Social exclusion at the intersections of immigration, employment, and healthcare policy: A qualitative study of Mexican and Chinese immigrants in California

Michelle K Nakphong; Maria-Elena De Trinidad Young; Brenda Morales; Iris Y Guzman-Ruiz; Lei Chen; Kathryn G Kietzman

doi:10.1016/j.socscimed.2022.114833

Social exclusion at the intersections of immigration, employment, and healthcare policy: A qualitative study of Mexican and Chinese immigrants in California

Soc Sci Med. 2022 Apr:298:114833. doi: 10.1016/j.socscimed.2022.114833. Epub 2022 Feb 18.

Authors

Michelle K Nakphong¹, Maria-Elena De Trinidad Young², Brenda Morales³, Iris Y Guzman-Ruiz⁴, Lei Chen³, Kathryn G Kietzman⁴

Affiliations

¹ Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA; Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: hmkao@ucla.edu.
² Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA; Department of Public Health, School of Social Sciences, Humanities, and Arts University of California, Merced, Merced, CA, USA.
³ Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA; Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, USA.
⁴ Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA; Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA.

Abstract

While immigrants in the US suffer poor access to healthcare in general, access within immigrant populations varies notably by legal status and employment. Intersections between immigration, employment, and healthcare policy have shaped immigrants' access or exclusion from healthcare; however, little research has examined how immigrants experience and navigate these intersections. Drawing on social exclusion theory and the theory of bounded agency, we aimed to investigate Mexican and Chinese immigrants' experiences of exclusion from healthcare as one key dimension of social exclusion-and how this was shaped by interactions with the institutions of immigration and employment. The examination of two ethnic immigrant groups who live under the same set of policies allows for a focus on the common impacts of policy. We selected Mexican and Chinese immigrants as the two largest subgroups in California's Latinx and Asian immigrant population. We use a policy lens to analyze qualitative data from the mixed-methods Research on Immigrant Health and State Policy (RIGHTS) Study, involving 60 in-depth interviews with Mexican and Chinese immigrants in California between August 2018-August 2019. We identified two primary themes: pathways of social exclusion and access, and strategies used to address social exclusion. Findings show that immigrants' exclusion from healthcare is fundamentally linked to legal status and employment, and that immigrants navigate difficult choices between opportunities for improved employment and changes in legal status. We argue that multiple categories of legal status affect immigrants' employment opportunities and social position, which, in turn, translates to stratified healthcare access. Our findings support the literature establishing legal status as a mechanism of social stratification but challenge legal-illegal binary paradigms.

Keywords: Emigration and immigration; Employment; Health policy; Insurance coverage; Social hierarchy; Social inclusion.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

California
China
Emigrants and Immigrants*
Emigration and Immigration*
Employment
Health Policy
Health Services Accessibility
Humans
Social Isolation

Abstract

Publication types

MeSH terms

Grants and funding