Policy Solutions Are Needed for a Strong Latino Immigrant Workforce

Rapid changes in immigration patterns and demographic shifts in the United States require informed policies to address both the needs of our new residents and our country as a whole. The story of Latino immigration to the United States is intertwined with the economy and the nation’s workforce. In the mid-20th century, the US and Mexican governments formalized the Bracero program designed to bring Mexican workers into agriculture to fill jobs unfilled by American workers because of war and low wages. In the 21st century, while the newest immigrants from Central and South American countries have moved into jobs in agriculture, there is also an increasing number of Latin American immigrants represented across a diversity of sectors, including the health sector. Latino immigrants are both having an impact on the demographic profiles of the US population and improving the nation’s health as critical members of the health workforce. A public policy is therefore necessary to support the Latino immigrant workforce in the United States to address their lower access to affordable, high-quality, and culturally and linguistically competent health services. Such policy would ensure that our newest residents might enjoy the same opportunities for health care as the communities in which they work and enable their full participation in the workforce, including the health positions.

DEMOGRAPHICS AND EMPLOYMENT

Until recently, Mexican immigrants and their children have driven the composition of Latino immigrants; however, immigrants from Central America and Caribbean countries are now increasing. In 2017, there were 11 269 900 Mexican immigrants living in the United States, down from 11 711 100 in 2010 (https://pewrsr.ch/2OWaTlF).¹ Of those Mexican immigrant men, 94% were working. Newly arrived immigrants tend to work in hazardous jobs that pay low wages—mostly in service, construction, and agriculture. In the United States, 40% of dishwashers, 36% of roofers, and 35% of gardeners are Mexican immigrant men (https://www.census.gov/acs).

Since the end of the 2008 recession, more Mexicans have returned to Mexico than have migrated to the United States. This is a result of multiple factors including stricter border enforcement, the improved Mexican economy, and declines in Mexico’s birth rate (https://pewrsr.ch/2OWaTlF). Conversely, the number of Central Americans in the United States has increased. In 2015, there were approximately 6.2 million immigrants who were born in Central America or reported Central American ancestry living in the United States. The majority of these immigrants are from the Northern Triangle (El Salvador, Guatemala, and Honduras). Most are employed in high-risk and low-paying industries such as construction, transportation, and agriculture. The type of work and their irregular migration status are key factors influencing their low health insurance coverage and utilization rates.¹

ACCESS TO HEALTH CARE AND HEALTH WORKFORCE

In 2016, Latinos had the highest uninsured rate compared with other ethnic groups at 16.0% (https://www.census.gov/acs). However, over the past 30 years, Latino physicians per 100 000 Latinos decreased by 22% while the US population of Spanish-speaking households increased by 233%.² This mismatch, also seen in other health professional fields such as nursing,³ is concerning at a time when the Latino population, representing the largest and second-fastest-growing ethnic group in the United States, is predicted to become 30% of the US population by 2050.⁴

Nonetheless, Latin American immigrants are active players in the US health workforce. According to the US Census Bureau, foreign-born immigrants from Latin American countries in the health sector reported working as physicians (6%), nurses (14%), and allied health professionals (80%). Furthermore, there are potential players who are being excluded from participating in the health workforce. According to a letter from the American Medical Association CEO, James Madara, MD, written to Congressional Leadership, Deferred Action for Childhood Arrivals “could help introduce 5,400 previously ineligible physicians into the US healthcare system.”⁵

As the US population ages, baby boomers retire, and birth rates decline, the future of US economic growth and the survival of federal programs such as Social Security will increasingly depend upon the contributions of immigrant and foreign workers and their children, who now constitute 24% of US children.⁶ In fact, in New York, California, New Jersey, Hawaii, and Florida—the five states with the highest percentages of immigrant direct care (home care) health workers—of those providing home care services to vulnerable adults, more than 40% are immigrants.⁷

POLICY SOLUTIONS

To accelerate progress in employment of Latino immigrants in the health workforce, it is necessary to consider policy options in the education, immigration, and health care sectors, which are summarized in Box 1. Though not sufficient, at minimum, these policies are necessary to ensure greater diverse representation in the health workforce, thus increasing access and quality health services for the increasingly multicultural and aging US population. In fact, many Latinos are already in the workforce in California, the state with the largest number of Latino immigrants.

Policy Solutions for Latino Immigrant Workforce.

Education and immigration policies
Increase funding for health professions pipeline programs at K–12 and higher education levels.
Consider priority admissions for students with cultural and linguistic competency in health professions graduate programs.
Increase residencies and access to licensure for international medical graduates and other health professions.
Increase funding for loan repayment programs that require health professions graduates to work in medically underserved areas.
Pass the federal DREAM Act and comprehensive immigration reform.
Workforce and health care policies
Consider cultural and linguistic diversity in recruitment, hiring, and promotions.
Retain employees by promoting a work environment that elevates diversity, equity, and inclusion.
Establish inclusive contracting and procurement policies for minority-owned business.
Implement Medicaid in nonexpansion states.
Expand Medicaid to vulnerable groups at a state level, regardless of immigration status.
Increase funding for federally qualified health centers, which disproportionately care for low-income, uninsured, and underinsured individuals.

Note. DREAM Act = Development, Relief, and Education for Alien Minors Act.

CONCLUSION

These immigration and demographic trends are important predictors of who might become a part of the health workforce and provide vital health services and support. These health workforce trends also directly affect whether immigrant Latinos have access to affordable, high-quality culturally competent health services able to support their health. Public policy is required that actively values cultural and linguistic assets, promotes inclusion and retention of qualified immigrants in the health workforce through recognition of their contributions and leadership, and by leveling the playing field by growing opportunities for education and access to care by passing the federal DREAM act and promoting access to care through Medicaid and FQHC expansions. As nonimmigrant America ages, the contributions that immigrants could make if supported by educational policy and inclusionary practices are vital to the future and diversity of our country.