Immigrant Access Research Articles

They Call Me George: The Untold Story of Black Train Porters and the Birth of Modern Canada

They Call Me George: The Untold Story of Black Train Porters and the Birth of Modern Canada

Which Integration Policies Work? The Heterogeneous Impact of National Institutions on Immigrants’ Labor Market Attainment in Europe

Can specific policies support the economic integration of immigrants? Despite the crucial importance of this question, existing evidence is inconclusive. Using data from the European Social Survey, we estimate the effects of integration and anti-discrimination policies, alongside social expenditure and labor market regulation, on the labor market performance of 6,176 non-European immigrants across 23 European countries. We make three contributions: 1) we investigate the distinct role of discrete policy areas for labor market integration outcomes, 2) we allow for heterogeneous effects of policies on immigrants with different characteristics, and 3) we examine immigrants’ occupational attainment while accounting for their selection into employment. We find that immigrants’ employment chances are negatively associated with national levels of expenditure on welfare benefits but positively associated with policies facilitating immigrant access to social security. We also find that labor market rigidity is negatively associated with immigrants’ occupational attainment, but we find little evidence that policies aimed at supporting the transferability of immigrants’ qualifications promote their occupational success. Our results strongly suggest that anti-discrimination policies are important for immigrant economic integration. Yet while these policies are associated with greater occupational success for all female immigrants, they seem to be only positively associated with the occupational attainment of higher-skilled and non-Muslim immigrant men. As this article suggests, anti-discrimination policies can foster immigrants’ labor market success, yet these policies currently fail to reach those who face the strongest anti-immigrant sentiments — that is, unskilled male immigrants and Muslim immigrant men.

How the Norwegian population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown.

AimsThe aim of this study was to examine how the Norwegian general adult population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown. We assessed quarantine, symptoms, social distancing, home office/school, work status, social contact and health-care contact through digital access and knowledge.MethodsA cross-sectional survey was performed of 29,535 adults (aged 18–99) in Norway after six weeks of non-pharmaceutical interventions in March/April 2020.ResultsMost participants found the non-pharmaceutical interventions to be manageable, with 20% of all adults and 30% of those aged <30 regarding them as acceptable only to some or a limited degree. Sixteen per cent had been quarantined, 6% had experienced symptoms that could be linked to COVID-19 and 84% practiced social distancing. Eleven per cent reported changes in the use of health and social services. Three-quarters (75%) of those who had mental health or physiotherapy sessions at least monthly before the pandemic reported a reduction in their use of these services. A substantial reduction was also seen for home nursing, hospital services and dentists compared to usage before the non-pharmaceutical interventions. Immigrants were more likely to experience a reduction in follow-up from psychologists and physiotherapy. With regard to the use of general practitioners, the proportions reporting an increase and a reduction were relatively equal.Conclusions The non-pharmaceutical interventions were perceived as manageable by the majority of the adult general population in Norway at the beginning of the COVID-19 pandemic. A substantial proportion of adults <30 years old experienced difficulties with social distancing, and those >70 years old lacked the digital tools and knowledge. Further, immigrant access to health services needs monitoring and future attention.

Barriers to and facilitators of South Asian immigrant adolescents’ access to sexual and reproductive health services in Canada: A qualitative study

Data on immigrant access to sexual and reproductive health (SRH) services in Canada typically focus on adult populations generally but not adolescents specifically. To fill this gap, this study explored South Asian immigrant adolescents’ perceptions of barriers and facilitators for SRH care and services in Edmonton, Alberta, Canada. In this qualitative descriptive study, researchers conducted six focus group semi-structured interviews with South Asian immigrant adolescents who live in Edmonton, Canada. Barriers included fear of stigma and judgment, lack of information about the healthcare system, lack of privacy and youth-friendly SRH services, lack of comprehensive sexuality education, lack of trust of online SRH information, and language barriers. Facilitators included SRH information classes at school, parental support, and provision of free services. South Asian immigrant adolescents expressed their need for more inclusive and relevant sexual health education, more support from parents and teachers with adequate and evidence-based SRH information and effective communication strategies to enhance communication with adolescents, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centered sexual health education at home, in school, and in the community.

The Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California.

