The recent upsurge of xenophobia in the United States, the United Kingdom, and elsewhere has resulted in a number of anti-immigration policies that range from added barriers to public assistance to threats of long-term detention and deportation. Research has shown that such practices have a direct negative impact on the ability of undocumented immigrants to access healthcare and lead to poor health outcomes. In addition, policies targeting undocumented immigrants also pose a threat to the health of lawfully residing family members and of the public at large.
Scared Away from Care
With increased pressure from Immigration and Customs Enforcement and the threat of deportation, undocumented migrants and their families go without necessary medical care. For some, this means refusal to participate in free and low-cost health programs, while others are wary of seeing a doctor at all.
Families Living in Fear
Mixed households that include a combination of citizens, documented, and undocumented immigrants are placed in a particularly precarious position. Some 16.7 million Americans live in a household with one or more undocumented relatives and over four million child citizens of the US have at least one undocumented parent.
Worried about exposing undocumented family members to law enforcement, many of these mixed households forgo critical public assistance programs that promote good health, such as Medicaid, SNAP, CHIP, and WIC. Additionally, the more stringent proof-of-citizenship requirements enacted by some states most frequently delay care for citizens and legal residents, as undocumented individuals are already barred from most forms of public assistance in the US. As a result of these and other factors, social service organizations in the US have seen drops in enrollment since Trump's inauguration.
In addition to barriers to healthcare access, the stress of living in a hostile and uncertain environment takes a major toll, especially among children. Living with such profound insecurity, these children are at high risk of developing stress-associated conditions, such as depression and PTSD, which can last for years to come. Pro-immigrant lawmakers have also expressed concern that these policies help to normalize anti-immigrant attitudes, which keep some children out of school.
The Threat of Communicable Disease
Such a high-stress environment can weaken the immune system, but it is far from the only way in which anti-immigration policies play a negative role in infectious disease management. When it comes to tracking and combating serious pathogens, epidemiologists and public health authorities rely on accurate reporting data of notifiable diseases. And anti-immigrant policies make this more difficult to accomplish.
In the UK, the National Health Service may soon share patients' digital demographic data directly with the Home Office Immigration Enforcement Team. In addition to keeping undocumented immigrants out of the clinic, some experts worry that this breach in confidentiality will discourage healthcare workers from reporting important epidemiological data out of concern for patient wellbeing.
These trends and predictions are especially troubling in the case of tuberculosis. Many immigrants come from countries where TB is endemic, which is why the NHS instituted a screening program for all non-UK-born individuals from such areas. If a latent TB infection is identified in primary care, it is then treated with appropriate antibiotics, which reduces the chances of developing the active transmissible form of the disease by 90%. Active TB requires significantly greater resources and attention to be resolved and can result in life-threatening, long-term, and sometimes permanent complications. Consequently, early detection and treatment are crucial for both individual patient health and in preventing the spread of multi- and extensively drug-resistant TB.
Public Health Hazards of Immigration Detention Centers
In the US, the ICE maintains a minimum of 34 thousand beds in its detention centers. Frequently contracted out to private for-profit prison companies, these detention centers are plagued by a lack of transparency and appropriate oversight. The refusal of ICE and its contractors to allow independent inspections of detention centers may be hiding conditions that can cost detainees much more than their freedom.
Risks for Detainees
In addition to the intrinsic stress of imprisonment, detainees are subject to a number of threats to their physical and mental health. Some of these facilities have been reported to have overcrowded housing conditions, which can make such group settings even more conducive to the spread of serious pathogens, such as TB. Conversely, solitary confinement poses its own threats, as its overuse can lead to permanent psychological damage. Such punitive measures are inappropriately and arbitrarily applied in US detention centers where detainees belonging to vulnerable groups, such as LGBT individuals and those with disabilities, are disproportionately targeted.
Even more disturbing, one recent independent review of ICE reports found substandard medical care to be responsible for the deaths of a number of detainees between 2012 and 2015. And this does not appear to have changed: Over the past few months, detainees have reported a lack of adequate healthcare training among detention center staff, along with the mismanagement of serious chronic health conditions, such as diabetes.
Impact on Local Communities
Like the previously mentioned barriers to healthcare, detention centers may contribute to the spread of pathogens, such as TB, throughout the general population. While detainees are initially held in local facilities, they are often transferred to remote locations, sometimes states away. If proper screening practices and precautions are not followed, detention center employees may carry TB and other infectious diseases home with them, spreading pathogens throughout small towns and rural communities.
Damaging an Already Porous Social Safety Net
The economic effects of anti-immigration policies represent a third major public health threat in the attack on important public programs: In the US, where the needs of many people living in poverty go unmet, communities cannot afford to lose the programs currently in place.
Economic Penalties for Sanctuary Cities
In January, Trump issued Executive Order 13768, demanding a withdrawal of funding from sanctuary cities that do not cooperate with ICE requests. Outside of law enforcement, all federal grants to these cities would be frozen. While an injunction against its implementation quickly followed — and was recently upheld — the future remains uncertain.
At the state level, conservative lawmakers have proposed similar legislation, withdrawing state funding from sanctuary cities. While this provision was ultimately removed from the version of the anti-sanctuary-city legislation SB4 recently passed in Texas, such measures are still under serious considerations in other states.
If enforced, cutting off government funding to sanctuary cities would have far-reaching negative health consequences for all local residents, not just immigrants, undocumented or otherwise. Because such cities are some of the most populous in the nation, a significant portion of the population stands to be affected. From nutrition and education programs for children to aid for homebound adults, cuts to government-funded programs will disproportionately harm the elderly, disabled, and impoverished.
The Drain on Finite Resources
The more tax dollars are spent on enforcing anti-immigrant policies, the fewer are available for much-needed public health and wellness programs. Such initiatives have a far greater potential to improve the lives of residents than ones designed to deny freedom to immigrants. Unfortunately, anti-immigration measures in the US have become big business backed by powerful lobbyists: The ICE detention bed quota mandate alone costs billions more annually than would less extreme measures, such as electronic monitoring or community-based programs.
For a happier, healthier constituency, policymakers must move away from the current trend of anti-immigrant measures.
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