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<title>Outside / Inside: | NLM</title>
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<h1>Immigrants&#8217; and migrants&#8217; experiences with U.S. health care have changed over the past 130 years.</h1>
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<p>Twenty million people, mostly from Southern and Eastern Europe, came to the United States during the era of &ldquo;new immigration,&rdquo; between 1890 and 1924. </p>
<p>At ports of entry, health officials screened new arrivals for contagious diseases, physical defects, and psychiatric problems.</p>
<p>Many immigrants dreaded the inspections, which could be humiliating, frightening, and even painful.</p>
<p>Despite the sometimes demeaning and arbitrary health inspections, only about two percent of new immigrants would be excluded from entering the country because of medical reasons.</p>
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&ldquo;Germs do not recognize nationality.&rdquo;
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<p>Germs do not recognize nationality. However, at different times in U.S. history, Irish, Jewish, Chinese, Mexican, and other immigrant groups have been stigmatized as disease carriers.</p>
<p>Medical campaigns that focused on people&#8217;s ethnicity or national origin were not effective methods of disease prevention. Instead, they led to discrimination and sometimes danger for immigrants and migrants.</p>
<p>Lillian Wald, a nurse and reformer who was herself of German-Jewish heritage, established the Henry Street Visiting Nurse Service on New Yorks Lower East Side, the worlds largest immigrant neighborhood, in 1893.</p>
<p>Visiting nurses could play a crucial role in reducing death rates, in helping immigrants adjust to life in the United States, and in advocating for the rights of these “strugglers on a foreign soil.”</p>
<p>The idea that health care should be inclusive and should address the needs of immigrants evolved throughout the 20th century.</p>
<p>After the Immigration Act of 1924 ended mass immigration, some public health efforts began to focus on migrant agricultural workers, both domestic and foreign.</p>
<p>In the late 20th and early 21st centuries, local governments, private organizations, and medical practitioners sought new ways to provide care to migrants and immigrants.</p>
<p>Immigrants also took action on behalf of their own health and rights. They established hospitals and clinics, led public health campaigns, and pushed back against exclusion, stigmatization, and discrimination.</p>
<p>Health initiatives by and for immigrants and migrants have promoted the idea that health care should be available to all, regardless of nationality, citizenship, or immigration status.</p>
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Nurse and reformer Lillian Wald believed that the care provided by visiting nurses could change the lives of individuals and communities.
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