Lili Farhang

Lili Farhang
Co-Director
lili[at]humanimpact.org

Lili Farhang joined Human Impact Partners in December 2009 and serves as one of its two Co-directors. Guided by her long-standing belief that health is a product of social, economic and political forces, Lili works with community organizations, government agencies, and others to re-conceptualize how health is understood and how we can collectively improve health by taking action in, for example, land use, transportation, housing, incarceration, and labor domains. As one of the first practitioners of health impact assessment in the U.S., she has extensive experience in the management, research, and community engagement aspects of HIA – for example, she led the first ever community-based HIA in the country and has since conducted over a dozen HIAs. She also provides training and technical assistance to aspiring practitioners, using her practical experience to guide how HIAs are conducted, how public engagement is incorporated, and ultimately, how research that is meaningful and responsive to community and stakeholder needs is generated. Lili received her Master's degree in Public Health from Columbia University and her Bachelor of Arts in Sociology and Women's Studies from Brandeis University.

Public Health Awakened: A movement whose time is now

Donald Trump made many promises on the campaign trail, many of which were unconscionable to those working to advance health, equity, and justice. Those promises and the harmful and hateful rhetoric of the campaign are well embodied in Trump’s 100 Days Plan — a set of proposals articulating the Administration’s agenda and priorities.

If anything is clear from these initial weeks, it is that Trump and his enablers are ready and willing to act, often spitefully, on this regressive and anti-democratic vision of America.

About the plan, let us say loud and clear: There is no end to the harms that may be inflicted on people, families, and communities. Both because of the actual policies proposed AND because of the ethos of divisiveness and bigotry that undergird every element in this plan.

In this climate, public health advocates — especially those operating from a structural and social determinants framework — have endless opportunities to resists the harms to health. One of our first responsibilities is to understand, what is at stake for the health of communities?

Here’s a snapshot:

Illustration of social determinants of health
Original drawing of social determinants by Sam Bradd. HIP adapted this drawing to include impacts resulting from the 100 Days Plan. Learn more about the origins of this image and the indigenous communities it was created with at: http://drawingchange.com/gathering-wisdom-visuals-for-a-healthy-future/

In brief, you can see that every building block of health — at the individual, institution, or community level — is bound to lose, with the impacts disproportionately felt among black and brown folks, immigrants, queer folks, and others who don’t identify as part of our dominant society.

Today, many health stakeholders are setting their sights on protecting as much of the Affordable Care Act as possible, including the Public Health and Prevention Fund. It’s understandable. However, as people passionate to get at the root causes of poor health and health inequities, we must figure out how to align and be in solidarity with wider social justice movements to protect all these other elements as well. We must remember to keep our sights set on this big picture and figure out how to multiply our power and voice.

One way Human Impact Partners is doing that is through Public Health Awakened, an emerging movement organizing for health, equity, and justice — formed in response to the Trump administration. We work with social justice movements on strategic and collective action to resist the threats faced by communities of color and low-income communities and to create a world in which everyone can thrive. We are calling on public health nonprofits, government agencies, academics, and others to courageously step up and use their power — their evidence, expertise, voice, and resources — to protect and promote people’s lives and communities.

You can request to join Public Health Awakened.

 

One of our initial activities was to publish Public Health Actions for Immigrant Rights: A Short Guide to Protecting Undocumented Residents and Their Families for the Benefit of Public Health and All Society. You can read more about this resource in our recent blog post here.

We’ve also got a group of folks diving deep into a health-frame analysis of a few areas in the 100 Days Plan — immigration, infrastructure, ACA — to better understand the impacts and identify ways to respond.

For a long time, I lamented that ours is a profession that does not maximize its voice and power — and no doubt, I have been guilty of the hedging and risk avoidance that comes with my public health training. A community organizer I talked with described public health as “under-leveraged” and ripe to be organized.

Since the election, I’ve felt moved to confront this reality. There is no doubt at all that our time has come and the moment is now. If not now, in the face of all these risks, then when?

To stay connected with this work and other things Public Health Awakened will do, please join us.

