The “American dream” is the vision found amongst many immigrants coming to the United States who often leave their home country in hopes of achieving a better life for themselves and their children. Immigrants come to America with the aspiration of achieving the “American dream” but often face a myriad of physical, psychological, and societal hardships on their journey to the U.S. that negatively impact their health. Immigrants make up approximately 26% of the total US population, roughly 85 million people, and the numbers only continue to rise (Esterline & Batalova, 2022). Still, immigrant health is overlooked within the United States. Due to determinants that occur during immigration and acculturation, immigrants' health is negatively impacted. Factors, such as the healthy migrant effect, dietary standards, acculturative stress, and access to health care that happen during immigration and acculturation, all have an impact on negative health outcomes that occur within these populations.
For a person to immigrate to the United States, their health must be of a certain standard. Individuals who meet these health requirements are more likely to be permitted to migrate to America. The healthy migrant effect (HME) is a paradoxical phenomenon that explains the ways in which immigrants are found to be healthier than the rest of the U.S. population upon arrival (Ichou & Wallace, 2017). Selective migration may be one of the reasons behind the healthy migrant effect. Research conducted by Ichou & Wallace (2017) in their exploration of the healthy migrant effect found that “migrants are not a random sample of their origin population but a select group who are healthier, wealthier and more highly educated than the population they leave behind”.
Although these individuals may come to America with a health advantage, what many people fail to understand is that this advantage diminishes over time. This can be described as the “paradox of assimilation” (Rumbaut, 2017), a case that states that as the length of time an immigrant spends in America increases, the migrant health advantage decreases; a negative correlation between the two factors. Many studies have examined the deterioration of this health advantage within immigrant populations. A study produced by Antecol & Bedard (2005) utilized the National Health Interview Surveys (NHIS) to study the effects of the HME using self-reported health indicators concerning BMI and found that immigrants, “converge toward lower health levels of natives” as they assimilate into American culture. (Antecol & Bedard, 2005). Utilizing data from the National Vital Statistics System and a logistic regression mode, researchers have found that, “immigrants’ risks of disability and chronic disease morbidity increased with the increasing length of residence” (Singh & Miller 2004). Migrants initially come to the U.S. with a health advantage according to HME but their health slowly deteriorates as they become more adapted to American society.
The gradual diminishment of this health advantage can be described as a “function of acculturation” (Fennelly, 2005). As immigrants try to assimilate into U.S. culture, they adapt to poor lifestyle behaviors, routines, and habits that lead to an overall decline in their health, eliminating their initial health advantage. Immigrants typically experience a nutritional transition when coming to America. The nutritional transition relates to the tendency of individuals to eat lower quantities of healthy and nutritional foods and more fatty and processed foods, which is typical for developing countries. This effect would be accelerated after immigrating to America, where a significant portion of food is already processed and fatty. Research has found that immigrants who were more acculturated tended to adapt to unhealthier dietary patterns compared to those who were less acculturated (De La Rosa et. al, 2000). Similarly, Barcenas et al. (2007) utilized cross-sectional data from 7,503 Mexican adults to assess the association between years spent in the U.S. and BMI. Their findings indicated that the length of residency was positively associated with an increased risk of obesity among these immigrants. These studies display a variety of ways in which immigrants integrate into American culture at the cost of their own health.
Immigrating to America comes with many sacrifices, some of which include having to depart from one’s home country. Others include making the brave decision to leave family and friends, learning a new language, and experiencing identity crisis. There are just a few of many factors that contribute to the acculturative stress one may experience in their immigration to America. Acculturative stress is experienced among many immigrants in America as they become part of American society. The stress of having to adapt to a second culture can lead to many negative health implications amongst these populations. Factors such as financial stress, feelings of guilt, racism, and challenges in assimilating into a new community can all manifest themselves in ways that lead to the development of mental illnesses. Findings by Hwang & Ting (2008) used a hierarchical regression analysis to find a correlation between psychological distress and acculturation. Their results found acculturative stress posing as a risk factor for developing mental health problems in Asian-American immigrants (Hwang & Ting, 2008). The pressures to become part of American society can become overbearing for these individuals who are trying to adjust to their new country. Navigating through an unfamiliar place while simultaneously leaving everything one ever knew behind can become extremely overwhelming.
