Strong immigration enforcement likely harming health among Hispanic adults

Aggressive federal detention and deportation policies in the United States have a chilling effect on health care use among Hispanic adults, including those with diabetes, new research by the Yale School of Public Health finds.

In the study, Yale's Abigail Friedman and Atheendar Venkataramani of the University of Pennsylvania's Perelman School of Medicine matched nationally representative survey data on non-institutionalized U.S. adults to filings of I-247 forms—one of the first steps taken to detain and deport undocumented immigrants—by states during the 12 months before they were surveyed.

Analyses linked increases in deportation enforcement to reduced use of health care services among Hispanic but not non-Hispanic adults, who are less likely to be directly affected by immigration enforcement activities. This relationship was also evident when researchers looked specifically at adults with diabetes, a condition in which poor disease management has extensive consequences for long run health and life expectancy.

Specifically, the researchers found that an additional 20 I-247 requests per 100,000 state residents would predict a 1% decline in having a regular medical care provider and a 0.6% decline in routine checkups among Hispanic adults. Implications were similar for Hispanic adults with diabetes: reductions of 0.9% and 0.7%, respectively.

"Given the structure of our analysis, these estimates would imply particularly large effects if they were driven exclusively by the undocumented population," said Friedman, associate professor of public health (health policy) at Yale School of Public Health. "It is more plausible that our findings reflect changes in behavior among documented and undocumented Hispanic adults. This would also be consistent with other work finding effects of immigration policies on U.S. citizens in mixed-status families."

The findings are published July 6 in the journal Health Affairs.

While not assessed in the study, the researchers suggested that fear of deportation may have discouraged undocumented people from seeking COVID-19 testing and treatment, potentially increasing the disease's spread in Hispanic communities and contributing to higher-than-average COVID-19 mortality rates in the U.S. Hispanic population.

"Our results highlight an urgent need for health care systems, practitioners, and public health agencies to not only track effects of immigration policies on health and health care, but also develop inclusive methods to ensure care for people who may retreat into the shadows," Friedman said.