The objective of this study was to examine changes in health care access and utilization for White, Asian, and Latino immigrants associated with the implementation of the Patient Protection and Affordable Care Act (ACA) in California. Using the 2011-2013 and 2015-2017 California Health Interview Survey, we examined changes in 2 health care access and 2 utilization measures among 3 immigrant racial/ethnic groups. We estimated the unadjusted and adjusted percentage point changes in the pre-ACA and post-ACA periods. Adjusted estimates were obtained using linear probability models controlling for predisposing, enabling, and need factors. After the ACA was nationally implemented in 2014, rates of insurance increased for non-Latino (NL) White, NL Asian, and Latino immigrant groups in California. Latino immigrants had the largest increase in insurance coverage (14.3 percentage points), followed by NL Asian immigrants (9.9 percentage points) and NL White immigrants (9.2 percentage points). Despite benefitting from the largest increase in insurance coverage, the proportion of insured Latino immigrants was still lower than that of NL White and NL Asian immigrants. Latino immigrants reported a small but significant decrease in the usual source of care (-2.8 percentage points) and an increase in emergency department utilization (2.9 percentage points) after the ACA. No significant changes were found after the ACA in health care access and utilization among NL White and NL Asian immigrants. Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups.

Choose your battles: How civil society organisations choose context‐specific goals and activities to fight for immigrant welfare rights in Malaysia and Argentina

AbstractHow do the goals and activities of civil society organisations (CSOs) that are active in the field of immigrant welfare rights differ between autocracies and democracies? In this paper, we argue that a mechanism of CSO engagement plays out differently in these two political contexts because organisations adapt their goals and activities to the political regime they operate in. In the empirical analyses, we compare democratic Argentina and electoral‐authoritarian Malaysia using data from CSOs' public mission statements as well as from interviews with CSO members from both countries. We find that in Argentina, more universalistic constitutional provisions and commitments to international treaties allowed CSOs to reference norms of equal treatment, arguing for immigrant access to a variety of programmes, including non‐contributory social assistance benefits. In Malaysia, CSOs relied on moral frames of equality to a lesser extent. Instead, they advocated for inclusion in contributory schemes on the basis of deservingness of migrants given their contributions to society, focusing on minimum standards to guarantee that basic needs are met.

The changing credibility of institutions: how household registration systems (hukou) in Mainland China and Taiwan define immigrants’ social benefits

The hukou is one of the enduring institutions that defines social citizenship of residents/immigrants in mainland China. Whilst much discussion has focused on the Chinese case, relatively little attention has been paid to the system in Taiwan, to say nothing of a comparison between the two. This article seeks to enrich the discussion of the two hukou systems in terms of their functions in determining the access of cross-strait immigrants to social benefits in the respective host countries. Drawing on the ‘credibility thesis’, the analytical locus is placed on the continuity and change of institutional functions underlying the apparent persistence of institutional forms. When granting/withholding immigrants access to local social benefits, hukou systems fulfil several functions: firstly, a symbolic dimension, in which immigrants from both sides are (artificially) regarded as citizens of a divided nation rather than two separate countries; secondly, a substantial dimension that defines the scope and extent of social benefit entitlements granted to the immigrants in question; and finally, a management dimension that allows room for considerable administrative discretion in terms of adaptation to various circumstances arising from the unsettled state of cross-strait relations. Often times, realisation of these various functions is compounded by conflicts in identity politics, with repercussions for the generosity/rigidity of social inclusion for cross-strait immigrants. Evidence underpinning the theoretical elaboration stems from the analysis of legal documents regulating the social rights of immigrants in mainland China and Taiwan, supplemented by historical traces of the politics of cross-strait migration. The final findings should shed light on the facilitative/restrictive mechanisms of the hukou regulations in mainland China and Taiwan, highlighting the puzzling phenomenon that both hukou systems are gaining increasing significance in steering the cross-strait migration at a time when their functions in regulating domestic migration are changing, if not waning.

Provider Perspectives on Latino Immigrants' Access to Resources for Syndemic Health Issues.

Latino immigrants to the United States experience disproportionate impacts from the syndemic formed by substance abuse, violence victimization, HIV/AIDS, and mental health (SAVAME). This study characterizes resource access for Latino immigrants living in Philadelphia, as perceived by staff at Latino-serving organizations. An online cross-sectional survey of staff at key Latino-serving Philadelphia organizations assessed access to their organization and citywide access to each type of service (substance use, HIV/AIDS, domestic violence [DV], and mental health) for Latino immigrants. Descriptive statistics for organizational access indicators and citywide access scores across four syndemic domains (availability, accessibility, adequacy, and quality) and by syndemic condition were computed. Organizational access and citywide access across HIV/AIDS (mean = 1.94, SD = 0.83), mental health (mean = 1.37, SD = 0.95), substance use (mean = 1.11, SD = 0.74), and DV (mean = 1.49, SD = 0.97) services were perceived as far from optimal. Domain scores were highest for accessibility (mean = 1.66, SD = 1.03), followed by quality (mean = 1.44, SD = 0.79), availability (mean = 1.41, SD = .81), and adequacy (mean = 1.24, SD = .75). Based on findings from a survey of staff working at Latino-serving organizations, this study highlights the lack of support and resources for Latino immigrants, in particular those related to mental health and substance use. Programs and interventions are needed to improve service delivery in Latino immigrant communities.

