"I'm Sorry, I Can't Hire You because of That": Examining the Role of Employment and Exclusion on Health and Well-Being among U.S. Asylum Seekers.

Employment is a social determinant of health, providing differential access to health insurance, social networks, and other resources that influence health trajectories. Asylum seekers are a subgroup of immigrants who have fled persecution in their home countries and with both precarious immigration status and employment access while they await adjudication of their asylum claims. We explored U.S. asylum seekers' experiences at the intersections of immigration, employment, and health and wellbeing. English and Spanish-speaking asylum seekers (age >/=18 years old) were recruited predominantly from an academic medical center-based Asylum Clinic. Interviews were conducted over the phone by a bilingual research coordinator, recorded, transcribed, and analyzed thematically. We identified four themes: (1) Work as essential yet inaccessible within the asylum process, marked by waiting, limited ability to access basic necessities and health services, and people resorting to desperate methods to obtain income; (2) Underemployment, which involved suboptimal opportunities due to devaluing of experience in their home country, transportation challenges, and competing demands; (3) Workplace inequity and exploitation; and (4) Employment as a source of stability, identity, and purpose. Our study highlights the employment challenges faced by U.S. asylum seekers, which can harm their health and wellbeing. Increasing pathways to employment during the asylum adjudication process can be one mechanism for promoting health and wellbeing in this population. Further, asylum policy, and the labor regulations connected to it, must be examined through the lens of structural vulnerability.