Coming to America: The contribution of immigrant healthcare workers

The US may sometimes seem a cold place for immigrants despite their indispensable role in sustaining the country’s healthcare sector, writes Bette Browne

The first black and Asian-American woman nominated as a US Vice Presidential candidate, Senator Kamala Harris, cites her Indian mother’s pioneering work in America’s healthcare sector as one of the factors that propelled her into politics. It also highlights the role immigrant families play in ensuring a functioning US healthcare system.

Relative to their share of the total workforce, immigrants comprise a disproportionate number of healthcare workers. They account for over 28 per cent of 958,000 doctors and surgeons practising in the United States and more than 38 per cent of 492,000 home health aides.

“The American healthcare system relies very heavily on individuals who were born in other countries,” according to Dr Anupam Jena of Harvard Medical School and Massachusetts General Hospital, Boston, speaking in 2018. Dr Jena was one of the authors of a study on the contribution of immigrant healthcare professionals, which was published in the Journal of the American Medical Association and based on US census data.

Past studies focused on doctors who trained abroad, but Dr Jena said “our research shows that skilled immigration from other countries is an important contributor to nearly every occupation within the broader healthcare industry”.

The highest proportion of healthcare professionals coming to the US are from Asia, accounting for about 6 per cent of the total workforce, followed by Mexico, Central America, and the Caribbean. America’s best-known doctor in the fight against the Covid-19 pandemic, Dr Anthony Fauci, is the grandson of Italian immigrants. Neurosurgeon and CNN medical correspondent Mr Sanjay Gupta’s parents are from India and former Surgeon General Dr Vivek Murthy is also Indian-American.

Drawn to medicine

Where numerous Irish-American families, such as the Kennedys, were drawn to politics, many Indian immigrants, like Senator Harris’s mother, Dr Shyamala Gopalan (PhD), were driven by a desire to work in the medical or scientific field. Dr Gopalan, whose work in isolating and characterising the progesterone receptor gene stimulated major advances in breast biology and cancer, was born in India in 1938. Her father was a diplomat and her mother was a women’s rights activist.

Dr Gopalan was a talented singer of South Indian classical music and won a national competition in the discipline as a teenager. But she had bigger dreams. Encouraged by her mother to seek a career in medicine, she left for America in 1958 at the age of 19 after successfully applying to a master’s programme in nutrition and endocrinology at the University of California (UC), Berkeley. She earned a PhD in nutrition and endocrinology in 1964.
A year earlier at Berkeley she met and later married economics graduate Donald Harris, who had immigrated to the US from Jamaica and went on to teach at Stanford University. The couple divorced in 1971, when their daughter Kamala was seven.

Dr Gopalan conducted research in UC Berkeley’s Department of Zoology and Cancer Research Laboratory and worked as a breast cancer researcher at the University of Illinois and the University of Wisconsin. Later she moved to Canada to work at the Lady Davis Institute for Medical Research and McGill University’s Faculty of Medicine. She was also a member of the US Special Commission on Breast Cancer.

The Breast Cancer Action organisation in California hailed Dr Harris as a “world renowned scientist” and said her work in isolating and characterising the progesterone receptor gene transformed understanding of the hormone-responsiveness of breast tissue. Her discovery sparked many advances regarding the role of progesterone and its cellular receptor in breast biology and cancer, stated the organisation. “The world of women affected by breast cancer changed for the better because of Dr [Gopalan].”

Prejudice

But America did not always see her that way and she often encountered prejudice. Indeed, as Irish immigrants had experienced in other fields, Dr Gopalan’s rise was sometimes stymied by prejudice.

“My mother, who raised me and my sister, was a proud woman,” Senator Harris told NBC. “She was a brown woman. She was a woman with a heavy accent. She was a woman who, many times, people would overlook or not take her seriously. Or because of her accent, assume things about her intelligence. Now, every time my mother proved them wrong.”

Senator Harris was inspired by her mother’s persistence and dedication to her work despite the prejudice she faced. “My mother never asked anyone permission to tell her what was possible,” according to Senator Harris. Neither, it seems, did the senator herself, who secured her place in US political history in August as Democrat Joe Biden’s running mate in the White House race against Republican President Donald Trump.

“There’s another woman whose shoulders I stand on,” Senator Harris declared at the Democratic Convention in August, paying tribute to her mother. “My mother came here from India at age 19 to pursue her dream of curing cancer… she probably could have never imagined that I would be standing before you now speaking these words: I accept your nomination for Vice President of the United States of America.”

But poignantly, Dr Gopalan never lived to see her daughter’s groundbreaking achievement. She died of colon cancer in Oakland, California, on 11 February 2009. Later that year, Senator Harris travelled back to India with her mother’s ashes and scattered them on the waters of the Indian Ocean.

