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Public Health Workers Must Join the Struggle for Immigrant Justice

Public health professionals can take concrete actions to meet the needs of immigrants and their families.

A Honduran mother holds her ill daughter as she's examined by a doctor outside a shelter for travelers in the migrant caravan, on November 21, 2018, in Mexicali, Mexico.

Part of the Series

Immigration researchers have often taken a bird’s eye view of migratory patterns across the globe, or considered the ways in which newly arrived immigrants “assimilate” into their new communities.

Given the increased immigration enforcement actions under former President Obama and current President Trump, many immigration researchers have focused on local immigration issues, and come to advocacy organizations and networks to guide and shape the implications of their work in their home communities.

As a public health researcher who aims to understand local policies in a broader context, I sat down with Lili Farhang and Sari Bilick to talk about Public Health Awakened — an national network formed soon after the November 2016 election in response to the Trump administration’s federal policy agenda.

Lili Farhang is co-director at Human Impact Partners (HIP), a national nonprofit organization based in Oakland, California, that uses research, advocacy, capacity building and field building to challenge the inequities that harm the health of communities.

HIP works in deep partnership with grassroots groups and movements around housing and displacement, criminal justice and economic security issues, jointly identifying policy priorities and using an inside/outside approach to changing the social determinants of health.

Sari Bilick is an organizer with HIP and coordinates Public Health Awakened, an initiative of HIP. Bringing together a group of more than 1,500 public health professionals in government agencies, academic institutions, clinical settings and others, Public Health Awakened mobilizes members to work with social justice movements to advocate for a world in which everyone can thrive and to resist the threats faced by marginalized people.

Nicole Novak: Why are your members concerned with immigration enforcement?

Lili Farhang: Core principles of public health include equity, valuing every life and preventing harm. The Trump administration’s plan to deport millions and separate families contradicts these values and ethics. The members of Public Health Awakened came to the field of public health because of these values and a desire to create healthy communities. As public health professionals, we recognize immigration raids, detainment, deportation and family separation as public health issues. In the current political climate — where even the constant fear of deportation can have a profound impact on health — we are experiencing a public health crisis that not only affects undocumented immigrants, but documented immigrants, their families and their communities.

Public health departments, clinics, hospitals and other health organizations provide important services to immigrants. When communities fear deportation or raids, they are less likely to use health services. There may be distrust of government institutions, uncertainty of how personal information is used or fear of being stopped by immigration agents. In this environment, it is easy to feel powerless. By recognizing the power we hold, public health professionals and the institutions we work for can take concrete actions to make sure services are inclusive, accessible, safe, and meet the needs of immigrants and their families.

What is the role of public health agencies and organizations in protecting immigrants from the fear of deportation?

Sari Bilick: In January 2017, Public Health Awakened published Public Health Actions for Immigrant Rights Guide. The guide describes concrete actions that public health departments, clinics, hospitals and other health service organizations that play an important role in protecting the health of immigrant clients can take to protect immigrants from the fear of deportation. Briefly, these include:

  • Promote health agency policies to provide services to all people, and to ensure all people understand that they are welcome at the agency
  • Support cities, counties and states that pledge to provide sanctuary in different forms to undocumented residents, and to reject 287(g) agreements
  • Advocate that local and state governments create a legal defense fund for undocumented residents
  • Connect undocumented clients and their families with legal rights and community organizing groups
  • Join and build alliances that cross issue areas and include immigration
  • Encourage and support the efforts of sister agencies, including in criminal justice, to protect undocumented people and their families
  • Encourage labor enforcement to adopt and implement policies that protect worker rights, regardless of immigration status
  • Review other health agency policies and services, considering how undocumented populations may be impacted
  • Work to change a narrative that portrays undocumented people negatively

By examining internal policies, procedures and services, while working with other agencies and educating clients and staff, public health organizations can ensure immigrant families receive the services they need, and also create welcoming spaces where the immediate fear of deportation and detention is reduced.

It is critical that we take a “health in all policies” approach, one in which health equity is being considered across sectors. While many decisions that affect the health of undocumented people and their families are outside of public health’s direct control, public health agencies often hold relationships with decision makers in other sectors. Public health agencies have an opportunity to use those relationships to improve health and advance policies that promote health equity across agencies. Decriminalization and harm reduction are part of public health prevention. ​It is in the interest of public health to support policies that unify families rather than separating them.

Many people who do not work with or are not themselves part of immigrant communities are not familiar with how the threat of detentions and deportations might affect health. If you could tell them one thing about this threat, what would you say?

Sari Bilick: Whether or not we are part of immigrant communities, we interact with immigrants in our daily lives — in our neighborhoods, workplaces, businesses, schools and communities. It is important to recognize these connections and work together to create healthy communities for all.

If people fear being stopped by police, detained and potentially deported, immigrants may change health-seeking behaviors for themselves and their family members, including:

  • Missing medical appointments or using health clinics less often
  • Using parks and community services less
  • Not reporting domestic violence and gender-based violence

This year, as there has been heightened climate of fear of detention and deportation, our organization did a research project in the Rio Grande Valley in Texas illustrating that the threat of deportation creates a climate of fear​ for undocumented as well as documented immigrants, their families and their communities.

This infographic from a previous research project illustrates how immigrant detention can have many consequences, for both individual and community well-being.

Many immigrants in the project experienced stress, anxiety and hopelessness​ due to fears of deportation for themselves or members of their community. Children, in particular, experienced direct impacts, including poverty, diminished access to food and health care, mental health and behavioral problems and limited educational opportunities. An extensive body of research shows that these factors are fundamental determinants of child health today, and their adolescent and adult health in the future.

It’s frequently stated that advocacy movements are siloed — that is, advocates do not work across issues. Do you see links between the public health movement work you do and that of other social movements?

Lili Farhang: Within the field of public health, issues are often siloed. Many health advocates don’t do work across issues, or only focus on health care advocacy without recognizing that advocacy around the social determinants of health is also necessary. If we recognize that factors like housing, education, transportation access, structural racism and immigration status affect health, then it becomes necessary to work across issues. Our perspective is not to activate the health sector to engage in social justice movements at the expense of any other social movement, but as leverage for those movements.

For example, in both Oakland, California, and Chicago, Illinois, public health professionals and health care workers recently came together with immigrant rights organizers and advocates at conferences to lift up the health impacts of immigration raids and deportations on communities and to strategize how to work together to advance health. These events and the conversations coming out of them are just a first step in working across issues and recognizing the ways in which different fields can support each other’s efforts.

As public health professionals, we can harness our data, stories, and experiences to validate lived experiences and to help move decision makers to consider the consequences of their actions in a different way. It is by working across issues and by bringing in diverse perspectives that we can be most effective as advocates.

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