Anti-immigrant sentiment threatens public health, study shows

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Anti-immigrant rhetoric during the Presidential campaign coincided with a decrease in undocumented immigrants seeking healthcare, according to a study.

It’s disturbing because immigrants need healthcare not only for themselves, but for the good of public health. A community does not benefit from a population that is unhealthy. It becomes a public health problem.

“In this cohort study, there was a significant decrease in primary care use among undocumented patients during a period of increased anti-immigrant rhetoric associated with the 2016 presidential campaign, coincident with an increase in emergency department visits among children and a decrease in inpatient discharges among adults, with the latter possibly attributed to a decrease in elective admissions during this period,” concluded the authors of the research.

Lead author Dr. Joseph Nwadiuko and colleagues conducted the research. Nwadiuko comes from the University of Pennsylvania Perleman School of Medicine, Philadelphia. Other authors represented Fielding School of Public Health at University of California, Los Angeles, John Hopkins School of Medicine in Baltimore, and Duke University School of Medicine.

Study looks at 20,211 adults and children

“In this cohort study based on a single-center analysis of health care use among 20,211 adults and children, there was a 34.5 percent decrease in completed primary care visits among undocumented children and 43.3 percent decrease in completed primary care visits among undocumented adults between June 16, 2015 (the start of the Trump campaign for presidency, associated with an increase in anti-immigrant rhetoric), and May 31, 2018, which was significantly greater than patients in the Medicaid group,” the authors found.

They examined Medicare and Medicaid records and compared them to records of immigrants not eligible for Medicare or Medicaid.

Illegal immigrants often are afraid of the healthcare system. They fear they might get into trouble or be deported for seeking healthcare without paperwork.

Undocumented immigrants and barriers to care

“Approximately 11 million undocumented immigrants live in the US,” the authors explain. “Undocumented populations face substantial, multifactorial barriers to health care, including lack of insurance, racism, limited English proficiency, complex and unfamiliar health systems, transportation, and lower household incomes.

“Even when available, health care use may be suppressed by both policy-driven changes in immigration enforcement levels and fluctuations in anti-immigrant sentiment.”

It’s a dangerous dichotomy. Immigrants of color are at greater risk of contracting COVID-19.

The study does not say whether conditions have normalized since the election of President Joe Biden. It does cite previous research, however, that shows how anti-immigrant sentiment impacts a community’s health.

The chilling effect: Immigrants’ distrust of healthcare system

“The association between restrictive or unfavorable immigration policies and health care and social service use, also known as the chilling effect, has been well documented,” the authors explain. “In a study of U.S. national Medicaid registration data from 1992 to 2003, decreases in Medicaid participation among citizen children of noncitizen parents corresponded to spikes in immigration enforcement.

“Decreases and delays in initiation of prenatal care in North Carolina and Arizona followed both states’ adoption of provisions increasing local law enforcement cooperation with federal immigration officials.”

The authors pointed out evidence anti-immigrant sentiment is up. “In Maryland, hate crimes increased by 31 percent between 2014 and 2015 and by another 45.8 percent again between 2015 and 2016, with most associated with the victim’s race or ethnicity,” they wrote. “Chu analyzed the association between anti-immigration rhetoric during the pre-2016 election period and prenatal care, finding in their study sample of approximately 17,000 women who had given birth between August 2011 and July 2017 a significant increase in days until the first prenatal visit and a decrease in both total prenatal visits and mean hemoglobin level (an indicator of inadequate prenatal care) among Latina immigrants, coincident to a pre-election inflection of Google search terms such as Make America Great Again, Mexico wall, and deportation.”

Racism detrimental to a community’s public health

The one-of-a-kind study illustrates how racism can affect a community’s overall health.

“The change itself may be attributed to rhetoric-induced hypervigilance (increased anticipation of being a target of discrimination), which has been well documented,” the authors explained. “A large number of undocumented immigrants in the region served by the health system fled from violence in Guatemala, Honduras, and El Salvador. As a result of destabilization in those nations, many of these immigrants become fearful of legal authorities and have symptoms of posttraumatic stress disorder, including hypervigilance.”

In the U.S., the immigrants face new challenges. “This hypervigilance is accentuated by racist harassment in the U.S. community as well as routine questioning regarding nationality and citizenship status during registration at some health facilities. As such, even in the absence of a clear upsurge of community immigration enforcement, the sudden and substantial shift in anti-immigrant and anti-immigration campaign rhetoric could lead them to avoid all but the most necessary of health care encounters.”

Residing in so-called sanctuary cities doesn’t seem to alleviate immigrants’ fears. “Even in California (considered a sanctuary state), only 4 percent of undocumented immigrants considered hospitals a safe space and delayed emergency departments visits by a median of two to three days owing to concern of being apprehended by immigration services,” the authors explained.