Report-back from National Public Health and Criminal Justice Convening

On November 9, Human Impact Partners and the Vera Institute of Justice co-convened over 40 criminal justice advocates and public health practitioners from around the country at a groundbreaking, first of its kind convening. The event grew out of the idea that health and justice system leaders’ work in the pursuit of health equity, public safety, and social justice could be magnified by a powerful partnership across the fields of public health and criminal justice to advance these collective goals.

ConveningGroupPictureAn advisory committee – with leaders from JustLeadershipUSA, The Sentencing Project, Ford Foundation, WISDOM, and Drug Policy Alliance – helped HIP and Vera envision what the gathering could accomplish, and ultimately proposed a bold and audacious goal: to develop an alternative vision for a justice system that works to improve population health and wellbeing at every step and to develop an agenda for collaborative work to achieve that vision.

The convening was envisioned as a space to build relationships between people working at the intersection of public health and criminal justice and had an ambitious agenda. We began with participants recounting the modern history of mass incarceration and its disproportionate effects on communities of color. Participants spent time describing how they using a public health approach to issues such as drug policy and drug use, sentencing, over-incarceration, victims’ services, and reentry. Over and over, the group kept coming back to the significance of the current political moment and recognized that the progress we’re witnessing today was due to the committed efforts of community organizers – many of whom were formerly incarcerated and some of whom were in the room – who kept a constant spotlight on the injustices of the criminal justice system over many decades.

The group then turned to a discussion of their vision for an alternative justice system, and principles that should ground that vision. It was a robust dialogue, with participants highlighting the need to make a broad statement about our societal obligation for health and safety and that both the criminal justice and public health systems need to be transformed to focus on creating the social, economic, and political conditions necessary for all to thrive. This includes making the criminal justice system the choice of last resort for addressing social problems, and instead, upholding and supporting communities to overcome those challenges. The group agreed on the need to explicitly name race and racism as a root cause of poor health and over incarceration, and that the vision should be framed as a call to action. At the end, the group came to agreement on points of unity for the vision and clarity about who the vision was for. It was quite an accomplishment!!

Finally, the last part of the day focused on identifying a set of joint goals to move the vision forward. It was another rich conversation with many ideas of how the group could collaborate. The group was able to come to consensus on a set of research, communications, policy, and community building goals to advance together. Working groups are kicking off their efforts in the New Year, and we anticipate convening again in 2016.

We continue to be inspired by the energy and commitment of convening participants. A deep thanks to them for working hard and giving each other the benefit of the doubt as they explored what it means to be in relationship with one another. A special thanks to Mari Ryono – our fearless facilitator – as well as Ford Foundation for hosting the event and Open Philanthropy for funding it.

This work is part of HIP’s Health Instead of Punishment Program, which grew out of our recently adopted Strategic Plan. Contact us if you’re interested in learning more!

Assessing Health and Equity Impacts of the Proposed Reef Development Project in South Central Los Angeles

Today, Human Impact Partners, Esperanza Community Housing, Strategic Action for a Just Economy and other members of the UNIDAD Coalition are releasing the executive summary of the report Assessing Health and Equity Impacts of the Proposed Reef Development Project in South Central Los Angeles. Our report finds that the proposed Reef Development Project, as currently designed, will place thousands of neighborhood residents at high risk of financial strain or displacement, which could negatively impact their health in many ways.

The Reef Development Project plans for the total renovation and expansion of a commercial area in South Central Los Angeles, and would cover 9.7 acres of land. It includes a 208-room hotel, two high-rise condominium towers, 528 mid-rise residential units, and 21 low-rise live/work residential units. This project is meant to be big. And with big projects come big impacts.

We found that an estimated 4,445 renters who live within ½ mile of the proposed Reef Development Project are already experiencing housing cost burdens and could be at high risk of financial strain or displacement as a result of the development. An additional 39,311 renters who live between ½ mile and 2 miles of the project could be at moderate risk. Overall, 52% of the nearly 84,000 residents living within 2 miles of the project could be at risk of financial strain or displacement as a result of the Reef Development Project.

