Barriers to immigration into the United States are a common topic of political debates. Less frequently publicized are the numerous barriers to healthcare that undocumented immigrants (UIs) face even after their arrival. These obstacles can have profoundly negative effects: not just on the individual immigrants’ health, but on their local communities as a whole. Medical schools must better prepare students to address this disparity in care if future progress is to be made.
Community-Aware
Even as a first-year student, the medical school curriculum has already introduced, acquainted, and practically wedded me to the idea of becoming a “community-oriented physician.” It has emphasized reversing disparities in treatment among patients based on race and ethnicity. It has instilled sensitivity towards patients with different sexual orientations and gender identities. It has highlighted the importance of considering socioeconomic status when evaluating patients’ risk factors and treatment. However, I have yet to receive a single lecture—a single Powerpoint slide—a single sentence, or even a footnote—on the inaccessibility of healthcare to UIs, even among “community-oriented” practices.
Perhaps (and very unfortunately) this should not come as a surprise. Contemporary policies and public discourse often actively discourage interactions between clinicians and undocumented immigrants. The Affordable Care Act, for instance, limits care to “lawfully present” persons (with the exception of waivers). Detainment facilities literally place UIs out of sight, often with substandard care practices. 90% of immigrants are between the ages of 18 and 40, age groups already at lower risk of needing medical attention. These factors, among others, can lead to physicians misjudging their community’s overall health profile. Worse still, their education may never have equipped them to comprehensively treat undocumented immigrants.
Community-Inclusive
For clinicians to serve their communities fully, they must aim to improve care for undocumented immigrants. These community members contribute not only to the local economy, culture, and social structure but also to the financial and logistical strains placed on local healthcare systems.
Lower access to and utilization of healthcare faced by undocumented immigrants only exacerbates this problem. Without the required financial or social capital to access healthcare, many UIs are forced to postpone medical attention. As a result, otherwise treatable illnesses progress to high-morbidity, high-mortality conditions requiring extensive and costly care. Less preventive care for infectious diseases also increases the risk of their spread throughout the local community, immigrant or otherwise. This compounds the personal, societal, and economic burden of wholly preventable illnesses. Finally, immigrant populations tend to access mental healthcare less than non-immigrants despite showing equal or greater need. Immigration-associated stress affects multiple generations, too, meaning this disparity can lower the quality of life for entire families.
Community-Oriented
To reverse these trends, educators must redefine community-oriented medicine to include actively seeking out and advocating for UIs in need of healthcare. Future physicians cannot perpetuate this system that withholds (directly or indirectly, intentionally or otherwise) healthcare from undocumented immigrants.
A truly community-oriented curriculum must familiarize students with the countless opportunities for action in improving undocumented immigrants’ care. For instance, limited English language proficiency unsurprisingly correlates with increased hesitancy to access healthcare. In this regard, practitioners can ensure consistent use of clinical translators or learn key medically-oriented phrases in immigrants’ native tongues. Community clinics also offer medical professionals the opportunity to volunteer their services, treating uninsured patients regardless of financial or immigration status. This completely sidesteps the manifold economic barriers faced by undocumented immigrants in accessing necessary treatment.
However, perhaps the most important and actionable barrier to healthcare access for immigrants can be mitigated on a day-to-day basis, outside the setting of scrubs, stethoscopes, and white coats. A perceived anti-immigrant environment can reduce undocumented immigrants’ interaction with healthcare programs, regardless of eligibility status. Political advocacy is doubtlessly important, certainly. However, each individual also has the opportunity to counteract anti-immigrant sentiments through thought, word, and action. Indeed, as future medical professionals, we are under oath to uphold the principles of autonomy, nonmaleficence, beneficence, and most critically, justice. Publicly endorsing the unbiased treatment of undocumented immigrants is more than just an opportunity: it is our sworn duty.