Undocumented immigrants’ and immigrant women’s access to healthcare services in the Basque Country (Spain)

ABSTRACT Background Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access. Objective This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). Methods The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals. Results No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing. Conclusions For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women’s possibility to access healthcare services and being undocumented led to restricted access entitlement and to fear rejection at health centres. Therefore, besides ensuring immigrants’ legal entitlement, there is need of promoting rights-based attention to get more inclusive health systems.

The adverse health effects of punitive immigrant policies in the United States: A systematic review.

BackgroundImmigrants in the United States (US) today are facing a dynamic policy landscape. The Trump administration has threatened or curtailed access to basic services for 10.5 million undocumented immigrants currently in the US. We sought to examine the historical effects that punitive laws have had on health outcomes in US immigrant communities.MethodsIn this systematic review, we searched the following databases from inception–May 2020 for original research articles with no language restrictions: Ovid MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), Web of Science Core Collection (Clarivate), CINAHL (EBSCO), and Social Work s (Ovid). This study is registered with PROSPERO, CRD42019138817. Articles with cohort sizes >10 that directly evaluated the health-related effects of a punitive immigrant law or policy within the US were included.Findings6,357 studies were screened for eligibility. Of these, 32 studies were selected for inclusion and qualitatively synthesized based upon four themes that appeared throughout our analysis: (1) impact on healthcare utilization, (2) impact on women’s and children’s health, (3) impact on mental health services, and (4) impact on public health. The impact of each law, policy, mandate, and directive since 1990 is briefly discussed, as are the limitations and risk of bias of each study.InterpretationMany punitive immigrant policies have decreased immigrant access to and utilization of basic healthcare services, while instilling fear, confusion, and anxiety in these communities. The federal government should preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

Migración y fronteras en el gobierno brasileño

While the world experiences a rapid increase in migrations, in many countries nationalist governments with conservative and authoritarian traits are rising to power. Indeed, border enforcement -and even complete frontier closures- have increased around the globe. Brazil is a paramount example of this relentless globalization (Appadurai, 2004). Based on the concept of “border” from Valenzuela (2014b) and García Canclini (2014), this article attempts to provide evidence on some of the Brazilian borders that are capable of generating material and symbolic barriers to the access and integration of immigrants. In Brazil, these barriers have been a state policy at least since Michel Temer took office in 2016, but have been dramatically strengthened during the current administration of Jair Bolsonaro 2019). Within this context, the goal of this article is to develop a reflection that articulates the concept of border with the exacerbated nationalism, particularly present in the political discourse about national security.

Illegality and Healthcare: A Federalist Perspective

With the contemporary rise of mass media, the historically disadvantaged status of the United States’ immigrant and undocumented populations has become increasingly well-known. Perhaps as a result thereof, both major political parties have utilized the United States’ dynamic immigration system as a scepter of justice in the nation’s ethical and political discourse. Despite the polarization that inter-party immigration controversies frequently beget, discussion of the mutually-reinforcing relationship between statutory immigration and healthcare subsidy exclusions is far more meager and thus the subject of our inquiry. Remaining cognizant of the imbricated relationship between the federal government and its state counterparts within the United States’ federalist system, we explore the economic and public health consequences of immigration and healthcare laws which deny many immigrants access to vital social services. As a product of these restrictive state and federal laws, we conclude that many immigrants not only lack meaningful access to primary care, vaccinations, and labor/environmental quality safeguards, but also that the inaccessibility of such social services has detrimental effects on the nation’s aggregate economic health and public health. In response to the deficiencies of the United States’ legal regime vís-a-vís immigration and healthcare, we offer three distinct categories of recommendations, each of which intends to support the economic success and public health security of the greater American populace.

Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties

ObjectivesLockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19–related lockdown on service utilisation and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties. Study designThe design of this study is a retrospective cross-sectional study. MethodsAll patients who visited the mental health outpatient service in the months of February and March in the years 2017–2020 were included in the study. To compare service utilisation before and after the lockdown, the number of patients who visited the mental health outpatient service for psychiatric interview were recorded. Follow-up adherence was calculated as the percentage of patients who visited in February and subsequently attended a follow-up visit in March of the same year. ResultsThe number of patients who visited the outpatient service between February 2017 and February 2020 was continuously increasing. In March 2020, fewer patients visited the service for psychiatric interview, in line with the introduction of lockdown measures. In addition, the number of the patients who visited in February 2020 and returned for their follow-up visits in March 2020 declined from approximately 30% over the same months in 2017–2019 to 17.53% in March 2020. ConclusionsThe lockdown-related reduction in numbers of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.

