Bioethics Forum Essay

Three Lessons from Leah

My colleague Leah Zallman, MD, MPH, died on November 5. Two days earlier – Election Day – she had walked to her polling place to vote. On her way home, she was hit by a pickup truck while crossing a street. Leah was 40 and had two young sons. The officiant at her funeral noted that two people had received her transplanted organs.

Leah was a primary care physician at Cambridge Health Alliance, where she cared for immigrant patients in East Cambridge, Mass. She was also one of the nation’s most distinguished researchers on immigrant health. At the time of her death, she had published 50 papers and was about to launch a new research center.

Leah was a crucial participant in The Hastings Center’s 2018 convening on creating systems of safety for immigrant health. She was a warm, generous colleague who was integral to my thinking and learning. She was always booked and she always made the time. Whenever I was in Cambridge pre-pandemic we would meet at Porter Square Books before she headed to clinic. I always imagined that the bookstore’s cafe opened so early just to accommodate Leah’s schedule. She described herself as a part-time Montessori teacher and would light up whenever she talked about her boys.

The loss of Leah Zallman has been devastating to her family and friends and the Boston-area immigrant health community. This loss has rippled across overlapping national networks of clinicians, attorneys, human rights advocates, health policy scholars, and community-based service providers who knew Leah or relied on her studies. Here are three things I learned from Leah that will continue to be touchstones for my work:

“Duh” studies about cost provide crucial data for policy reform: Leah’s special expertise as a quantitative researcher was clarifying how much undocumented and other low-wage immigrants contributed to public and private insurance programs versus how much was expended on these populations. She called these her “Duh” studies, as in, Duh, undocumented immigrants are a working-age population, so they pay into Medicare – let’s figure out how much they contribute. Leah’s studies and her willingness to mentor fellow investigators have contributed to policymaking and public knowledge.

Communicating about health justice for undocumented immigrants is difficult and necessary. Leah spoke the language of human rights and health justice. She was realistic about the limits of this language when presenting her findings to different publics. As she would say, mention “human rights” and you risk losing half your audience. Leah recognized the challenge of explaining how undocumented immigrants pay taxes that support federally funded programs: by using false Social Security numbers in industries where use of unauthorized labor is widespread and employers may avoid direct knowledge of this reality. As the field of bioethics turns toward health justice, we will continue to learn from Leah’s insights about framing the health-related needs and rights of immigrants and challenging their social marginalization.

Practitioners cannot make health justice on their own. As a working physician, Leah recognized the instinct to try to “make justice” for individual patients facing barriers to needed health care due to inadequate insurance or the chilling effects of immigration policies. At our 2018 convening, she was the source of the crucial observation that frontline practitioners need leadership support and validation for collective, measurable efforts to improve and innovate in the care of socially marginalized patient populations. Equity cannot be built on workarounds.

During the Covid-19 pandemic, she was an innovator in the effective use of primary care systems to reduce pressure on hospitals under surge conditions.

All who were privileged to know and work with Leah Zallman will miss her brilliance, warmth, and informal charm. Her meticulous research helps us all to tell the story of what immigrants give to this nation and what they should receive from this nation.

Selected papers by Leah Zallman:

Zallman, Leah, et al. 2019. “Care for America’s Elderly and Disabled People Relies on Immigrant Labor.” Health Affairs 38(6), June. https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05514

Zallman, Leah, et al. 2018. “Immigrants Pay More in Private Insurance Premiums than They Receive in Benefits,” Health Affairs 37(10), 1663-68. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0309

Zallman, Leah et al. 2016. “Unauthorized Immigrants Prolong the Life of Medicare’s Trust Fund.” Journal of General Internal Medicine   31, 122–127 (2016). https://link.springer.com/article/10.1007/s11606-015-3418-z

Zallman, Leah, et al. 2013. “Immigrants Contributed an Estimated $115.2 Billion More to the Medicare Trust Fund Than They Took Out in 2002-09.” Health Affairs 32(6), 1153-60. https://doi.org/10.1377/hlthaff.2012.1223

Nancy Berlinger is a research scholar at The Hastings Center.