Residents of the neighborhood came to South Central seeking economic opportunity, and built a thriving community. Over time, however, the city began to engage in a variety of different policies that led to increased segregation, concentrated poverty, and limited opportunity. This was followed by prolonged civic disinvestment that has perpetuated poverty and segregation to this day. Displacement and financial pressures from the Development Project will happen within the context of ongoing challenges with housing affordability and homelessness that are happening in the area. Focus group participants from the area anticipated they may become homeless.

“I keep thinking, ‘What am I going to do if this doesn’t work out? Where am I going to go? Am I going to see my neighbors again? Where am I going to find this kind of community again? Going to have to start over. Going to be homeless, without a family.’” –Anayetzy

Residents are already struggling intensely to afford housing, and are engaging in a variety of methods to address this problem: by making difficult choices on what necessities to do without, by living in overcrowded and substandard housing, and by looking for additional sources of income. Despite these challenges, residents and small business owners in the neighborhood have developed strong social ties and a sense of attachment to the area, and they want to stay. Many of the residents and businesses in South Central have been in the neighborhood for 10-20 years or more.

Community residents who experience financial strain and/or displacement may experience a wide variety of chronic stress-related physical and mental illnesses, including anxiety, depression, hypertension, heart disease, obesity, diabetes, and sleep disorders. Additional constraints on health-protecting resources and exposures to health-damaging environments such as substandard and overcrowded housing could further contribute to a variety of negative health outcomes. Disruption of social networks can lead to additional health challenges, including exposure to fragmented social environments that have higher rates of violence and sexually transmitted diseases.

Based on these findings, our primary recommendation to the City and project developers is that the Reef Development Project presents a unique opportunity to engage in a cutting-edge trauma-informed approach to community development. Trauma Informed Community Building (TICB) is a new innovative approach to development that recognizes the existing community as assets and proposes that these assets—or people—are considered the building blocks for the future. We recommend that the developer and the City work together to ensure that the Reef Development Project is developed using the four guiding principles of TICB: 1) Do no harm, 2) Acceptance, 3) Community empowerment, and 4) Reflective process.

In addition, the report makes a series of recommendations to:

  • Produce and protect affordable housing
  • Prevent displacement
  • House and protect the homeless
  • Create good jobs and career pathways for local residents
  • Support small businesses
  • Maintain public transit use by local residents
  • Protect the safety and security of the community
  • Provide green space for neighborhood residents

The report was produced in partnership with Advisory Committee members from: Community Development Technologies, TRUST South LA, Physicians for Social Responsibility – Los Angeles, Natural Resources Defense Council, Public Counsel, St. Francis Center, Advancement Project, All People’s Community Center, Los Angeles County Public Health Department, Occidental College, and a community advocate/column writer.

The report was released at a press event today in Los Angeles. Speakers included:

  • Jim Mangia, MPH, President and CEO of St. John’s Well Child & Family Center
  • Holly Avey, Human Impact Partners
  • Cynthia Bryant, local business owner, student and resident
  • Erendira Morales, local resident
  • Beatriz Solis, The California Endowment
  • Benjamin Torres, President and CEO of CDTech

Visit www.humanimpact.org or unidad coalition website for the executive summary (English), executive summary (Spanish), full report (English), full report (Spanish), and links to a series of blog posts about the project.

Turning on the TAP: How Returning Access to Tuition Assistance for Incarcerated People Improves the Health of New Yorkers

Graphic illustrations by Rosten Woo. http://rostenwoo.biz/
Graphic illustrations by Rosten Woo. http://rostenwoo.biz/

Today, Human Impact Partners, the Education from the Inside Out Coalition, and our partners are excited to release a report that examines an often-overlooked aspect of providing college education for people in prison. Turning on the TAP: How Returning Access to Tuition Assistance for Incarcerated People Improves the Health of New Yorkers set out to answer the question: How will providing college education to people in prison affect the health and well-being of those people, their families, and their communities?