Surgeon General

Dr Vivek Murthy is another leading Indian-American in the field of medicine, who was nominated by former President Barack Obama in 2013 to be the nation’s Surgeon General. The US Surgeon General is the country’s top public health doctor, providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury. The Surgeon General also oversees the US Public Health Service Commissioned Corps, a group of over 6,000 uniformed officers who are public health professionals and whose mission is to promote and advance the health of Americans.

Dr Murthy was born in 1977 to immigrant parents from India. When he was three years old, the family moved to Miami, Florida, where his parents established a medical practice. He went on to study at Harvard, where he graduated magna cum laude in 1997 with a Bachelor of Arts in Biochemical Sciences. In 2003, he earned an MD from Yale School of Medicine and an MBA from Yale School of Management.

During these years he also launched a major initiative to advance healthcare in the developing world. While still a Harvard freshman in 1995, he co-founded VISIONS Worldwide, which he led for eight years. The organisation, run by undergraduate, graduate, and professional school students, describes its mission as improving health in developing countries as well as under-served communities in the United States. It also sends American students to India to train students and nurses to run AIDS-prevention efforts.

In 1997, Dr Murthy co-founded the Swasthya Community Health Partnership to train women as community health workers in rural India. He is also a founder of Doctors for America, a group of over 15,000 physicians and medical students supporting access to high quality affordable healthcare for all Americans.

In 2011, Dr Murthy was appointed by President Obama to serve on the US Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health medicine within the US Department of Health and Human Services. The group advises the National Prevention Council on developing strategies and partnerships to advance the nation’s health through prevention.

Two years later, when Dr Murthy was nominated by Obama to be Surgeon General, the move was met with strong resistance from the powerful US pro-gun lobby group, the National Rifle Association, which was outraged at previous comments he made declaring gun violence a threat to public health in America. Finally, on 15 December 2014, he was confirmed in the post by a senate vote and, at 37, Dr Murthy became one of America’s youngest ever Surgeon Generals.

“For the grandson of a poor farmer from India to be asked by the President to look out for the health of an entire nation was a humbling and uniquely American story,” Dr Murthy said after his appointment. “I will always be grateful to our country for welcoming my immigrant family nearly 40 years ago and giving me this opportunity to serve.”  

During his tenure, Dr Murthy created initiatives to tackle urgent public health issues. He released the first-ever Surgeon General’s Report on Alcohol, Drugs, and Health, working with the nation’s leading researchers to compile scientific data on addiction. He also declared that America should recognise addiction as a chronic illness, not a moral failing. His 2016 report on e-cigarettes emphasised the vulnerability of young people to the products and recommended that e-cigarettes be incorporated into existing smoke-free policies to prevent young people from accessing e-cigarettes.
Dr Murthy has also written extensively about the importance of greater diversity of cancer clinical trial participants with regard to race, ethnicity, age, and gender. Furthermore, he also focused on the problem of loneliness.

He said he was shocked by how often he encountered people suffering from severe loneliness during his medical career. Dr Murthy argued that loneliness in America has become prevalent enough to count as an “epidemic”. 

Asked by The Times of India to describe what he liked best about his profession, Dr Murthy responded: “I love being a doctor. It allows me to learn, teach, and build wonderful relationships. It enables me to be a part of a patient’s journey to better health, which is a privilege that I treasure. I have always found medicine to be intellectually challenging and personally gratifying. You never learn all of medicine. It requires constant work, study, and humility. Practising medicine is what has kept me grounded.”

Dr Murthy’s tenure ended soon after President Obama left office and President Trump was elected to the White House. On 21 April 2017, the president replaced Dr Murthy with his own appointee.

President Trump had propelled himself to power, in part by further marginalising immigrants and other vulnerable groups. This is despite US dependency on immigrant families to power many sections of the economy, not least the healthcare sector, which is highly reliant on foreign workers.

Rural healthcare

Figures show that Americans, especially in rural areas, depend greatly on immigrant doctors to staff local hospitals and clinics. More than one-in-four doctors in the United States were born in another country and many nurses, dentists, pharmacists, and home health aides are also immigrants.

“India, China, Philippines, Korea, and Pakistan are the top five origin groups for physicians and surgeons,” according to Ms Jeanne Batalova, a Senior Policy Analyst and Demographer at the Migration Policy Institute. Compared with US-trained physicians, foreign doctors are also more likely to practise in rural areas where there are serious shortages of doctors. They are also more likely to serve poorer patients on the government’s Medicaid programme, according to the Centers for Disease Control and Prevention.
Data from the Association of American Medical Colleges (AAMC) shows that by 2032, the United States will see a shortage of up to 122,000 doctors, and rural areas will be worst hit by the crisis. Yet immigrant doctors often face tough immigration and licensing barriers that prevent them from serving in these communities, according to the Center for American Progress, a non-partisan policy institute.

