As the debate over immigration reform heats up, a number of contentious issues are front and center – including competition over jobs, border security, and the very meaning of U.S. citizenship. Politicians and pundits have plenty to say about these topics, and no doubt there will also be fierce debates about which public benefits should be available to new citizens or people on a “path to citizenship.” At what point, if any, should formerly undocumented residents gain access to welfare benefits, unemployment insurance, or the new protections included in the recently enacted health reform law?

One important topic that may not get enough attention is how the basic health of immigrants themselves could be affected by reforms. Will reforms make it easier for all migrants to get timely and adequate health care, not just for sudden problems like injuries in an accident but also for chronic diseases? The answers matter not just for the wellbeing of newcomers themselves, but for the health and prosperity of all Americans, the neighbors and co-workers of immigrants.

Immigrant health can serve as a sort of canary in the mine shaft, helping us to understand how readily immigrants are becoming incorporated into American society, and with what consequences for the rest of us.

Why Immigrant Health is an Important Issue

Good health for immigrants should concern all of us. Some immigrants are highly educated and slide smoothly into prosperous jobs and lives, of course. But poor and less educated newcomers often struggle at the margins of society and can easily end up suffering the same bad health syndromes as native-born impoverished people already suffer – conditions such as obesity, diabetes, heart problems, and other chronic diseases. These health problems are worrisome to society as a whole for several reasons:

• Paying for the care of people with chronic diseases is very costly, and places a big burden on public budgets that often pay all or a large part of the cost.
• Ill health hurts the economy, because obesity, diabetes, and other long-term ailments greatly reduce people’s quality of life and make workers much less productive.
• Unhealthy people without access to good care can make neighbors, co-workers, and customers less healthy, too. We all have a strong interest in basic health care for all, because infections spread in unpredictable ways, and over-crowded emergency rooms can make intensive care hard to deliver to anyone who comes by ambulance to that facility.

Added health-related threats can occur when large numbers of undocumented immigrants live in the shadows, afraid to have routine contacts with public officials. Some localities bend over backwards to make sure that even undocumented immigrants can interact without fear with police, teachers, and public health officers; but there are also states that have instituted “get tough” policies that make undocumented residents more fearful. That can backfire on everyone, however, if immigrants cope with treatable health threats in private and do not get timely help.

So far, undocumented immigrants have not been an important source of epidemics. Public health authorities agree that the undocumented have had little role in spreading infectious diseases such as the flu or whooping cough. But there is always the threat that a population without access to services could incubate and spread infections that threaten many others as well. Just as law enforcement officials fear that public safety can be put at risk if local police are perceived as collaborating with federal immigration enforcement agents, public health officials should be concerned about any measures that make undocumented immigrants more fearful about seeking services. Undocumented immigrants have had little role in spreading infectious diseases, but there is always the possibility that it could happen.

Will Creating a Path to Citizenship Solve These Problems?

Most approaches to immigration reform call for one sort of regular, legal status for many of the roughly eleven million undocumented immigrants in the United States. Undocumented migrants would not become U.S. citizens quickly or easily, but many would, as the saying goes, be on a path to citizenship. Would such reforms solve the health-related problems I have identified?

Regularization for undocumented immigrants would mean an undeniably momentous change in the lives of many. Nevertheless, current immigration reform proposals fail to address some of the key issues relevant to public health that I have identified – and in fact new reform laws could make some of these challenges even trickier for public officials to navigate.

• Under proposals currently on the table, many undocumented immigrants will be unable to get on the pathway to citizenship. For example, people with any sort of criminal record and those who arrived later in life may be denied regular status. A sizable population will remain in the shadows. Migrants who remain undocumented may well be driven even further underground, because of tougher enforcement measures to ferret out and deport people not eligible to get on the path to citizenship.
• New federal laws may also leave in place many of the immigration-related enforcement policies recently enacted in the various U.S. states – including some “get tough” measures that create unnecessary barriers between local public health officials and some immigrants.

The Way Forward

Comprehensive immigration reform enacted by Congress and signed into law by the President can do a lot to ease the full incorporation into American society of many immigrants who already live, work, and raise families in communities across the United States. But even if new national laws can be hammered out, many challenges will remain for immigrants and for the states and localities where they live. Undocumented immigrants will not suddenly disappear, and many documented as well as undocumented newcomers will continue to face illnesses that harm their personal wellbeing, burden public finance, and threaten community health. It may seem that immigration reform is exclusively about immigrants themselves. But policy makers must recognize that they cannot support the healthy communities Americans demand unless they craft laws and regulations that take into account everyone who calls America home.