Immigration Is A Public Health Issue, But Not For The Reasons Some Politicians Claim

With a new myth-busting report, experts hope real health concerns can become part of a “more human” immigration debate.
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As the United States and other global powers discuss immigrants, asylum-seekers and refugees through a purely political lens ― implementing policies, physical structures, and restrictions to deter migrants from coming into their countries ― global experts are urging policymakers to rethink restrictions placed on immigrants’ access to health care.

That’s the purpose of a report released this week by the University College London-Lancet Commission on Migration and Health ― a group of 20 experts from 13 countries, including the U.S., who have spent the last two years analyzing past evidence and gathering new data on the subject.

“[It’s] about positioning health within the migration debate ― to make the migration agenda more human and people-centered,” Dr. Mesfin Tessema, senior director of health at the International Rescue Committee, told HuffPost.

Tessema, who was not part of the commission, will be presenting the report’s findings and recommendations to improve the public health response to migration at the United Nations’ Intergovernmental Conference on the Global Compact for Migration in Marrakech, Morocco, this weekend.

Contrary to stereotypes that migrants are a burden on public health services and are bringing diseases with them ― a narrative that’s been repeatedly perpetuated in the United States by President Donald Trump, conservative news commentators and, most recently, Fox News host Tomi Lahren while discussing the migrant caravan at the U.S.-Mexico border this week ― the commission found no evidence that migrants pose a risk to public health in their new country. Instead, they were shown to be generally healthier than non-migrant populations and to contribute positively toward the nation’s sustainable development.

“Every time you make immigration policy more punitive or increase the chances of deportation, you’re driving immigrants away from seeking health services."”

- Megan McLemore, senior health researcher at Human Rights Watch

In the United States, specifically, research has found that immigrants paid more toward medical expenses than they withdrew, meaning they were a “low-risk pool that subsidized the public and private health insurance markets,” according to a Harvard Medical School and Tufts University report released in August. That same report also found that immigrants made up 12 percent of the population but only accounted for 8.6 percent of total U.S. health care spending.

But despite their contributions to the country, immigrants in the United States face significant barriers to health care. Megan McLemore, senior health researcher at Human Rights Watch, told HuffPost that legal immigrants often struggle to access health care due to a five-year delay in being able to apply for Medicaid, and because undocumented immigrants living in the United States often avoid preventive care for fear of deportation, ultimately relying on emergency health services. “It’s a public health issue,” she said.

Terry McGovern, co-author of the UCL-Lancet report and chair of Columbia University’s Heilbrunn Department of Population & Family Health told HuffPost, “One interesting thing to note is that the immigrant health of Latinos, for example, often declines in the U.S. due to poor health care, health food, total lack of accessible mental health services.”

Despite accumulating evidence of health care needs among immigrant populations, the Trump administration continues to propose policies that could further restrict these communities’ access to health services. In September, the administration proposed making it more difficult for immigrants who have enrolled for public benefits like Medicaid to either enter the U.S. or permanently stay here.

“Every time you make immigration policy more punitive or increase the chances of deportation, you’re driving immigrants away from seeking health services,” McLemore said, adding that Human Rights Watch is set to release an extensive response to this proposal because “it undermines all public health objectives that you can think of.”

McLemore also said her organization is collecting anecdotal evidence that shows immigrants are already hesitant to enroll in public benefits programs for fear that the proposal may take effect.

“All of this is going to become a serious public health problem because whenever you are denying people health services [or] reducing access to health services, you are increasing the risk to the public health,” she said.

The situation is particularly dire for refugees, asylum-seekers, and other displaced populations.

According to the UCL-Lancet report, the majority of migrants that cross international borders worldwide are either students paying for their education or labor migrants who contribute to their host country’s economy. A significantly smaller proportion of this population are individuals forced to leave their home countries due to persecution, conflict or disaster.

However, this small fraction of global migrants ― refugees and displaced populations, of which nearly 53 percent are children ― have the highest risk of exploitation, disease and death because they usually lack access to equitable health services in their home country and initially live in cramped refugee camps or shelters with substandard health services when they first arrive in their host country.

In the United States, this narrative can be seen playing out along the U.S.-Mexico border, where asylum-seekers crossing into the country are often placed in crowded detention centers where adults and children face an increased risk of disease transmission and mental health consequences.

Data on immigrants detained in the United States is hard to come by, but human rights advocates have worked diligently to put together a picture of what health care for these communities look like. A Human Rights Watch report released in June had independent medical experts analyze 15 cases of immigrant deaths in detention from December 2015 to April 2017. In eight of the cases, physicians found “inadequate” medical care had “likely” contributed to the immigrants’ deaths.

While these deaths represent a fraction of the tens of thousands of immigrants in federal custody ― including nearly 13,000 children, according to The New York Times ― the HRW report said the fact that the deaths were due to “botched” emergency responses and “poor quality of care” by officers and medical staff raised serious concerns.

“Human Rights Watch has documented and continues to document inadequate health care in detention and that situation is just getting worse as the numbers of those detained increase and the facilities are overcrowded and are inadequately staffed,” McLemore said, adding that the UCL-Lancet report only confirms what their research has shown in the U.S. for years.

McGovern said the discrimination and restrictions that migrants and asylum seekers face in the United States because of their status leave them vulnerable to negative health outcomes. Not to mention, restricting access to preventive care could mean a higher long-term financial burden on the country.

“Preventive health care is definitely much more cost-effective than refusing to give people treatment or ... putting people in detention centers where infectious disease can thrive.”

- Terry McGovern, co-author of the UCL-Lancet report

“I think this report firmly establishes that preventive health care is definitely much more cost-effective than refusing to give people treatment or separating families so that children are traumatized or putting people in detention centers where infectious disease can thrive,” McGovern said. “All of those things are just going to ultimately cause more catastrophic health problems.”

The solution, as far as the UCL-Lancet commission is concerned, is for governments like the United States to implement policies that give all migrants universal and equitable health care.

“When people are excluded from health services, they don’t seek care ― that means that chronic diseases and other conditions go untreated or unaddressed,” Tessema said. “That has long-term consequences for the individuals and for the health system overall, which has to now care for people who would have otherwise been treated earlier with simpler and more cost-effective means.”

McLemore agrees: “Long term, when you have people either avoiding health care or going to emergency services when they get very ill ― that’s the most costly kind of health care there is.”

But for McGovern, it’s clear that neither health costs nor public health concerns are what’s currently driving U.S. immigration policy.

“Unfortunately in the U.S. we are just not dealing with evidence and facts, we are dealing with hatred and racism and xenophobia,” she said. “And the long-term impacts of that on kids, on families, on communities is going to be truly terrible because as we keep showing our economy is very much dependent on labor migrants. It’s kind of a false dichotomy: We are dependent on the people who we are criminalizing.”

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