The Covid-19 pandemic has laid bare gross inequities in health care access and use bolstered by myriad strictures placed upon immigrant communities under the Trump administration. As of December 2020, in 20 of 45 states reporting ethnicity data, the proportion of Latinx individuals diagnosed with Covid-19 was at least twice as high as would be expected based on population size. In 11 states, the proportion was more than three times as high. These data do not distinguish between native, naturalized, noncitizen, or undocumented individuals. However, given that 44% of US immigrants report Hispanic or Latinx ethnicity, it is clear that the current pandemic has disproportionately affected these communities during a period of hostility and nativism unprecedented in recent political memory. To better understand these disturbing trends, we performed a systematic review of evidence documenting the historical effects of anti-immigrant policies on health outcomes for the communities they directly affect.
We identified 32 articles evaluating the effects of punitive immigrant policies in the US passed after 1992. We found that undocumented individuals frequently reported refraining from or delaying seeking medical treatment due to fears of immigration enforcement. Even in cities with inclusive local immigrant policies, interviews with Latinx immigrants, health care professionals, and advocacy organizations revealed that documentation status still discouraged individuals from accessing care due to the overwhelming national immigration climate.
Anti-immigrant policies have profound and quantifiable effects on the health of women and children. For example, regions subjected to anti-immigrant laws saw significant declines and delays in prenatal care, as well as fewer prenatal visits among non-US-born women compared to US-born women of similar educational attainment. Similarly, the number of Latinx children presenting to pediatric emergency departments decreased significantly following the 2011 passage of Georgia’s House Bill 87. Among the Latinx children that did present for emergency care, their severity of illness was significantly increased.
Frequently, foreign-born Latinx women expressed feeling “trapped” by their inability to seek publicly-funded services which might lead to their being unjustly considered “public charges” and unable to apply for legal status. They also reported being subjected to increased racism and discrimination and at risk for deportation. Following the passage of Proposition 187 in California, which mandated that health care professionals report suspected undocumented patients to federal authorities, autism diagnoses in Latinx children decreased by 13%, suggesting a considerable decrease in health care use. Notably, diagnoses increased by 25-30% once the Proposition was suspended.
Not surprisingly, anti-immigrant legislation has also been shown to adversely impact parent emotional well-being and family dynamics, resulting in poor scholastic performance in school-age children.
Several studies demonstrated decreased use of outpatient mental health services by Latinx individuals. Not surprisingly, anti-immigrant legislation has also been shown to adversely impact parent emotional well-being and family dynamics, resulting in poor scholastic performance in school-age children. These effects were only heightened in children with a detained or deported family member who demonstrated significantly higher rates of suicidal ideation, alcohol use, and aggressive behavior.
The passage of anti-immigrant legislation was also associated with significant decreases in seeking all types of health care, including communicable diseases, sexually transmitted infections, and immunizations. Finally, studies demonstrated that a hostile anti-immigrant climate resulted in increased discrimination.
Many punitive immigrant policies have decreased immigrant access to and use of basic health care services while instilling fear, confusion, and anxiety in these communities. The Biden-Harris administration should urgently preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.
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