Coming to a new country as the minority in America can cause some immigrants to experience some struggles concerning self-image. The high beauty standards set by American society to reach beauty and body ideals also result in immigrants experiencing body dissatisfaction; this in turn can lead to eating disorders. They face acculturative stress in their internal conflict of deciding between the norms and ideas of their native culture and their new dominant society. Stressors of limited social support, loss of identity, the mourning of culture, and discrimination among immigrant populations have resulted in the development of eating disorders found in migrant women (Kafri, 2020). In parallel to this, a study produced by Ahluwalia et al. (2007) found that immigrants with low acculturation degrees were more satisfied with their overall body image than their less acculturated counterparts. The impacts of immigration and acculturation on immigrant health can manifest itself in both negative physical and psychological implications within the population.
One of the main threats to immigrant health is the large gap that exists between the population and accessing care. Language barriers make up a large portion of this gap as they can significantly decrease access and quality of care. Immigrants who are non-native English speakers may have difficulties in filling out health insurance forms, establishing a relationship with a primary care physician, and receiving medical attention, which contributes to an increased risk for poor health; this only widens the gap in receiving adequate healthcare. Flores et al. (1998) conducted a cross-sectional survey of Latino parents on barriers to health care. They reported that language barriers increased medical barriers due to the misunderstanding of doctor instructions and misdiagnosis. Not being able to fully understand the treatment and diagnosis given by physicians is a serious problem. According to federal requirements, anti discrimination provisions require healthcare providers receiving federal financial assistance to provide ‘meaningful’ access to care for individuals with limited English proficiency (Jacob et al.,2018). Many immigrants are unaware of these federal provisions in place and so are still taken advantage of and mistreated by their providers, decreasing their overall health and wellbeing in accessing care.
Another cause of concern in accessing care for immigrants is insurance coverage. A report by the Kaiser Commission discussed the issue of lack of health insurance coverage among immigrant populations. Their report found that “of the 11 million low-income non-citizens, 60 percent had no health insurance [and] only 13 percent receive Medicaid” (KFF, 2003). Many immigrants are unaware that they are eligible for these types of insurance coverage programs due to language barriers, limited health literacy, and fears of deportation which is why many are reluctant to enroll themselves in these programs. In 1996, President Clinton signed the Personal Responsibility and Work Opportunity Act (PRWORA) law which restricted Medicaid eligibility for immigrants for their first five years in the United States (Ku & Matahi, 2001). This created immense fear for immigrant families trying to access care. Without adequate health insurance coverage, immigrants are faced with a high risk of poor health. Researchers have utilized a pre-and post-test comparison group research design to study the effects of PRWORA on foreign-born women and children and their findings suggested that the PRWORA, “may have engendered fear among immigrants and dampened their enrollment in safety net programs”. Immigrants face many barriers to health care, further exacerbating the deterioration of health that comes with acculturation. In an attempt to alleviate this burden, the government passed the Affordable Care Act (ACA) in 2010 which assisted in expanding Medicaid enrollment eligibility for some immigrant populations but not all; it still excluded undocumented immigrants including DACA recipients (Kaushal & Kaestner, 2005). Far too many immigrants remain uninsured and are therefore unable to access health care services.
In exploring the health implications of immigration and acculturation within immigrant populations in the United States, we can better be able to understand the negative health implications of immigration and acculturation on immigrant health. This research presents itself as both an indicator of what needs to be done to help these individuals and also as a limitation as these findings were inclusive to American immigration. More awareness needs to be raised on the struggles and hardships faced by these individuals. They are not receiving the help that they need to aid in their journey to achieving their goal of the “American dream”. It is evident that much needs to be done to help reduce the negative health impacts these populations currently face as they immigrate to America. It is important that people are aware of the negative health impacts that this community faces as they too are a part of the society that exists within the United States. Ignoring the health sufferings of immigrants within America will only have a ripple effect on the health of future generations of children to come. Actions need to be taken now in order to address these health disparities and reduce the health outcomes for immigrants in America.
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