Increased fear and “toxic stress” are preventing many undocumented immigrants from seeking adequate healthcare, negatively affecting both individual and public health, a new report finds.
The report, released this week by the Center for Health Progress, focuses on the immigration policies of Trump’s administration, including his executive order on public safety, the repeal of a program protecting undocumented immigrants brought here as children from deportation, and the travel ban. The premise is that “immigration policy is health policy”: Not only do anti-immigrant policies cause unhealthy distress among immigrants themselves, the report argues, but that distress can burden the public healthcare system as people avoid seeking healthcare services except in emergencies.
According to the report, deportations in Colorado and Wyoming were up 145 percent in 2017 since the passage of Trump’s executive order on immigration. And a 2018 survey of Denver healthcare providers conducted by the Mile High Health Alliance shows that among those polled, 88 percent have seen a decrease in appointments made by immigrants and refugees, and 75 percent have seen an increase in cancellations and no-shows by this population. The Pew Research Center estimates that about 200,000 undocumented immigrants were living in Colorado as of 2014.
“The culmination of these policies is really affecting immigrant health across the country,” said Joe Sammen, executive director of the Center for Health Progress. “The increased enforcement, the executive orders and the public narrative is all leading to increased fear and stress, and that leads to a lack of people going into clinics. It’s a big deal. Long term, the impacts are going to be dire.”
Dr. Kristine Rodrigues, a pediatrician who works in emergency services for Denver Health but spoke to The Colorado Independent on her own behalf, said she has noticed the effects of these policies firsthand.
“I’ve seen kids hyperventilating, having panic attacks when their parents are taken into custody by [immigration officials],” she said. “If your mother gets taken away from you and you don’t know what that’s going to mean, that’s terrifying. It can have huge impacts on development and mental health, not just in the moment, but for the rest of their life.”
Mayra, who is undocumented and chose not to share her last name, came to the U.S. when she was 21 years old for one reason: to send money back to her ailing parents in Mexico so they could buy medicine. Now, more than a decade later, the mother of three said her own children are showing signs of stress and fear related to immigration policy.
“My oldest daughter, she’s all the time asking me, ‘What do I have to do, to keep you and my dad with me?’ And it’s getting worse everyday.” Her daughter is 10 years old.
Her son, who is 14 and also undocumented, is starting to wonder why he should bother trying in school. Without DACA, the program protecting young immigrants, college feels like an impossibility. “We just try to talk to them about being patient, to try to enjoy their lives,” she said. “I mean, they’re kids.”
Sammen described what the report called the “pyramid of vulnerability,” in which immigration policies affect not just undocumented immigrants but their families, friends and communities. With children in particular, he said, “just because their parents are undocumented, there’s no reason for them to be uninsured — but they are.”
Two of Mayra’s children are U.S. citizens, but they still don’t have insurance. Mayra and her husband both work two jobs, putting their income level above the threshold for Medicaid. If her kids get “really, really sick,” she takes them to the medical center, but otherwise she makes do with natural, at-home remedies.
She said going to the doctor is almost prohibitively expensive, since she and her husband pay cash. “It’s kind of like, you don’t go to the doctor unless you really, really need to go,” she said. Preventative services like pap smears are pretty much out of the question.
That’s a problem, Sammen said, and not just for individuals. “When immigrants are being pushed out of our healthcare system because they’re staying in the shadows, their preventative care — which includes vaccinations — will be pushed out,” he said. “That pushes up costs for the whole system. Just because immigrants don’t have coverage doesn’t mean that they don’t get sick.”
Rodrigues, who also conducts public health research, notes that immigrants and refugees, regardless of status, already face decreased access to healthcare. “Cultural barriers, language barriers, financial barriers; it’s well documented. This is an already at-risk population, and these policies have made that even worse.”
Sammen says that making the connection between “seemingly unrelated” immigration policy and health policy is important, but that he also hopes Colorado will take action moving forward to make sure immigrants feel safe seeking healthcare. “We have the opportunity as a state to create a community that includes everybody,” he said.
As for Mayra, she’s remaining optimistic, but she’s gearing up to have a difficult talk with her kids. “It’s never the right time to have a conversation about, ‘Okay, if Mommy doesn’t come back home, you need to do this,’ but we need to do it. We need to have a Plan B, because we just don’t know.”
And sometimes, she wonders whether most would-be immigrants understand the tradeoffs that accompany the economic opportunities of moving to the U.S.
“I feel like many people come here and when they go back, they say, ‘Oh yeah, it’s fine, we have a job,’ but they don’t explain that we don’t have any access to healthcare, that sometimes we don’t eat the entire day because we work two jobs, that sometimes we don’t sleep our eight hours that we need,” she said.
“They don’t tell us that you live with all the time thinking that, for example, you send your kids to school and aren’t sure you’re going to see them again at night.”