Health service utilization in immigrants with multiple sclerosis.

Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus long-term residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent. However, immigrants had higher rates of hospitalization during the diagnosis year (ARR 1.20, 95% CI: 1.04-1.39), and had greater use of outpatient neurology (ARR 1.17, 95% CI: 1.12-1.23) but fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the first post-diagnosis year, immigrants continued to have greater numbers of outpatient neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94). Overall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis. Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation.

Federal and State Policies Affecting Immigrant Access to Health Care.

Federal and State Policies Affecting Immigrant Access to Health Care.

Ventanillas de Salud: Defeating challenges in healthcare access for Mexican immigrants in the United States

The 2010 Affordable Care Act (ACA) improved access to healthcare in the United States. However, immigrants —especially those undocumented— still faced difficulties, which have increased during the Trump administration. In order to bring access to health services to its nationals, the Mexican government has implemented the Health Windows Program (Ventanillas de Salud, or VDS). The article reviews changes in the U.S. healthcare system from the ACA to date, and assesses the role of VDS. The methodology is qualitative, consisting of a literature review, interviews with community leaders and Mexican government officials, and questionnaires sent to four VDS: Arizona, Florida, Idaho and Texas. Results show that VDS provide reliable and affordable access to basic healthcare services, and detection of chronic and non-communicable diseases, especially within undocumented immigrants. Public policy recommendations are offered based on these findings. Limitations of the study include the data collected, which is non-representative of all VDS.

Climate of Fear: Provider Perceptions of Latinx Immigrant Service Utilization.

Latinx immigrants endure stressors throughout the immigration process that detrimentally impact their health and wellbeing. Yet, they also face substantial barriers to accessing and utilizing services. These barriers might be heightened under the Trump administration, which has implemented policies facilitating increased immigration enforcement and punitive immigration practices. This study utilizes data collected from providers who serve Latinx immigrants in the border state of Texas to better understand current immigrant service utilization behaviors. Individual interviews and focus groups were conducted shortly after the last presidential election to inquire about recruitment, retention, program completion, and resources to address key client risk factors. Applying grounded theory analysis strategies, interviews, and focus group recordings were coded for key themes. Data demonstrated central concerns held by providers serving immigrants, and especially those who are undocumented or in mixed-status families. Concerns were related to the following three themes: (1) undocumented immigrant stressors, (2) limited resources for undocumented immigrants, and (3) service utilization barriers. Lack of services for undocumented immigrants and fear related to service utilization were prominent subthemes. These findings extend our knowledge of stressors and barriers of access and utilization for immigrants during this time period of increased immigration enforcement which have valuable implications for practice and future research. Providers can take concrete actions to educate immigrants, regardless of documentation status, on how their clients' identities will be protected. In addition, intentional trust-building strategies are essential to help overcome fear of utilizing services. Future research should ascertain perspectives of immigrant families, as this study drew perspectives only from providers.

Labor market impacts of states issuing of driver's licenses to undocumented immigrants

Over the last years several states have enacted policies granting undocumented immigrants access to driver's licenses. We exploit the state and temporal variation in the issuing of state driver's licenses to undocumented immigrants to estimate their impact on labor market outcomes. Using 2005 through 2017 data from the American Community Survey, we show that likely undocumented men increase their weekly hours of work in response to the availability of driver's licenses. Perhaps due to their already high labor force participation, the impact is somewhat moderate. We also find no similar impacts among similarly skilled foreign-born Hispanic men who have naturalized. The policy slightly raises commuting time, suggesting changes in work patterns, as well as likely undocumented immigrants’ propensity to have an occupation that requires driving. At a time when anti-immigrant sentiments are at an all-time high, understanding how these policies impact targeted groups and similarly skilled citizens is crucial for maintaining an informed immigration policy debate.

Licensing the Insured: Providing Driver Licenses to Unauthorized Immigrants Has Not Impacted Auto Insurance in California

A key argument for providing unauthorized immigrants with driver licenses is that such policies are expected to increase auto insurance uptake and lower premiums. The paper tests this expectation in the context of California's Assembly Bill (AB) 60, which gave about 2.6 million unauthorized immigrants access to driver licenses. Exploiting cross-county variation in the estimated share of AB60 licenses, we find that even though more than one million licenses have been issued under AB60 to date, the policy had no measurable effects on the share of uninsured vehicles or automobile insurance premiums. A power analysis and multiple robustness checks corroborate this conclusion. This result suggests that most newly licensed unauthorized immigrants were already driving an insured vehicle prior to the reform. In a highly car-dependent society, they had no choice but to drive even when it was illegal. Our research provides important insights about the behavior of one of the most marginalized populations in the United States and revisits prominent claims about how to improve auto insurance rates and premiums.