Immigrants and Public Health:
Why Immigration is a Health Care Concern
Why Immigration is a Health Care Concern
The impact of international migration on our public health is often overlooked. Although millions of visitors for tourism and business come every year, the foreign populations of special concern are immigrants -- nearly one million arriving as permanent residents each year -- and illegal residents, most often from countries with endemic health problems and less developed health care. These populations are of greatest consequence because they are living among us and often are using U.S. health care services.
Immigrants are often uninsured and underinsured. Forty-three percent of noncitizens under 65 have no health insurance. That means there are as many as 9.4 million uninsured immigrants -- in 1995 -- who constitute a disproportionate share of the total number of uninsured persons in the nation. 1 (By 1997 that number, has climbed to 9.9 million.) Earlier attempts by Immigration and Naturalization Service officers to require that new immigrants have health insurance were quashed by the INS administration. 2 The cost of the medical care of these uninsured immigrants is passed onto the taxpayer, and strains the financial stability of the health care community.
Another problem is use of hospital and other emergency services rather than preventative or normal medical attention. For example, the 29 percent of the illegal alien population is estimated to use public hospitals and clinics in a given year, compared to 11 percent use by the general U.S. population. 3
As a result, the costs of medical care for immigrants are staggering. The annual bill to the taxpayers for Medicaid received by immigrants is over $14 billion ($11.4 billion to legal immigrants, and $3.1 billion to illegal aliens). The cost is compounded by the immigrant bill for Medicare, $6.1 billion a year ($5.5 billion to legal immigrants and $.6 billion to illegal aliens). As of March 1997, there were 2.9 million immigrants receiving Medicaid, of whom 2.2 million were non-U.S. citizens.
As serious as these problems are, they are secondary to the threat of reintroducing serious contagious diseases into our society. "Contagious diseases that are generally considered to have been controlled in the United States are readily evident along the border. ... The incidence of tuberculosis in El Paso County is twice that of the U.S. rate[.] [Director of the El Paso heath district] Dr. Laurence Nickey also reports that leprosy, which is considered by most Americans to be a disease of the Third World, is readily evident along the U.S.-Mexico border and that dysentery is several times the U.S. rate. ... People have come to the border for economic opportunities[,] but the necessary sewage treatment facilities, public water systems, environmental enforcement[,] and medical care have not been made available to them, causing a severe risk to health and well being of people on both sides of the border." 4
Consistent with the El Paso incidence of tuberculosis cited above is more recent data from the Centers for Disease Control and Prevention that indicates that in 1999, the American rate for TB fell to an all-time low of 17,531 active cases. But the incidence of active cases among immigrants, who are a tenth of the population, rose and accounted for over 40 percent of the cases. The incidence among immigrants rose by 2.6 percent (from 7,402 in 1993 to 7,591 in 1998). Most cases were found in people from Mexico, the Philippines, Vietnam, China, India, Haiti and South Korea, countries where TB is prevalent. Those countries accounted for about two-thirds of foreign-born persons with TB. Six states accounted for nearly three-quarters of the TB cases. They were California, New York, Texas, Florida, New Jersey and Illinois. Those six states accounted for 38.9 percent of the total U.S. population in 1990 and 72.9 percent of the foreign-born population. 5
"The pork tapeworm, which thrives in Latin America and Mexico, is showing up along the U.S. border, threatening to ravage victims with symptoms ranging from seizures to death. ... The same [Mexican] underclass has migrated north to find jobs on the border, bringing the parasite and the sickness cysticercosis its eggs can cause[.] Cysts that form around the larvae usually lodge in the brain and destroy tissue, causing hallucinations, speech and vision problems, severe headaches, strokes, epileptic seizures, and in rare cases death." 6
Typhoid struck Silver Spring, Maryland, in 1992 when an immigrant from the Third World, (who had been working in food service in the United States for almost two years) transmitted the bacteria through food at the McDonald's where she worked. River blindness, malaria, guinea worm, have all been brought to Northern Virginia by immigration. 7
Contrary to common belief, tuberculosis (TB) has not been wiped out in the United States, mostly due to immigration. In 1995, there was an outbreak of TB in an Alexandria high school, when 36 highschoolers caught the disease from an immigrant student. 8 The four greatest immigrant magnet states have over half the TB cases in the U.S. 9 In 1992, 27 percent of the TB cases in the United States were among the foreign-born; in California, it was 61 percent of the cases; in Hawaii, 83 percent; and in Washington state, 46 percent.
Disease within in the immigrant community can be particularly difficult to combat. "Immigrants present a special challenge, as health officials struggle with language and cultural barriers to find active TB cases and cure them before they spread to the general population." 10 "When the migrants develop TB they often remain untreated, as health systems tend to overlook mobile individuals. They can then spread TB to others in crowded housing and can infect otherwise healthy populations as they move through new towns and countries. ... And as many as half the world's refugees my be infected with TB." 11 Legal immigrants must pass a medical examination, and a number of communicable diseases constitute grounds for visa denial. However, there are only eight diseases that bar immigrants from admission. 12 And of course, illegal immigrants, who are the most likely to have communicable diseases, are not screened at all. To better ensure public safety, we must end illegal immigration. And to reduce the burden on public health services, we need to reform legal immigration to assure the American taxpayer that legal immigrants are being adequately screened for their ability to be responsible for their own health care and to assure that they are not introducing exotic communicable diseases.
FAIR, 12/00
