Every day, organizations worldwide are engaged in a collective two steps forward, one step back march toward improved immigration services and policies. What hard-earned lessons are these nonprofits, and the foundations that support them, learning from their persistent efforts? This collection of evaluations, case studies, and lessons learned exposes and explores the nuances of effective collaboration, the value of coordinated messaging, the bedrock of ongoing advocacy efforts, and the vital importance of long-term and flexible funding.

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Exposed and At Risk: Opportunities to Strengthen Enforcement of Pesticide Regulations for Farmworker Safety

September 13, 2022

In May 2021, the Center for Agriculture and Food Systems published Essentially Unprotected: A Focus on Farmworker Health Laws and Policies Addressing Pesticide Exposure and Heat-Related Illness as a companion report to the Johns Hopkins Center for a Livable Future's report Essential and in Crisis: A Review of the Public Health Threats Facing Farmworkers in the US. Both reports focused on the public health threats facing farmworkers in the United States. Essentially Unprotected specifically addressed pesticide exposure and heat-related illness, highlighting the gaps in federal law in addition to state efforts to fill those gaps.This report was conceived by farmworker advocates to expand on the research and analysis contained in Essentially Unprotected. In continued partnership with Farmworker Justice, CAFS seeks to create resources to support the expansion of laws and policy that can improve conditions for workers throughout the food system. This report is part of a series that spotlights various issues affecting farmworkers where law and policy can play a role in offering protection.The direction of this report was influenced heavily by interviews with farmworker advocates in various states. Through these conversations, it became clear that the legal and regulatory landscape of pesticide law enforcement is complex given the cooperative relationship between federal and state governments and the myriad agencies involved at both levels. This resource is intended to provide clarity on pesticide regulation enforcement efforts to enable advocates and law and policymakers to identify opportunities for improvement. It concludes with a set of recommendations to better protect the health and safety of the farmworkers who comprise an integral part of our food system

Migrant Workers

Changing the Playbook: Immigrants and the COVID-19 Response in Two U.S. Communities

July 27, 2022

U.S. cities and towns have responded to COVID-19 in ways that are as diverse as the communities they aim to support. This report looks at how two very different locations—Worthington, MN, and the greater Houston area—incorporated immigrants into their relief efforts, through partnerships, strategic outreach, targeted assistance, and more. The report also highlights useful lessons for responses to future emergencies.

Social Determinants of Immigrants’ Health in New York City: A Study of Six Neighborhoods in Brooklyn and Queens

June 15, 2022

More than 3.1 million immigrants reside in New York City, comprising more than a third of the city's total population. The boroughs of Brooklyn and Queens are home to nearly 940,000 and more than 1 million immigrants, respectively. According to the New York City Department of Health and Mental Hygiene's (DOHMH) Community Health Survey (CHS), foreign-born New Yorkers have poorer health and less access to healthcare than their US-born counterparts.For this study, the Center for Migration Studies of New York (CMS) focused on six neighborhoods in these two boroughs whose immigrant residents were identified by a previous CMS study, Virgin and Warren (2021), as most at risk of poor health outcomes. The CMS research team conducted a survey of 492 immigrants across these six neighborhoods and convened one focus group to collect data on immigrants' health and well-being. CMS also surveyed 24 service providers including community health clinics, health-focused community-based organizations, and hospitals that work with immigrants in the studied neighborhoods. Analysis of these data, together with the US Census Bureau's American Community Survey and the DOHMH's CHS, provides insight into the factors that affect immigrants' health and wellbeing across these neighborhoods.

COVID-19’s Effects on U.S. Immigration and Immigrant Communities, Two Years On

June 9, 2022

More than two years into the COVID-19 era, the United States has seen more than 1 million people die of the virus, and a sharp recession and uneven recovery that have caused hardship for many families. And while the pandemic has touched the lives of all U.S. residents, immigrants have been among the hardest hit. Understanding how the pandemic has reshaped U.S. immigration policies and levels, and how the pandemic and associated economic downturn and recovery have affected immigrant families, can guide better policymaking as the United States grapples with COVID-19's ongoing impacts and faces future public-health crises, natural disasters, and other emergencies.This report takes a look back. It first details immigration policy changes the U.S. government made after the emergence of COVID-19 and the effect these policy changes and visa processing challenges have had on immigration levels to the United States. Next, it describes the essential roles that immigrant workers have played during the pandemic in health care and other fields, and early evidence on the disproportionate impact of the novel coronavirus on immigrants' health. Finally, the report describes the high unemployment rates foreign-born workers experienced during the pandemic, the limited access many noncitizens have had to the safety nets that many citizens have relied upon after losing jobs, and innovative approaches states, localities, and nonprofit organizations have used to support immigrant families.

The Impact of Language on Health Care Accessibility

June 8, 2022

Language barriers can impact the ability of individuals to access vital services such as health care. The COVID-19 pandemic highlighted many of the challenges faced by limited English proficient (LEP) individuals. Health centers and other federally-funded programs aim to ensure that patients' language does not impact their ability to access health care.This issue brief will inform service providers about policies to promote language access for LEP patients. After identifying and explaining the urgency of the challenges of LEP patients, this issue brief will provide practicable and accessible solutions that service providers can implement both immediately and in the long-term. We hope providers will create their own innovative solutions to meet the language needs of the communities they serve.

