Immigration Policy As Health Policy: A Systematic Review of Immigration Policy Impacts on Health and Healthcare Outcomes

Background and Purpose: Immigration policy is frequently framed as a legal or political matter, yet it also functions as a powerful determinant of health. U.S. immigration policies shape access to public benefits, healthcare, employment, and exposure to surveillance and enforcement, with consequences for mental health, physical health, and healthcare access. Although scholarship on these issues has expanded, evidence remains fragmented across policy domains, study designs, and populations, making it difficult to identify what policies are most consistently harmful or protective and to translate findings into policy and practice. This systematic review synthesizes empirical evidence on how immigration policy affects health and healthcare outcomes in the United States, asking: (1) what types of immigration policies have been studied; (2) what outcomes have been examined; and (3) what patterns of harm or protection emerge across policy domains and populations?

Methods: Following PRISMA and narrative synthesis principles, this review examined peer-reviewed, U.S.-based empirical studies published between 2001 and 2025. Searches were conducted across six databases using terms linking immigration policy to health and healthcare. Studies were eligible if they explicitly examined an immigration policy and at least one health or healthcare outcome. Studies focused solely on migration or acculturation without a discrete policy exposure were excluded. After screening 2,773 records, 44 studies met inclusion criteria. Data were extracted on policy domain, study design, population, and outcome domain, with findings synthesized across restrictive, inclusive, and conditional policy regimes.

Results: Most studies were quantitative (79.5%), with quasi-experimental designs more common than observational analyses. Policy exposures were concentrated in enforcement and exclusion policies (56.8%) and welfare or public benefit restrictions (40.9%), with federal (54.5%) and state-level (50.0%) policies dominating the literature and local policies remaining understudied. Among restrictive policies, welfare exclusion and benefit restriction (n=12) showed the strongest evidence of adverse effects on healthcare access, insurance coverage, and reproductive health. Enforcement, surveillance, and criminalization policies (n=11) produced consistently adverse outcomes, particularly for healthcare utilization, mental health, and birth outcomes. National origin bans and administrative barriers (n=2) showed sustained psychological distress and physical harms. Composite restrictive policy indices (n=7) were generally associated with worse insurance coverage and healthcare utilization. Among inclusive policies, protective state policy contexts (n=7) and inclusive eligibility or benefit expansions (n=6) were associated with improved access, coverage, and reproductive and mental health outcomes. DACA (n=5) produced short-term protective effects on health and coverage; however, these gains attenuated over time.

Conclusions and Implications: This review demonstrates that immigration policy shapes health through material exclusion, institutional deterrence, psychosocial stress, and legal precarity. Research should move beyond documenting policy effects toward mechanism-oriented inquiry, testing pathways such as administrative burden, fear of institutional contact, and stress proliferation. Policy advocacy should treat immigration enforcement, welfare eligibility, and legal status as public health issues. In practice, immigration policy exposure should be integrated into biopsychosocial assessments, and policy-related distress should be recognized as structurally induced. Future work should expand local policy analyses, center understudied populations, and examine how policy functions as a health intervention to support health equity and democratic inclusion.