Immigrant legal status determines access to the rights and privileges of U.S. society. Legal status may be conceived of as a fundamental cause of health, producing a health disparity whereby unauthorized immigrants are disadvantaged relative to authorized immigrants, a perspective that is supported by research on legal status disparities in self-rated health and mental health. We conducted a systematic review of the literature on legal status disparities in physical health and examined whether a legal status disparity exists in chronic conditions and musculoskeletal pain among 17,462 Mexican-born immigrants employed as farm workers in the United States and surveyed in the National Agricultural Workers Survey between 2000 and 2015. We found that unauthorized, Mexican-born farm workers have a lower incidence of chronic conditions and lower prevalence of pain compared with authorized farm workers. Furthermore, we found a legal status gradient in health whereby naturalized U.S. citizens report the worst health, followed by legal permanent residents and unauthorized immigrants. Although inconsistent with fundamental cause theory, our results were robust to alternative specifications and consistent with a small body of existing research on legal status disparities in physical health. Although it is well known that Mexican immigrants have better-than-expected health outcomes given their social disadvantage, we suggest that an epidemiologic paradox may also apply to within-immigrant disparities by legal status. We offer several explanations for the counterintuitive result.
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In addition to the publicly available data, the DOL granted us use of restricted data containing detailed reports of musculoskeletal pain.
The DOL uses a worksite survey in order to obtain a nationally representative sample of farm workers. No universal lists of U.S. farm workers exist, and telephone and address frames exclude farm workers who live in irregular housing or in housing for short periods. The NAWS uses the U.S. Bureau of Labor Statistics agricultural employer census as its sampling frame. Employers are randomly selected, and workers are randomly drawn from a sampling frame of farmworkers developed at each sampled site. Although farmworkers are selected at the worksite, interviewers do their best to interview farm workers off the work site, before or after the workday, or during lunch or a break. All interviews are completely voluntary and confidentiality is strictly maintained.
Approximately 10 % of U.S. agricultural workers are estimated to hold H-2A visas (Wilson 2013). Estimating the size of the H-2A population is complicated by the nature of data on the H-2A program. The Department of Homeland Security reports H-2A admissions, and some H-2A farm workers enter the United States more than once per year; the State Department reports H-2A job certifications, and some H-2A farm workers hold multiple jobs (Martin 2017). In the NAWS data, farm workers who hold temporary visas include refugees, asylees, and immigrants with temporary protective status, U visas, T visas, border crossing cards, and some student visas. Excluding H-2A visa holders makes our analysis of temporary visa holders nongeneralizable to all temporary visa-holding farm workers but should not bias our results for other legal status categories.
We compared our results for health conditions for all years (2000 to 2015) with the NIOSH years, and results were similar.
Results are consistent when we use multiple imputation for all missing values.
Although we are not aware of studies that have directly assessed the validity of the NAWS questions on legal status, the NAWS data have been used as the standard-bearer for the development of other techniques for identifying the legal status of respondents in survey data, such as the “three-card method” proposed by the Government Accountability Office (GAO 2006). A recent study assessed the validity of direct measurement of immigrant legal status in the Survey of Income and Program Participation and the Los Angeles Family and Neighborhood Survey and found that the questions did not discourage participation and appeared to be answered accurately (Bachmeier et al. 2014).
Giving greater credence to the person’s response on period of entry or other information over their reported legal status reflects the assumption that respondents will be more likely to misreport sensitive information.
Personal correspondence with Daniel Carroll at the DOL. More recent estimates of the recoding are not available. We were not able to identify farm workers who were recoded.
Among those under age 40, authorized farm workers have higher levels of education.
The survey asks whether the farm worker has seen a health care provider in the past two years, but this question captures both access to and need for health care.
This is an imprecise measure of duration in the United States because it does not account for periods of return to Mexico. However, the variable is highly correlated with a variable measuring how long the farm worker has been employed in farm work in the United States (rho = .87), and we find that English language proficiency, property ownership, and insurance coverage all increase with years in the United States, as expected.
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We gratefully acknowledge support from the Western Center for Agricultural Health & Safety, which is funded by National Institute of Occupational Health and Safety Grant No. 2U54OH007550, and from the Max Planck Institute for Demographic Research. We also thank Trish Hernandez and Susan Gabbard at JBS International; Daniel Carroll at the U.S. Department of Labor; Don Villarejo and Gail Wadsworth at the California Institute for Rural Studies; Marc Schenker, Heather Riden, and Emily Sousa at the Western Center for Agricultural Health and Safety; and Angelo Lorenti.
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Hamilton, E.R., Hale, J.M. & Savinar, R. Immigrant Legal Status and Health: Legal Status Disparities in Chronic Conditions and Musculoskeletal Pain Among Mexican-Born Farm Workers in the United States. Demography 56, 1–24 (2019). https://doi.org/10.1007/s13524-018-0746-8
- Legal status
- Mexico–United States
- Farm workers