"Yo Ya Ni Voy Al Doctor": Fear As a Social Determinant of Health Among Hispanic Immigrants

Background and Purpose: Most immigration-related research focuses on younger immigrants and their children. By 2060, Hispanics will comprise 21 percent, or 20 million people, of the population 65 and over in the United States. Older Hispanic immigrants reach later life with more functional limitations and with fewer resources to face long-term care than other groups because of decades of low-wage, physically-demanding jobs without benefits, including a lack of health care coverage. These challenges are compounded by restricted opportunities to tap into safety nets, such as immigration status and lack of access to community services, which make it difficult to secure a protracted retirement in fragile health. Using a life-course and intersectional approach, this study investigates how U.S. older Hispanic immigrants access and navigate social services.

Methods: We conducted 160 in-depth interviews with people 60 years of age and older from Cuba, Dominican Republic, El Salvador, Puerto Rico, Mexico, and Venezuela. In addition to variability by country of origin, level of education, and age, we use the following criteria to capture the great diversity of this population: immigration status, age at migration, time in the U.S., working or retirement status, living arrangements, race, and English language ability. To analyze the data we used Nvivo and followed the steps outlined in Deterding and Waters (2018). To maintain a balance between data categorization (coding and analysis), and preserving the narrative qualities of the interviews we wrote brief profiles of the interviewees and chronological summaries of their lives.

Results: Regardless of immigration status, many respondents cited the Public Charge rule as a primary reason to avoid seeking services. They did not want themselves or family members to be excluded from a potential immigration amnesty by using services. Even long-term immigrants who had aged in the U.S. were afraid to have to deal with the government. People refused to seek assistance because they were afraid it could jeopardize their chances for naturalization and family reunification. The mistrust towards the government extended to non-governmental and community-led institutions. People turned to food pantries and other non-governmental services, but only if they did not require registration or asked for identification. The chilling effect concerning public benefits steaming from the Public Charge rule was similar across participants regardless of migratory status or time in the U.S.

Conclusions and Implications: The Trump administration’s threat to use the Public Charge rule to deny citizenship or legal status to people who received any government aid created a great deal of confusion among our respondents. The fear of the Public Charge rule meant that immigrants who were eligible for help were hesitant to apply or to use basic services such as health care, jeopardizing their health and well-being as a result. The twin burdens of poverty and fear forced older immigrants to choose among basic necessities such as medicines and food. Many of our respondents reduced their food intake and went hungry. This public policy failure has made an already precarious situation for older Hispanic immigrants much worse than it had to be.