While many immigrants arrive in the US with good health status, there are persistent disparities in access to health care for immigrant groups that may contribute to their more than expected health declines over time, particularly among the nation's two largest immigrant populations, Latinos and Asians. Since the late 1990s there has also been a proliferation of public policies at the state level that have an impact on immigrant populations. There is growing evidence that immigrant policies are a structural factor associated with disparities in Latino and Asian immigrant health care access. Yet, there is limited understanding of the processes by which policy, a contextual factor, has an impact on individual-level health care access outcomes. This study aims to examine the pathways between state policy and access to care by (1) identifying and assessing the variation among Latino and Asian immigrants' experiences of exclusion related to immigrant policies, (2) understanding the extent to which experiences of policy-related exclusion are associated with barriers to health care, and (3) assessing the extent to which those associations are modified by citizenship status, race/ethnicity, and knowledge of policies. We will conduct a mixed-methods study of the experiences of exclusion among Latino and Asian immigrants in California, a demographically diverse state with a range of state-level immigrant policies. We will assess the association between access to health care and experiences of exclusion across five sectors: health care, social services, education, employment, and law enforcement. We will analyze data from the California Health Interview Survey (CHIS), a representative population survey of state residents, combined with a follow-up survey of 2,000 CHIS immigrant respondents that collects additional information on experiences related to immigrant policies. We will also conduct semi-structured interviews of immigrants in two regions to identify the nuances of their experiences of and responses to those policies. The findings from this research can both identify policies outside the health sector that have impacts on immigrant access to health care, and suggest educational interventions which could improve immigrant knowledge in ways that improves their access to needed health care.
This study will contribute to knowledge regarding the impact of public policies on access to health care by examining the experiences of Latino and Asian immigrants. It will build from research on the social determinants of health to understand the pathways between contextual social factors and individual-level health access outcomes.
