A Champion for Ethical Policies on Migrant Health

Columbia Mailman health policy scholar and applied ethicist Thalia Porteny traces the launch of her academic career to her first job out of college. “Working with my counterparts in the U.S., it became very apparent to me that we lacked a good evidence base to advocate for access to care for Mexican immigrants abroad,” says Porteny, who was born in the U.S., grew up in Mexico, and worked as the deputy director of migrant health for the Mexican Ministry of Health. “I saw the need for data to advocate for this population, the value in getting the numbers, the stories, particularly for seniors.”

Now an assistant professor in the Department of Health Policy and Management, Porteny was graduating from her PhD at Harvard University in 2019 when the Trump administration redefined the U.S. public charge rule, making it much more difficult for migrants who might subsequently access certain safety net services—including healthcare—to gain permanent resident status. While those rules were loosened by the Biden administration, the variability and volatility of policy in the U.S. continues to have a negative effect on the health of migrants in the U.S.

“It’s not like health policy exists in a silo,” says Porteny, who has investigated barriers to implementation of community-based health initiatives among minoritized elders and the effect of the Affordable Care Act on healthcare coverage and access among California residents of differing immigration statuses. “There are so many things that people perceive to be safe or not—how people are treated in healthcare settings, how they’re treated on the streets—that affect their overall health.”

You’re bicultural, bilingual, and a migrant yourself. How do those facets of your personal experience affect your research?

Porteny: I really love mixed-methods research. The qualitative component means making sure that people are represented in my work through stakeholder advisory boards and community engagement strategies. We’re doing a lot of interviews and focus groups. I’m often confronted by people whose immigration status affected—or is still affecting—the decisions they can make about their healthcare.

What brought you to Columbia Mailman?

Porteny: The Department of Health Policy and Management is a perfect fit for me. I work with sociologists, lawyers, political scientists, health economists. It’s a very cool mix of disciplines and a supportive environment that really allows and encourages independent creativity and thought.

At Tufts you integrated ethics, aging, and community health; now you’re affiliated with the Robert N. Butler Columbia Aging Center. What projects are you currently pursuing?

Porteny: The burden of chronic kidney disease among older adults in the U.S. is extremely high. But if you’re an older adult, dialysis isn’t necessarily life-prolonging, so it’s a preference-based decision whether to do care in the clinic or at home or get a transplant. As a post-doc, I did research on a decision aid to help people make more informed decisions. Now I’m doing a pilot study with colleagues at Tufts and Columbia to adapt and culturally tailor that decision aid to Spanish-speaking, adults.

What are the unique concerns for Hispanic seniors with kidney disease?

Porteny: While the incidence among Latinos is about the same as other populations, the rate of advancing to kidney failure is much higher. That has to do with access to care due to restrictive policies and cultural barriers and other challenges related to the structural determinants of health.  For me, working on an intervention that can enhance better decision-making was a way to tackle these issues. The challenge will be how to disseminate these tools and how to tailor them to people’s reality. That’s part of the ethical dimension and tension that I’m dealing with. I’m thinking about how we can design tools in a culturally concordant way that feasibly meets the needs of the population.

What other research questions are you investigating?

Porteny: According to federal surveys, older adults working in community health centers seem to have better well-being and less turnover than other age groups. This is also true for people with limited English proficiency. Over the past 18 months—with seed funding from the Columbia Population Research Center—I’ve been working very closely with organizational sociologist Sorcha Brophy. We’re curious whether this is an opportunity to invest in recruiting and retaining adults who are nearing retirement, to support clinics in New York City that are understaffed, and under-resourced.

You coauthored a Lancet paper analyzing how the Mexican government’s reversal of universal health coverage negatively affected population health. What insights from that work would you underline for U.S. policymakers in this election year?

Porteny: One of the biggest takeaways is the importance of institutionalizing advances in policy—I don’t think it helps to dismantle health policies that extend coverage for vulnerable groups; It’s better to work with what we have. And when institutionalizing reform, build in input from people doing the implementation, as well as stakeholders and beneficiaries. Most times, the policy makers are not the policy implementers.