing in transformative research to change that. There already exists a lot of important research exploring the chilling effect of restricting access to public benefits and the impact of incremental reforms, such as reconfiguring the Supplemental Nutrition Assistance Program (SNAP). Our goal here is more ambitious: we want studies of innovative policies designed to overhaul systems and structures in order to advance full social, economic, and civic inclusion.
Some municipalities and states have already implemented policies that offer immigrant families more equitable access to goods and services, and we want to know how well they are working and what the impact of scaling up those strategies might be. We are also interested in research that simulates policies under consideration or advances entirely new ideas that can be evaluated with equity-oriented processes and methodologies. Cross-sectoral approaches are of particular interest because immigrant families intersect with a wide range of systems, including early childhood care and education, healthcare, social services and safety net programs, affordable housing, civic engagement, and legal and financial services.
Community Insights Lead Research
It is a vital part of our work to have affected communities take the lead in designing this research because they bring an intimate understanding of the challenges associated with being an immigrant in America. That emphasis is part of RWJF’s priority effort to shift health science knowledge-building techniques so that they are more inclusive. The dominant norm of academic-based research, rooted in Western traditions and assumptions, too often excludes other culturally relevant ways of knowing and limits the view of where expertise lies. We think we will get better solutions if we bring a multicultural lens to the work, one that values the wisdom and knowledge of those who are most proximate to the issues under study.
In these ways, the research field can identify evidence-based models that advance racial and health equity, demonstrate respect for different cultures, and build on community-defined ideas about what it means to be healthy. Bold policies like these help the nation thrive by supporting a strong social fabric in which all members can realize their full potential.
Visit Policies for Action to see how research evidence identify ways for more people in our pluralistic society to have opportunities for health and wellbeing.>>
About the Author
Christine Fu joined RWJF in 2021 as a senior program officer in the Research-Evaluation-Learning department. She is excited to marry her passion for generating evidence and how it informs policy and practice with RWJF’s mission to build a Culture of Health in the U.S.