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  • Review health issues faced by immigrants.

  • Discuss a framework for understanding the health risks of immigrants.

  • Describe demographics and other characteristics of immigrants to the United States.

  • Review determinants of legal immigrant status in the United States.

  • Discuss interventions to improve care.

  • Review patient, provider, and system challenges in the care of immigrants.


Mr. Moraga fled political persecution in Guatemala. He is undocumented, speaks little English, and has been working as a janitor. Many people assume, because he is undocumented, poor, and Latino, that he is also uneducated. He holds a PhD.

Multiple waves of immigration, including the prolonged importation of African slaves, account for the fact that 99% of all US residents are either immigrants or their descendants. Immigrants everywhere in the world are a diverse group, differing in everything from their backgrounds to reasons for immigration. People have migrated to the United States, as they have other places in the world, searching for economic and educational opportunity and fleeing religious persecution, political and social unrest, and personal danger. Consequently, political, economic, geographic, and cultural stimuli and barriers to immigration have shaped the character and experiences of immigrant communities in the United States and globally. Immigrants face increased risks of many illnesses, poor health-care access, and lower-quality health. This chapter reviews these risks and the ways to help mitigate them.


Immigration is defined as resettlement in a country to which one is not native. Immigration is a potent global force (Figure 29-1).1 Indeed, according to the US census, in 2010 almost 13% of the population was foreign born (Table 29-1).2

Figure 29-1.

Top 25 destination countries, 2013: International migrant population and migrant share of total population. Source: Migration Policy Institute tabulation of data from the United Nations, Department of Economic and Social Affairs (2013). Trends in International Migrant Stock: The 2013 revision (United Nations database, POP/DB/MIG/Stock/Rev.2013). Available at

Table 29-1.Foreign-Born Population by Region of Birth: 2010

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