Advocating Policy for Children of Immigrant Families

Latino children represent one quarter of the pediatric population in the United States. Although most Latino children (93%) are United States born, the immigrant experience remains central to their health and well-being.¹  In almost half of Latino households in the United States, at least 1 family member is an unauthorized immigrant.^2,3  Stigma and discrimination because of immigration status adversely affect well-being, with chronic anxiety and stress and, in many cases, poor health outcomes as a result of decreased utilization of necessary health services regardless of eligibility because of fear of deportation.⁴ 

Although the federal government is solely responsible for immigration policies that regulate who can or cannot legally enter and remain in the United States, immigrant policies at the state level affect rights, protections, and services to immigrant groups.⁵  Additionally, enforcement of immigration status at the state level, including mandatory legal status checks for universal employment verification and state licensing services (ie, driver’s license) as well as state cooperative immigration enforcement agreements with the federal government pose additional barriers to immigrants and are associated with hostility toward Latino communities regardless of their immigration and nativity status.³ 

In this issue of Pediatrics, Slopen et al present new findings on the association between state-level systemic exclusionary policies and prejudicial attitudes toward immigrants and Latinos and the physical and mental health of Latino children.⁶  Using nationally representative data from the cross-sectional National Survey of Children’s Health, the authors included 17 855 Latino children 3 to 17 years of age. They assessed the presence of health problems reported by parents as well as parent-reported diagnoses by a medical provider. An ordinal 4 level categorical variable was created to indicate the absence or presence of 1 or more health problems. The exposure variable—systemic inequities—elegantly uses 3 separate measures to generate a factor score, with higher factor score levels reflecting higher levels of inequity.

The authors’ findings demonstrate an association between systemic inequities and higher co-occurrence of mental and chronic physical health conditions among Latino children, even after adjusting for a wide variety of potential confounders, including a child’s personal experiences of discrimination and family’s immigration, and socioeconomic characteristics. A dose effect was also shown in which every unit-increase in the systemic inequities factor score increased the odds of co-occurrence of physical and mental health conditions.

Several aspects of this work merit further discussion. First, rather than evaluating individual experiences of discrimination and stigma, the authors evaluated systemic measures at the state level. This places the findings within the realm of public policy with a call to action to address state mandates that directly affect individual children, such as funding for early and K through 12 education for dual language learners and the inclusion of children of immigrant families in state social support services, following federal policy recommendations from the Task Force on New Americans.⁷ 

Their work also aligns with the National Institute on Minority Health and Health Disparities Research Framework, in which different levels (biological, behavioral, sociocultural and environmental) and domains (individual, interpersonal, community and societal) of influence are considered when studying the health of minoritized populations.⁸  More specifically, Slopen et al thoughtfully demonstrated the effect of discrimination and stigma in relation to immigration across different levels of influence from the individual to the societal level. This facilitates formulating multilevel strategies to address these disparities.

At the societal level, this study provides further evidence that immigrant policy is health policy. The effect of exclusionary policies on Latino children have real implications in US population health. Any policy that affects a quarter of the pediatric population has significant implications in the health of the overall US pediatric population.

The findings regarding systemic inequities and health conditions prompt us to recognize that there is an immense opportunity to improve the health of Latino children by addressing these inequities at the state level by advocating for public programs such as provision of language concordant information and services, and/or access to housing and higher education, all of which can have a positive effect on a child’s health.

Echoing the authors, we pediatricians and other child health clinicians have a responsibility to educate ourselves and others about the harm of stigma and discrimination directed against immigrant children and children of immigrant families. Although Slopen et al have focused their work on Latino children only, we should remember that the immigrant experience is also central to children of immigrant non-Latino families.

We can influence the sense of belonging and inclusion of our patients by incorporating trauma- and culturally informed care that will build on the strengths and address the needs of our patients and their families who have immigration experience.