Anti-immigrant rhetoric and political actions gained prominence and public support before, during, and after the 2016 presidential election. This anti-immigrant political environment threatens to increase health disparities among undocumented persons, immigrant groups, and people of color. I discuss the mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities through increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources. I argue that the anti-immigrant sociopolitical context is a social determinant of health that affects mostly communities of color, both immigrants and nonimmigrants. Public health has a moral obligation to consider how immigration policy is health policy and to be prepared to respond to worsening health disparities as a result of anti-immigrant racism.

As of March 2021, Native Hawaiians and Pacific Islanders (NHPIs) in the United States have lost more than 800 lives to COVID-19—the highest per capita death rate in 18 of 20 US states reporting NHPI deaths. However, NHPI risks are overlooked in policy discussions. We discuss the NHPI COVID-19 Data Policy Lab and dashboard, featuring the disproportionate COVID-19 mortality burden for NHPIs. The Lab democratized NHPI data, developed community infrastructure and resources, and informed testing site and outreach policies related to health equity.

This study assesses whether anti-immigrant prejudice at the community level is prospectively associated with mortality. We used 10 waves of data from the General Social Survey (GSS) that were linked to mortality data via the National Death Index (NDI) for the period between 1993 and 2014 (n = 13,242). The 2014 GSS-NDI dataset is a nationally representative sample reporting social characteristics and attitudes in the United States that was prospectively linked to mortality data. Community-level prejudice was measured with 5 questions regarding anti-immigrant sentiments across 123 communities, defined using primary sampling units. Cox proportional hazards models tested the association between anti-immigrant prejudice and mortality hazard, controlling for covariates at the individual and community levels. Findings showed that among "other race" respondents, those born in the US had higher risk of mortality in communities with greater anti-immigrant prejudice, whereas foreign-born "other race" respondents had lower risk of mortality in communities with greater anti-immigrant prejudice. Sensitivity analyses indicated that the "other race" category was comprised largely of Asians and Hispanics, and that these results were similar for both groups. In contrast, anti-immigrant prejudice was not associated with mortality for foreign-born immigrants who self-report as white or black. We provide various hypotheses for why US-born immigrant groups seem to suffer higher mortality risk, while foreign-born immigrant groups do not, when they live in communities with high levels of prejudice.

Data on the health and social determinants for Native Hawaiians and Pacific Islanders (NHPIs) in the United States (US) are hidden because data are often not collected or are reported in aggregate with other racial/ethnic groups, despite decades of calls to disaggregate NHPI data. As a form of structural racism, data omissions contribute to systemic problems such as inability to advocate, lack of resources, and limitations to political power. We conducted a data audit to determine how US federal agencies are collecting and reporting disaggregated NHPI data. Using the COVID-19 pandemic as a case study, we reviewed how states are reporting NHPI cases and deaths. Last, we calculated the extent of NHPI underrepresentation in communities targeted for COVID-19 resources in California using the state’s neighborhood equity metric—Healthy Places Index (HPI). Our analysis shows that while there has been improvement in collection and reporting of NHPI data nationally, federal data gaps remain. States are vastly underreporting—over half of states are not reporting NHPI COVID-19 case and death data. The HPI, used to inform political decisions about allocation of resources to combat COVID-19, systematically underrepresents NHPI communities. We make recommendations for improving NHPI data equity to achieve health equity and social justice.