Immigrant Families – A New Report

In the last two years, the immigration debate has become louder and arguably less civil. Political platforms and decisions based on fear have dominated the conversation, but behind the conversation are approximately 23 million people. The number includes those lawfully present as well as those who are undocumented. It includes around 12 million children who are legal citizens born in the United States, but whose parents are non-citizens.

How does the current climate affect the health and daily lives of these millions of people?

Kaiser Family Foundation wanted to find out more, and so began work with a research company to interview families in 8 cities in 4 states. They also interviewed pediatricians who work closely with immigrant families in these cities.

Their findings are significant and troubling. Among those findings are these:

Fears of deportation and overall uncertainty have increased in the last year. These fears extend to those who are here lawfully.

"I feel unsettled. Even though we already have the green card, if we do not apply for citizenship, I don't think we can be at ease." -Korean Parent, Chicago, Illinois "Uncomfortable and unstable; we feel that in any moment a new rule could be issued leading to expelling us and sending us back." -Arabic-speaking Parent, Anaheim, California "There's no stability. [The President] could write a tweet on Twitter tomorrow and turn things upside down." -Arabic-speaking Parent, Anaheim, California

Children are facing increased fear that their parents will be deported and/or that they will end up having to uproot their lives and go to their parent's countries.

"My children would come home from school and say that at school they were saying that all parents would be deported..." -Portuguese-speaking Parent, Chicago, Illinois "All the children, even if they were born here, are fearful. They fear that anytime they'll come back from school and won't find their parents there." -Latino Parent, Chicago, Illinois "In Brownsville we have about 1,700 homeless children in the schools. Many of those children are homeless because of a parent that was deported or placed in detention." -Pediatrician, Texas

Pediatricians and participants said that bullying and discrimination at work and at school has increased in the past year.

"They get bullied...told things like, 'now you and your family will have to leave.'....And so, even though those kids don't actually have to worry about their immigration status, I think obviously a child, they don't know the details of how the system works." -Pediatrician, Pennsylvania "I work in landscaping, and we're working and they see you working...and they just start yelling stuff at you..." -Latino Parent, Fresno, California

Families are making changes in their daily lives and routines base on fear.

"I am also concerned because if anything happens to us on the street, if we get assaulted or something, we won't even be able to call the police because they will see we are immigrants." -Latino Parent, Boston, Massachusetts "...but now around six or seven in the evening you won't find anyone in [the neighborhood]... due to the fear we all feel about what is going to happen." -Latino Parent, Chicago, Illinois

Increased fear in kids is resulting in behavioral issues, mental health problems, and psychosomatic symptoms.

"The kids who come in with concerns that you can kind of trace back to anxiety are usually the upper elementary age students, like the 3^rd, 4^th graders, to middle school students... 7^th and 8^th grade, who have nonspecific complaints like abnormal pain or headaches or decreased appetites... And then, in kids that are in the junior high to high school age range, it's a little more overt: sadness, decreased appetite, not wanting to engage in usual activities, decreased in-school performance, those sorts of things." -Pediatrician, Arkansas

Across the board, pediatricians are concerned with the long-term consequences of this environment.

"I think that we are going to have a generation of kids, who, especially in our immigrant homes, who are going to have more adverse childhood experiences than they would have. So, I think that we're just setting up this generation of kids to have higher incidence of chronic disease, higher incidence of poor mental health, higher incidence of addiction..." -Pediatrician, California "I think a huge worry is that children who have problems that are minor and fixable now... that, if those children go untreated, those could end up being bigger problems in the future that are going to be harder to treat and are really going to impact the child's quality of life." -Pediatrician, Pennsylvania

The health and well-being of immigrant and refugee communities is something I care deeply about. Yes, it is my daily work as a public health nurse, but it is more than that. It is something that is deeply embedded into who I am as a person. I have only benefitted from the many in my life who are immigrants and refugees, and it is troubling to me that there is documented fear and anxiety that is affecting the daily lives of those I care about.

What might we do to change this? What might we do to help those whose anxiety is affecting their health and the health of their families? The answer is bigger than any one of us, but some of the things that can help are these:

• Know the law* and be able to point people to the law. Some of the fear is based on rumor. It is important to squash rumors and to point people to laws.
• Sensitive locations. Both ICE (Immigration and customs enforcement) and CBP (Customs and Border Patrol) consider hospitals and other health care facilities to be "sensitive locations." Both agencies have issued memoranda that say that immigration enforcement actions are to be avoided at sensitive locations, including at hospitals and other health care facilities, unless urgent circumstances exist or the officers conducting the actions have prior approval from certain officials within the enforcement agencies.
• Right to remain silent. While immigration enforcement at health care facilities is limited by the "sensitive locations" guidance, immigration agents may enter a public area of a health care facility without a warrant or the facility's consent and may question any person present, but those people have the right to remain silent.
• Reassure your patients. Educate and reassure patients that their health care information is protected by federal and state laws.

An appeal to those of us who are Christians:

Caution and compassion are not incompatible; instead it is reasonable to assume that they work well together. The state is not the master of the church. If you are part of a faith community, none of this prohibits you and your faith community from reaching out to those who may be affected. They do not prohibit you from reaching out, in love, to refugees and immigrants in your midst. It is a lot easier to wear a sign and yell than it is to make a hot meal and take it to strangers, to check in with sick neighbors, to pray for those who are anxious and fearful. We must be willing to do more than react emotionally. We must be willing to put our loudly voiced news feeds into real action.

"The ability to love refugees well doesn't require a certain party affiliation. It doesn't require you to vote a certain way. But it does require us to show up, to step across "enemy" lines, and to choose love over fear." from Preemptive Love

*See this document for more information.

Note: Communicating Across Boundaries has never been, and never will be, a political blog, but I see this not as a political issue, but as a human health care issue. The brief is much longer and more detailed than this blog post. This post is simply to raise awareness of the issues that result from an environment of fear and anxiety.