Migrant Workers

New Analyses on US Immigrant Health Care Access Underscore the Need to Eliminate Discriminatory Policies

May 18, 2022

Previous Guttmacher Institute research has described sexual and reproductive health disparities between immigrant women and their US-born counterparts. We present new analyses, based on two nationally representative surveys, that show inequities in health insurance coverage by citizenship status and race or ethnicity, and health care service use by citizenship status. These new findings are consistent with existing evidence indicating a need for policies to eliminate sexual and reproductive health inequities that have long persisted along lines of race and ethnicity, immigration status and income in the United States.These analyses make it clear that policymakers need to address these inequities. Two bills, the Health Equity and Access Under the Law (HEAL) for Immigrant Families Act and the Lifting Immigrant Families Through Benefits Access Restoration (LIFT the BAR) Act, represent opportunities to do just that.

Farmworker Justice: Health Policy Bulletin (Spring 2022)

April 27, 2022

This brief is a summary of policy developments that affect farmworker health and access to health care. This issue focuses on heat stress and heat-related illness.

Migrant Workers

Health Care Access among California’s Farmworkers

April 25, 2022

Recent federal and state policies may have improved access to health insurance for farmworkers, who are important contributors to California's economy and an essential link in the food supply chain. The Affordable Care Act (ACA) included an expansion of Medi-Cal to most low-income adults, and a mandate requiring companies with at least 50 workers to offer employer health insurance. California also expanded Medi-Cal to young undocumented immigrants, and will soon extend it to older individuals. This report investigates whether these policies coincided with better insurance coverage or reduced barriers to health care for immigrant farmworkers.Farmworkers are aging and more likely to settle in the US with family; thus, their health care needs—and those of their families and children—will likely grow. Cost or lack of insurance are the most salient barriers to health care for farmworkers; few farmworkers note barriers related to immigration status, although being undocumented is a strong predictor of lacking health insurance. Many documented farmworkers have enrolled in Medi-Cal following the ACA expansion, which has increased coverage rates and lowered cost and insurance barriers to health care. Undocumented farmworkers have not fared as well in these areas. Employer health insurance coverage for farmworkers did not change detectably with the rollout of the ACA employer mandate, regardless of a farmworker's documentation status or whether the worker was a direct hire versus a contractor. These findings take on special importance during the coronavirus pandemic. Farmworkers have continued to work during the public health emergency. Yet with California's high cost of housing, many farmworkers live in crowded conditions, making it difficult to remain socially distant from other household members. Although emergency Medi-Cal covers COVID-19 treatment regardless of immigration status, long COVID and resulting disability may threaten farmworkers' health and livelihoods.

Migrant Workers

The Growing Demand for Physicians in Colorado

April 6, 2022

New research from the American Immigration Council highlights the crucial role immigrants and refugees in Colorado are playing to help address critical physician shortages. To meet the growing healthcare needs of the Centennial State, especially in rural counties, the state will need to implement policies that attract and retain immigrant talent that is complementary to the U.S.-born workforce, and that also builds career pathways for immigrants who already call the state home.

The Growing Demand for Healthcare Workers in Illinois

March 24, 2022

New research from the American Immigration Council highlights the crucial role immigrants in Illinois are playing to help address critical workforce shortages in the healthcare field. To meet the growing need for physicians and nurses, especially in rural counties, the state will need to implement policies that not only attract and retain immigrant talent that is complementary to the U.S.-born workforce, but that also build career pathways for the immigrants who already call the state home. This research brief highlights the growing demand for healthcare workers in the state and the need to reduce barriers for internationally trained professionals.

NYC Hispanic/Latinx Health Action Agenda 2021-2025, Our Health-Our Future

March 9, 2022

The New York City Hispanic/Latinx Health Action Agenda is a result of a community driven health policy process that brought together over 60 Community-Based Organizations/Agencies and 72 community leaders, faith-based leaders, experienced clinical and non-clinical service providers. Facilitated by the Hispanic Health Network, Hispanic Federation, and the Latino Commission on AIDS, the process started in October 2020 with a series of consultations with key public health leaders, community providers, and members of health networks with expertise in the health field and Hispanic/Latinx communities. Soon after, steering and planning committees were developed to ensure a broader reach of Hispanic/Latinx community leaders and Hispanic/Latinx serving organizations throughout all NYC boroughs.In the Spring of 2021, the steering and planning groups engaged in facilitated conversations aimed to reach consensus on key subpopulations and health issues to focus on for this health policy agenda. Additionally, this newly formed network of organizations and leaders sought to fortify Hispanic/Latinx health leadership with a health policy-focused perspective to guide decision-makers and impact legislation, particularly at a moment in which NYC is preparing for a critical municipal election scheduled for November.The overarching goal of this NYC Hispanic/Latinx Health Action Agenda is to improve health outcomes among Hispanic/ Latinx New Yorkers living throughout all the boroughs while ensuring Hispanic/Latinx participation and inclusion and impacting health policy decision making in order to address health disparities and inequities in New York City. To do so, participants in this process established a conceptual framework to guide the assessment of the health needs of Hispanic/Latinx New Yorkers and develop a set of health policy recommendations.

Community Needs Assessment on Immigrant Bangladeshi Women’s Mental Health

February 23, 2022

This case summary conducted by the Urban Institute and Sapna NYC, a community-based organization serving low-income Bangladeshi women through health and empowerment programs, explores the findings of a community needs assessment focused on the mental health challenges and needs of Bangladeshi immigrant women living in the Bronx, Queens, Manhattan, and Brooklyn and can help inform practice and policy in New York City. Data from our interviews indicated that the three major contributing factors to the mental health of women in our study were economic and financial insecurity, home life and social networks, and traumatic events. Based on these insights, we propose recommendations for policymakers and funders to better support the mental health of vulnerable and immigrant communities.

Women