Our conclusion is that expanding access to college education for people in New York state prisons would benefit the overall health and well-being of the communities that formerly incarcerated people return to, as well as the individuals who receive the education, and their families. And yet, despite these benefits, funding through the state’s Tuition Assistance Program (TAP) – which provides grants to low-income New York residents to help them afford college – is unavailable to people who are incarcerated.

This wasn’t always the case. Until 1994, TAP and its federal equivalent, the Pell Grant Program, helped incarcerated people in prison enroll in courses offered by public and private colleges. Despite evidence of the benefits of correctional education, as part of the “tough on crime” wave that engulfed federal, state, and local policy-making in the early to mid-1990s, Pell and TAP grant eligibility was rescinded for people in New York State prison. After such funding was eliminated, in-prison college education programs in New York almost disappeared.

Today, there are approximately 53,000 people in New York state prisons, 59% of whom have a verified high school diploma and could therefore be eligible for TAP funding if it were made available to them. Legislators in New York State are considering S975/A2870 (2015), a bill that would repeal the ban on incarcerated people receiving financial aid for college education through TAP. Should the legislation pass, people in prison would have increased access to educational resources and, ultimately, experience increased educational attainment.

Data generated through the project shows how such legislation would be good for health and health determinants:The benefits of in-prison college education mean that when students return to the community, they engage in lower rates of crime and have a higher level of civic engagement when compared to other formerly incarcerated people returning to the community.

  • College teaches critical thinking skills that help people better understand and take responsibility for the consequences of their actions. It also improves their chances of getting a job, reuniting with their families, finding their place in society, not committing new offenses, and not returning to prison.
  • Benefits of in-prison college education include improved parenting behaviors, higher family income, increased likelihood that children and family members achieve higher levels of education, and reduced likelihood that children experience behavioral problems and get involved in the criminal justice system themselves.
  • College education improves relationships and reduces conflicts, resulting in a safer prison environment.
  • In-prison college education is a cost-effective investment in reducing crime and recidivism. Every $1 million spent on building more prisons prevents about 350 crimes, but the same amount invested in correctional education prevents more than 600 crimes.

Data from existing college education programs surveyed through the project show that lack of resources is one reason that only one-third of prison applicants are accepted for college study. If tuition assistance funding was restored, existing programs would be able to enroll over 3,200 people a year.

Based on such findings, the report makes a series of recommendations to ensure that such health benefits actually accrue – foremost among these is a recommendation to restore TAP funding for incarcerated people.

The report was produced in partnership with our Advisory Committee members from the Vera Institute of Justice, the Correctional Association of New York, the Fortune Society, Syracuse University, and the New York City Department of Health and Mental Hygiene. Over the past few weeks, these partners have released a series of blog posts focused on the issue of college education in prison. They were written from a variety of perspectives – including about recidivism and cost savings, human rights, community impacts, college environment impacts, and health impacts. Each of these partners has a compelling case to make about the value of providing college education to people in prison and the benefits to families and communities.

Our report – which ties these perspectives together – was released at an event today in Albany, NY. Speakers included:

Visit TurnOnTheTAPNY.org for a full electronic version of the report, as well as an executive summary, and links to all of the previous blog posts of our partners. Be sure to follow #TurnOnTheTAPNY to find out more about any additional activities related to these findings.

#TurnOnTheTAPNY

Compassion for Individuals or Working to Change the System?

Two recent stories about people’s generosity toward strangers moved me deeply – but also got me thinking about the gap between our willingness to help individuals and the need to address the roots of our society’s problems.

  • In Detroit, the Free Press featured the determination of James Robertson, who walked 21 miles a day to his $10.55-an-hour factory job, never missing a day of work. His last car broke down 10 years ago. There there’s no bus service along most of his journey, and area residents have repeatedly voted against funding the local suburban transit system. But a gofundme.com campaign – “Help James Robertson Get a Car” – quickly exceeded its initial goal of $5,000, raising more than $350,000 in just nine days.
  • In New York City, Humans of New York blogger Brandon Stanton had a chance encounter with 13-year-old Vidal Chastanet, who cited his principal at Mott Hall Bridges school in a low-income section of Brooklyn as a source of inspiration. Stanton visited the school and learned about principal Nadia Lopez’ efforts to show students they could aspire even the most elite colleges. He started a crowdfunding campaign that has raised more than $1.4 million to not only provide students with the opportunity to visit Harvard, but scholarships to help them attend.

