Why Protecting Safe Access to Health Facilities for Everyone Should be a National Priority

The Trump administration’s aggressive immigration enforcement stance has caused immigrant communities to fear that spaces formerly considered safe may not continue to be safe to visit or use. This fear and uncertainty has made immigrants more reluctant to access health facilities, courthouses, schools, and various other public settings.

Over the past month, many health facilities have reported significant increases in missed appointments by their immigrant patients. Patients are afraid that immigration agents could arrest them either at a health facility or when they’re on their way to an appointment. The CEO of Alliance Medical Center in Santa Rosa, Calif., recently told the health and medical news website STAT that “twice as many patients as normal” had canceled their appointments the previous week, “some saying they were afraid of immigration officials.” STAT reported that “one man, who is a U.S. citizen, missed an oncology appointment [at the medical center] because his caretaker wouldn’t drive him, fearful of being stopped.”

Another primary care physician, in Massachusetts, whose patients are mostly immigrants told STAT that she has seen a 50 to 75 percent drop in the number of patients keeping appointments. Anecdotal reports of immigration agents either near health facilities or roaming parking lots have resulted in immigrants’ rights organizations and health care providers being compelled to reach out to the communities they serve to try to allay concerns about possible immigration enforcement at health care facilities.

Although U.S. Immigration and Customs Enforcement (ICE) as well as U.S. Customs and Border Protection (CBP) have policies in place to discourage immigration enforcement activity at or near locations considered to be “sensitive,” including health facilities, these policies don’t do enough to allay fears. They provide “guidance,” but the guidance is hardly enforceable. (The guidance is laid out in ICE and CBP memos that were issued in 2011 and 2013, respectively.) The U.S. Department of Homeland Security’s (DHS’s) statement that the guidance on sensitive locations remains in effect (see Q26) is similarly insufficient.

DHS and its agencies need to go further than issuing guidance through internal memorandums. Instead, they need to write and publish reasonable regulations that are strictly enforceable. They must prioritize our health—everyone’s health—over making immigration arrests at health care facilities.

Communities are healthier when everyone can get the health care they need, when they need it. Helping everyone in a community feel that they can visit their doctor without fearing that they may be arrested and deported can be the difference between a person receiving preventative care now and having to undergo emergency—and potentially life-saving—treatment in the future. Helping immigrant patients feel safe can also reduce the need for mental-health care, as it may shorten the “[p]rolonged exposure to serious stress” that immigrant communities are currently experiencing.

When Arizona enacted SB 1070, its drastic immigration enforcement law, in 2010, adolescent mothers stopped seeking care for themselves and for their babies. The law in effect authorized local law enforcement to use racial profiling to detain people officers suspected were not authorized to be in the U.S. Shortly after SB 1070’s enactment, health care and community service providers experienced a drop in appointments.

The enactment of SB 1070 had a significant negative impact on public health, according to a 2012 article published in the American Journal of Public Health, because it “changed health-seeking behaviors of residents of a predominantly Latino neighborhood by increasing fear, limiting residents’ mobility,” and reducing their use of health services.

A correlation between immigration enforcement and health care utilization had also been reported after the notorious, highly publicized federal immigration raid in Postville, Iowa, in 2008. A study found that after the raid on the Agriprocessors meat-packing plant in Postville, Latina mothers delivering babies within 37 weeks of the raid were more likely to have preterm births and lower-weight babies than babies born before the raid.

It is imperative that we learn from the past and take swift action now. Every member of all our communities needs to know that they are safe when going to the doctor, so that our current—and future—generations can be as healthy as possible. Ensuring that immigrants seeking medical care are safe—and feel safe—is an obligation not limited to advocates and health care providers. It’s also the responsibility of the government agencies that currently are scaring would-be patients away from getting the care they need, to everyone’s detriment.