How Structural Racism Shapes Immigrant Health
It’s 9:15 a.m. in a busy community clinic in Queens. A nurse calls out a patient’s name, once, twice, a third time. Finally, a woman approaches slowly, her eyes cast down. She explains quietly that she almost didn’t come. There were rumors swirling in the neighborhood about “officials” checking documents nearby, and the fear of detention felt more immediate to her than the cough that had kept her awake for three nights. This small moment captures something far larger: the ways structural forces—not just individual choices—shape the health of millions of immigrants across the United States.
A 2021 study published in Health Education & Behavior argues that immigrant health inequities cannot be fully understood through traditional lenses, such as nativity, acculturation, or individual behavior. Instead, they must be viewed through the lens of structural racism, a system that racializes immigrant groups and embeds inequities across immigration policy, enforcement, labor markets, and neighborhoods. This broader framing offers public health leaders a clearer picture of the root causes shaping immigrant well-being—and the systems that must be transformed to advance health equity.
The Problem: We’ve Been Asking the Wrong Questions
For decades, immigrant health research has focused on topics such as healthcare utilization, preventive screening, diet and exercise, or the so-called “immigrant paradox.” These areas matter, but they tell only part of the story. The deeper issue, as Misra and colleagues argue, is that immigration in the United States has always been racialized. Immigrants from Latin America, Asia, Africa, and the Middle East enter a society where race dictates access to opportunity, safety, and resources. Their health outcomes are shaped not only by who they are or how long they have been in the country, but also by how laws, institutions, and public narratives categorize them.
The study identifies three major structural pathways through which racism shapes immigrant health: (1) immigration policy and citizenship restrictions, (2) disproportionate enforcement and criminalization, and (3) economic exploitation and neighborhood disinvestment. These pathways reveal how health inequities emerge long before a person steps into a clinic.
How Immigration Policy Becomes a Health Policy
The first pathway—formal racialization through immigration policy—shows that laws determining who can enter the country, who can remain, and who is recognized as a full citizen have a direct influence on health. Policies at the federal, state, and local levels shape access to health insurance, public benefits, safe housing, and higher education. For many immigrants, restrictive policies lead to chronic stress, reduced care-seeking, delayed treatment, and poorer mental health. Even U.S.-born children of immigrants may lose out on health-promoting resources when their parents fear that using services could jeopardize the family’s status.
Citizenship itself serves as a powerful determinant of health. It dictates who can vote, who is counted in the census, who can access public services, and who is eligible for political representation. The study notes that immigrant communities—particularly mixed-status households—often avoid the very civic processes designed to allocate resources, because participation feels unsafe. Incomplete census counts, limited voting rights, and denaturalization efforts collectively restrict political power in ways that ripple into public health. All of this means that health inequities among immigrants are not an accident; they are shaped by a political system that determines whose voices matter.
Enforcement and the Chronic Stress of “Living in the Shadow”
The second pathway—increased enforcement and criminalization—creates an environment of constant threat. Immigration raids, workplace sweeps, racial profiling, and detention practices directly affect physical and mental health. Research shows that the fear of deportation alone can worsen anxiety, depression, and chronic stress, and that simply knowing someone who has been detained can produce measurable health impacts. Families in mixed-status households often avoid public places, skip medical appointments, or delay seeking emergency care because of fear. m
The study describes the merging of criminal and immigration systems—what some scholars call “crimmigration”—as a form of informal racialization that marks entire communities as suspect. Historical examples like the National Security Entry-Exit Registration System (NSEERS) after 9/11 and contemporary policing partnerships (such as those that funnel local arrests into deportation proceedings) create a climate where routine interactions with government or law enforcement feel dangerous. The public health consequences are wide-ranging: disruptions in community cohesion, heightened toxic stress, and long-term trauma among children separated from detained or deported parents.
The Economic and Neighborhood Conditions That Shape Immigrant Health
The third pathway highlights how structural racism produces economic insecurity and neighborhood disinvestment. Many immigrants, particularly those with precarious or temporary legal status, work jobs that are physically demanding, poorly paid, and devoid of basic protections. Wage theft, unsafe working conditions, inadequate sick leave, and the risk of retaliation pose daily hazards. Even documented workers on employer-sponsored visas may endure exploitation because their right to remain in the country hinges on their employer’s sponsorship.
Neighborhood conditions also matter. Immigrants are more likely to live in communities affected by poor housing quality, environmental hazards, limited political influence, and underfunded local infrastructure. Some ethnic enclaves provide social support and cultural familiarity, yet they often overlap with areas of concentrated poverty and disinvestment. These place-based inequities—shaped by both historic and current policies—affect everything from exposure to pollutants to opportunities for physical activity, educational attainment, and long-term health trajectories.
Why These Findings Matter for Public Health Practice
Understanding these structural pathways shifts the role of public health from reacting to individual behaviors to addressing the conditions that produce inequities. Local health departments can build systems that are safer for mixed-status families by ensuring confidential, “fear-free” access to care and clearly communicating protections around patient information. Community organizations can strengthen networks of trust that link families to legal support, worker rights organizations, and culturally grounded health education. Health systems can invest in language justice and trauma-informed care, recognizing that experiences with enforcement shape how immigrant communities engage with services.
Public health professionals must also expand data systems in ways that reflect lived reality. Many immigrant groups—especially Arab, South Asian, and certain Asian subgroups—are rendered invisible in current racial/ethnic categories. Without better data on citizenship status, visa type, language, and exposure to enforcement, health inequities remain obscured.
Barriers and the Road Ahead
Structural racism limits not only access to care but also participation in the civic and research processes that shape public investment. Immigrant communities, often excluded from political decision-making, have limited influence over the policies that affect their health. Distrust of institutions, language barriers, and fears of surveillance also limit participation in research studies, resulting in underrepresentation and misaligned public health interventions. The study notes that only a fraction of federal research funding supports work focused on immigrant populations, leaving major questions unanswered about the full health impacts of immigration policy.
Looking ahead, the authors call for research that incorporates citizenship, racialization, and belonging—not just nativity or acculturation. They also emphasize the need for cross-group structural interventions that address the shared impacts of racism on Latino, Asian, Arab, African, and other immigrant communities. Implementation science offers a pathway for scaling effective programs and ensuring they reach the communities most affected by structural barriers.
Questions to Move the Conversation Forward
As you reflect on this research, consider: How might your agency shift from focusing on individual behavior to addressing the structural forces that shape immigrant health? In your community, what policies—local or state—most directly influence access to care, safety, or economic stability for immigrant families? And what partnerships could help you build a more coordinated, trust-centered response to these structural barriers?
Public health cannot change immigration policy on its own. However, it can wield data, influence, and community power to reshape the environments in which health is cultivated—or constrained.