I am truly grateful to the many folks who supported these campaigns. But I have to ask: What if the power of all these supporters was used for more transformational change to address the underlying causes of James Robertson’s and Mott Hall Bridges’ needs?

The funding campaigns were a transactional approach in that they helped in negotiating the existing system by providing simple, direct assistance to people impacted by the systemic failures of Detroit’s transit system and the Brooklyn neighborhood’s poverty and limited educational resources. By contrast, a transformational approach is one that works to shift societal policies, practices, and values towards solutions that change the way institutions operate.

Transformational solutions benefit not just one person or community, but also others facing the same challenges. Transformational solutions aren’t simple, can be expensive, and require significant political will – but they change the system in a more meaningful and lasting way. It’s the difference between putting a bandage on a wound and preventing the injury in the first place.

President Obama’s State of the Union address and his recently released budget makes a series of proposals for transformational changes – affordable child care, paid family leave, paid sick leave, universal preschool, tuition-free community college, workforce development, raising the minimum wage, criminal justice reform, comprehensive immigration reform – that would affect the lives of people in structural and sustainable ways. From a public health and health equity perspective, these proposals would make a significant contribution towards creating the conditions people need to live healthy lives.

Another advantage of transformational change: the people with the problem do the work of solving it. Every one of the president’s proposals has its roots in the strategic work of organizations and community members who advocate for structural solutions that affect the lives of low-income communities and communities of color nationwide. They know that the deep challenges experienced in their communities cannot be solved by the kindness of strangers alone.

This aligns with how we at Human Impact Partners think of our work to improve health and equity at a population level, rather than at the individual level. We’ve recently seen two public health departments – in Alameda County and in Minnesota – who are taking this approach in their work.

At HIP, more and more, we’re thinking of our contributions as part of a larger, more coordinated movement with organizers, advocates, public health practitioners, and others to change the decision-making context that ultimately creates the conditions for health and equity. I’m reminded of the words of Lilla Watson, an aboriginal anti-apartheid activist from Australia, in 1965: “If you have come here to help me, you are wasting our time. But if you have come because your liberation is bound up with mine, then let us work together.

Giving Thanks for Obama’s Bid to Bring Millions of Immigrants Out of the Shadows

This Thanksgiving, I have a lot to be thankful for: a healthy family, a roof over my head, a well-paying and secure job and a community I feel safe in. Most of all, I am thankful for the peace of mind of knowing my family will be here for me, day in and day out.

As I write this morning, up to 5 million more people who live, work, and love in this country also have the promise of knowing they will not be torn apart from their families and communities. Last night President Obama announced that he will grant deportation reprieves to many undocumented parents whose children are American citizens and legal permanent residents. Migration Policy Institute data shows who will be affected.

The president is exercising his executive powers to end the cruel breakup of families of children entitled to be here, and allowing them to remain and work here legally. Although it offers no path to citizenship, the order effectively ends the Secure Communities program that has resulted in the deportation of hundreds of thousands of immigrants, and local police can no longer routinely detain immigrants without papers.

What the executive order does, first and foremost, is create a reprieve for many mixed-status families who have been suffering from anxiety, stress and other ill health effects from the lack of legal status. In 2013, HIP released Family Unity, Family Health, an HIA to understand how immigration policy – specifically the ongoing threat of detention and deportation – influenced the health and well-being of children and families. Our evidence overwhelmingly showed that harsh and inflexible immigration policies were harming hundreds of thousands of children, and that their health suffered needlessly as a result of laws that threatened to tear their families apart.