Immigrants are also paying a major role in the battle against the coronavirus pandemic that is devastating America. The latest data from the American Community Survey by the US Census Bureau shows that immigrants play a significant role in the pharmaceutical manufacturing industry, developing and producing vaccines and medicines that prevent infections, cure diseases, and save lives. The more than 132,000 immigrants working in the industry made up a quarter of the total workforce in 2018. In California and New Jersey, more than two-in-five workers in this industry were immigrants.

Immigrants in the pharmaceutical manufacturing industry have highly specialised skills that are critical in the fight against Covid-19. More than half of the immigrant workers in the industry held an advanced degree and about one-fifth of these immigrants were scientists. They include virologists, immunologists, and chemists, many of whom are working hard to study the coronavirus and find effective ways to prevent and treat the pandemic.

When it comes to medical innovations, immigrant scientists make major contributions in American hospitals as well, where new medications and treatments are developed and applied. More than two-in-five life scientists (43.2 per cent), such as biologists and health scientists, and one-in-three physical scientists (36.1 per cent), such as chemists in hospitals, were immigrants in 2018. They work closely with doctors, nurses, and respiratory therapists to improve the diagnosis and treatment of patients, especially during the pandemic.

Immigrants are also vital to the medical equipment and supplies manufacturing industry, which is rushing to meet the growing demand for ventilators and personal protective equipment in response to Covid-19.
Nearly 149,000 immigrants made up about 24 per cent of the workforce in this industry in 2018. In Massachusetts alone, one-third of all workers in the sector were foreign-born. About 30 per cent of immigrant workers in the industry were production workers, assembling and testing critical medical supplies ranging from face shields to protective gowns to parts needed in pulse oximeters and testing kits.

Another 142,000 immigrants are among the essential workers in pharmacies across the country, making up more than 15 per cent of the pharmacy workforce. At least half of the immigrant workers in this sector were pharmacists and pharmacy technicians. In several states, the industry is even more reliant on immigrant workers, including New York, where about 27 per cent of the workforce is foreign-born.

US immigrants’ storied contribution to medicine and science

Since 2000, some 40 per cent of the Nobel Prizes won by Americans in the areas of chemistry, medicine, and physics — 31 of 78 awards — were earned by immigrants. Historically, too, immigrants have blazed a pioneering trail in medicine and science after arriving in the US, among them German-born Albert Einstein, who was awarded the Nobel Prize in Physics in 1921. Less well known, perhaps, was biochemist Dr Gerty Cori, who emigrated from Czechoslovakia to the US in 1922.

Dr Cori was appointed a Professor of Biochemistry at the Washington University Medical School in St Louis, Missouri, in 1947. She collaborated with her husband, also a biochemist, in most of her research and they were jointly awarded the Nobel Prize in Physiology or Medicine in 1947 — along with Dr Bernardo Alberto Houssay of Argentina — for their work decoding a form of glucose, contributing to scientific understanding of the role played by hormones in metabolising sugars and starches.

Belgian-born Dr Albert Claude became a US citizen in 1941 and just over 30 years later he shared the Nobel Prize in Physiology or Medicine in 1974 for discoveries concerning the structural and functional organisation of the cell. He spent subsequent decades analyzing and mapping cell structures and their functions.

Dr Elizabeth Stern, born in Ontario, Canada, attended medical school at the University of Toronto and received her US citizenship in 1943. She became a Professor of Epidemiology at the University of California in 1963 and was one of the first researchers to specialise in the study of diseased cells.
Dr Stern published a study describing a link between herpes simplex and cervical cancer and her discovery is thought to be the first case study linking a specific virus to a specific type of cancer. Her work investigating cervical cells identified 250 progressive stages as the cells transitioned from healthy to cancerous, enabling earlier cancer detection and treatment.
Another famous immigrant was Dr Rita Levi-Montalcini, who was born in Turin, Italy, and studied medicine at the University of Turin, graduating in 1936.

Through World War II, Dr Levi-Montalcini lived under precarious conditions in Mussolini’s Italy. Barred from academic work and in hiding due to her Jewish ancestry, she conducted neurological research on chicken embryos in a makeshift lab in her own home.

Dr Levi-Montalcini moved to St Louis, Missouri in 1947 to accept a post there at Washington University, and she eventually became a dual citizen of the US and Italy. In 1986, she was awarded the Nobel Prize in Physiology or Medicine with biochemist Dr Stanley Cohen (PhD) for isolating a protein that contributed to embryonic cell growth, transforming scientific understanding of how cells divide and multiply. 

Today, one of America’s best-known doctors is also an Italian-American.
Dr Anthony Stephen Fauci, the grandson of Italian immigrants, is leading the US battle against the novel coronavirus. He has been Director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984 and has served under six US presidents.

After taking over as NIAID Director, he became known for his groundbreaking work in HIV-AIDS research, helping to develop effective drugs to scale back the mortality rate. He later led US government efforts to combat outbreaks of the West Nile virus, SARS, and Ebola, before returning to the spotlight this year with the arrival of the coronavirus pandemic.