The review underscores the importance of integrating behavioral health into the public health agenda, opposing the health-detrimental effects of anti-immigration policies and calling for collective efforts to advocate for policy changes. This call for action urges healthcare professionals, policymakers, and advocates to evaluate the intersection of immigration policies and behavioral health, emphasizing that global health actors have a duty to serve the most vulnerable populations.

The authors assert the societal interest in providing healthcare access to all residents and call for the integration of affordable, culturally relevant behavioral health services into healthcare systems worldwide. They also offer specific recommendations to mitigate the identified negative health impacts of immigration policies. I will be listing those, but first, I will review some of the factors mediating the intersection of immigration policies and behavioral health.

Dimensions of Agency within Biopsychosocial Contexts

Psychological health depends on the development of a viable enough sense of agency, a core psychological function defined as the sense of control over one’s actions and their effects on the environment. If this condition is not met, mental health is jeopardized, and so also, via complex biopsychological pathways, is physical health.

In their text Psychology Regulates Activity in the Social World, Bolton and Gillet explore various dimensions of agency within biopsychosocial contexts, examining its developmental, psychological, linguistic, moral, political, and social implications. They provide a multifaceted view of agency, linking all those dimensions and highlighting the interdependence of societal power dynamics and individual agency.

Sociopolitical structures impact agency by enabling or constraining personal growth and social participation through education and resource access. Social contexts that support the satisfaction of basic needs facilitate natural growth processes, including intrinsic motivation. In contrast, those that forestall autonomy, competence, or relatedness are associated with poorer motivation, performance, and well-being.

Socioeconomic status impacts health outcomes by affording autonomy and social participation. Also, societal expectations penetrate agency through a moral dimension, with the potential for moral praise and blame to serve as behavioral controls. Lastly, agency in interpersonal and social activity depends on the person as an agent being recognized as such.

Inclusive communities provide conditions for agency through mutual recognition, but power imbalances and exclusionary practices threaten agency and health. If more powerful forces exclude inclusive communities from access to resources, community and individual autonomy are threatened, raising health risks. 

Promoting Health at Macro and Micro Levels

Martinez and his colleagues offer the following recommendations to mitigate the negative health impact of immigration policies:

1. Establishing global and national policies to ensure healthcare access for immigrants.
2. Recognizing public health risks associated with undocumented individuals’ lack of medical care access.
3. Encouraging national policies to improve vaccination and disease screening among all residents.
4. Enhancing healthcare services through interpreter services and culturally appropriate programs.
5. Supporting safety-net health facilities to provide comprehensive care to underserved populations.

Also, they identify discrimination in healthcare settings fueled by anti-immigrant rhetoric as another barrier to health and remind us of the ethical obligation of healthcare providers to deliver care impartially. Thus, they suggest:

1. Encouraging cultural diversity and linguistic competency in health professional training.
2. Promoting educational programs to better equip health professionals for serving diverse populations.
3. Building community referral systems to inform immigrants about their rights and opportunities.

Integrated Care Clinicians

My two cents is that for integrated clinicians, exploring agency in all its dimensions aligns with our focus on context and should be an integral part of our patient encounters. Let’s ensure we always assess their access to material and educational resources, their degree of autonomy and social participation in connection with their health, and their perception of being recognized as rightful human beings. By doing so, we will recognize them in such a way and contribute to building agency. In unscripted, genuine, and inclusive ways, giving space for expressing the singularities of their unique experiences and honoring their relationship with us.

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