We learned that nationwide, an estimated 4.5 million children who are U.S. citizens lived in families where one or more of their parents was undocumented. Between 1998 and 2012, at least 600,000 children who were citizens had a parent or guardian deported. If deportations were to continue at 2012 rates, in 2014 alone, more than 152,000 children who were citizens would have a parent taken away from them.

I earlier wrote in detail about findings from our report. To summarize, these children and their families live with anxiety about the future – fearful that arrest, detention or deportation will tear their families apart. And anxiety and fear are only part of the damaging impacts of their families’ precarious legal status: Children of the undocumented may also suffer from poverty, diminished access to food and health care, mental health and behavioral problems and limited educational opportunities—particularly when a parent is arrested and detained or deported.

What was new about HIP’s research was that we shined a light on health consequences that are rarely discussed in the immigration policy debate. Our findings were highlighted extensively in national and international news coverage.

When the children of undocumented immigrants live daily with the effects of losing a parent, or anxiety about losing a parent, they are fearful that their families will be torn apart. The trauma of actual separation – or simply just the fear of it – can imprint on a young child’s brain, and result in what researchers call toxic stress response. The effects of immigration policy matter not just to children’s health today, but pose risks to health as these kids grow into adolescents and adults.

The new executive order goes a long way towards alleviating these risks. Tens of thousands of fewer children will experience poorer physical health outcomes. Over 100,000 fewer children will show signs of withdrawal. Over 125,000 fewer children will live in a food insufficient household. As Paul Krugman put it in today’s New York Times:

Today’s immigrant children are tomorrow’s workers, taxpayers and neighbors. Condemning them to life in the shadows means that they will have less stable home lives than they should, be denied the opportunity to acquire skills and education, contribute less to the economy, and play a less positive role in society.

There is still much more to do. It is unknown whether the order will be maintained under future administrations, and the order excludes access to food stamps, health care subsidies, and other public benefits – the very supports that create optimal health for children and families. And another 5 million people – including the parents of DREAMers and farm workers – who are not covered under the order will be forced to remain in the shadows.

But let us be thankful for progress – even as we vow to continue to work for just and humane immigration policies that place family unity and children’s health before fear, exclusion and punishment.

Wages are a Public-Health Issue

The Commissioner of the Minnesota Department of Health, Dr. Edward Ehlinger, just published this article on MinnPost.com. We recently referenced the work of his Department in a February blog post about how public health should get more engaged in minimum wage campaigns. Read the article to learn more about why Dr. Ehlinger “prescribes an increase in the minimum wage to improve the lives and health of vulnerable children and families.”

The Public Health Community Must Support Minimum Wage Campaigns

In his State of the Union address, President Obama called on Congress to increase the federal minimum wage to $10.10 from $7.25 per hour. As discussed in New York Times coverage of the address, 21 states and the District of Columbia have a minimum wage higher than the federal rate. Across the nation, from Minnesota and Massachusetts to Seattle and Washington, D.C., efforts are underway to increase the minimum wage either through the legislative process or the ballot box.

This should be welcome news for public health practitioners. Income is one of the strongest and most consistent predictors of health and disease. Even modest increases in the minimum wage can lead to benefits for adults and kids – by decreasing the risk of premature deaths in adults, by decreasing the risk of early childbirth, and by increasing high school graduation rates among the children of workers earning higher wages.

But where is the public health establishment on this issue? Few state or local public health departments or national health organizations are engaged in organizing campaigns to adopt a higher minimum wage. This must be remedied, particularly given our collective interest in acting on the social determinants of health, reducing health inequities, and affecting population-level health change.

Opportunities for the public health community to engage in minimum wage campaigns are many. Public health departments can generate data and evidence to demonstrate how income affects health, provide comment letters and public testimony, and write op-eds and other materials to raise awareness. By lending their support, practitioners also can establish relationships and build credibility with social movement organizations and identify new roles for themselves in advancing social policy. But above all, we will show that we view ourselves as part of the larger movement for social justice.

There are only a few examples of public health departments that have done or are doing this. The first HIA in the U.S. was conducted by the San Francisco Department of Public Health and examined the health effects of a proposed living wage ordinance in the city. Today, HIP is working with social justice advocates – for example, in Minnesota – to encourage public health departments to weigh in on state proposals to raise the minimum wage.

