Producing citizenship position through state immigrant policies: an examination of the relationships between health, policy, citizenship, and race in the United States
Drawing from citizenship stratification theory and Public Health Critical Race Praxis, this study examines how the intersection of immigrant policy, citizenship, and race/ethnicity shape health care access and health status. State immigrant policies influence the significance of citizenship position and intersect with racial hierarchies in each state, shaping the extent to which noncitizens are integrated into or coercively excluded from state social, economic, and other institutions. To understand how such polices policies affect the health inequalities between noncitizens and citizens, I conducted a systematic review of 15 integration and 6 criminalization policies in each US state and merged the data with health and demographic data from the 2014 and 2015 National Health Interview Survey. I assessed the variation in having a usual source of care and self-reported health between noncitizens and citizens across states with varying levels of integration or criminalization policy, net of other factors. In states with lowest levels of integration policies, noncitizens, compared to US born citizens, had a lower level of having a usual source of care; but in states with the highest level of integration, there was no difference in having a usual source of care, suggesting a reduction of health care inequities in these states. In states with lower levels of criminalization there was, similarly, no statistically significant difference in excellent health between noncitizens and US born citizens. However, in states with higher, compared to lower, levels of criminalization there was a divergent pattern in which a greater proportion of noncitizens and a lower proportion of US born citizens reported excellent health. These findings suggest that in states that are more welcoming of immigrants there are fewer inequalities in health care access and health status between citizens and noncitizens. Future research, however, is needed to understand the mechanisms by which policy shapes proximal health factors, such as immigrants’ perceptions of and exposure to discrimination and their resilience within hostile policy climates. Public health practitioners may advance immigrant health by supporting immigrant integration policies in health care, education, and workplace settings and counteracting criminalization policies that sanction the policing and apprehension of noncitizens.