A Cornell collaboration crossing medicine, law, technology and communication is aiming to encourage the use of health care benefits by refugees in the United States – who often suffer poor health but are using these entitlements less than they have in the past.
“Many of them believe – wrongly – that if they take any public benefits they will become deportable or not be able to get a green card,” said Stephen Yale-Loehr ‘77, J.D. ’81, professor of immigration law practice at Cornell Law School. “They lack clear and accurate information about what public benefits they are entitled to in the United States.”
Led by Yale-Loehr and Dr. Gunisha Kaur ’06, M.D. ’10, assistant professor of anesthesiology, Weill Cornell Medicine, the team tackling this information gap includes Natalie Bazarova, associate professor of communication in College of Agriculture and Life Sciences, and researchers at the Bronfenbrenner Center for Translational Research.
The researchers joined forces through the Mario Einaudi Center for International Studies and Global Cornell’s multidisciplinary Migrations initiative, with multiyear funding to discover how much immigrants know about public benefits and identify the best ways to educate them about their legal rights.
Forced to leave their homes, refugees and asylum seekers often have health issues such as post-traumatic stress disorder and anxiety, as well as undiagnosed infections or diseases. In the project’s first phase, the researchers assessed immigrants’ barriers to health care services; the next phase will aim to change their behavior to help them use the services they need.
“Immigrants, and particularly refugees and asylum seekers, face enormous barriers to accessing health care,” said Kaur, who is also a medical director of the Weill Cornell Center for Human Rights. The COVID-19 pandemic, she said, shows that everyone, including immigrants, needs access to testing and vaccination.
“That’s what makes us as individuals and as a community safe,” she said. “Understanding the barriers to access and building trust with immigrants is a major component of public health.”
The researchers interviewed patients at Weill Cornell Medicine – both current and former refugees and asylum seekers – as well as legal and medical professionals who work with immigrants. They discovered confusion and considerable fear about how entitlement programs administered by the U.S. government may affect users’ immigration status and long-range prospects in the country.
Some of the misunderstanding stems from the Trump administration’s 2019 changes to the public charge rule that deterred immigrants from accessing public benefits such as food stamps, housing assistance or Medicaid by linking public assistance to negative consequences that would be used against them if they sought to change their immigration status. The rule was withdrawn in 2021, but immigrants remain reluctant to use benefits – even those they are entitled to, the researchers said.
The team also wanted to learn where refugees and asylum seekers currently get their information on immigration issues and how they assess its reliability. One important finding: Immigrants are more inclined to trust websites that have .gov or .edu addresses, Yale-Loehr said.
“We found that immigrants don’t know what to trust on the internet,” he said. “But they are more likely to trust information from universities, government or hospitals than something on a dot-com website or something they hear on the street.”
The project’s next phase aims to create a change in migrants’ behavior so that more make use of their health care benefits. To educate immigrants about health benefits they can access, the researchers are designing a website called Rights for Health. The site carries the cornell.edu domain name and highlights current information on public health benefits in New York state for immigrants and their health care providers.
Bazarova, who leads a social media lab focused on designing digital engagement tools, is helping to develop the website. The team plans to refine the site through a participatory design process, working with social workers, immigrant advocates and health care professionals.
“One idea is to allow these professional stakeholders to create customizable tip sheets that they can give to immigrants as they help them find up-to-date legal information relevant to their specific healthcare needs,” Bazarova said.
The tailored, one-on-one approach is one strategy for conveying accurate information that immigrants will find both personally relevant and credible, the researchers said. After the website launches, the team plans to branch out to different technologies to disseminate the information more broadly. Communication strategies could include apps for cell phones, printed comics and even radio plays.
The project’s findings on barriers to claiming legal entitlements apply to many types of public benefits, Yale-Loehr said – and a range of immigrants, who account for about 14% of the U.S. population.
“We started with a small sample size in a small sector,” he said, “but the implications are huge.”
Jackie Swift is a freelance writer for Global Cornell.