The occupational safety and health community led the organizing in the 19th and 20th centuries to adopt safer workplace standards. Let’s continue the tradition of these public health champions by providing our skills, relationships, power, and passion to the many minimum wage campaigns being waged across the country – and thereby improve the health and well-being of those who need it the most.

As Bills Await Governor’s Signature in Sacramento, Health and Equity Must Come First

The end of the California legislative session brings intense speculation about which laws the governor will sign and which he will veto. In the session’s final days, legislators sent Gov. Jerry Brown some 400 bills, which he must sign or veto by Oct. 13.

Many of the bills Brown is considering – on law enforcement, employment, the environment and education – have implications for health and well-being, and may also alleviate inequities in communities across the state. HIP didn’t do an HIA analysis on any of these bills, but much of the research we and others have done helps understand what is at stake. Momentum for this kind of informed decision-making is growing nationwide, and we’re hopeful that consideration of health and equity benefits and harms will only increase in California.

Here are two measures being considered by the governor and evidence that speaks directly to health considerations:

AB 4, the TRUST Act: Prohibiting police from turning undocumented immigrants over to federal authorities unless the immigrants already have a violent felony on their record. This measure directly affects many of the findings reported in Human Impact Partners’ Family Unity, Family Health HIA. If passed, the TRUST Act would reduce the threat of detention and deportation for California’s 2.7 million undocumented immigrants, many of whom are parents of children who are U.S. citizens.

Our HIA found that the mere threat of detention or deportation had profound effects for these children and their families. Nationwide, if deportations continue at 2012 levels, consequences would include poorer child health, behavioral and educational outcomes as well as poorer adult health and reduced lifespan, increased levels of poverty, and diminished access to food.

Though targeted to the federal level, our HIA made a recommendation to effectively adopt the TRUST Act as a way of reducing the harms of current policies. We found that such a policy would help to turn around the wide range of health harms we identified that result from the threat of detention and deportation.

AB 10: Increasing the California state minimum wage from $8 to $10. The first HIA in the U.S., conducted by Dr. Rajiv Bhatia at the San Francisco Department of Public Health, examined the effects of a proposed living wage ordinance in San Francisco.

The analysis documented the benefits to adult health and children’s education achievement attributable to the adoption of a living wage of $11 per hour. The findings were significant, and predicted that adoption of the increased wage would result in decreases in the risk of premature death by five percent for adults 24 to 44 in households whose current income was around $20,000. For the children of these workers, a living wage would also result in an increase in high school graduation rates and a decrease in the risk of early childbirth. San Francisco legislators used findings from the research in adopting the ordinance, and it became law in 2003.

For both of these proposed policies, the evidence of health and equity benefits is compelling. In making his decisions, Gov. Brown should make public health and community equity the highest priority.

Family Unity, Family Health

This week HIP released an HIA report and website highlighting an often overlooked aspect of the current heated debate on immigration policy reform. Family Unity, Family Health: How Family-Focused Immigration Reform Will Mean Better Health for Children and Families sets out to answer a question: how does immigration policy, specifically the threat of detention and deportation, influence the health and well-being of children and families?

Our conclusion is that the health and well-being of children who are citizens, but whose parents are undocumented, suffers needlessly because of harsh and inflexible immigration laws which, at any moment, threaten to tear their families apart.

Nationwide, an estimated 4.5 million children who are U.S. citizens live in families where one or more of their parents are undocumented. For this report, we examined more than 30 scientific studies from Harvard, University of Texas, Urban Institute and many others, and we also used data provided by government agencies. Our evidence overwhelmingly showed that current policies are harming the health and well-being of hundreds of thousands of children of undocumented immigrants, many of whom are U.S.-born.

We learned that between 1998 and 2012, detention and deportation policies affected at least 600,000 children who had a parent or guardian deported. If we look at this number differently, if deportations continue at current rates, just this year alone, more than 152,000 children who are citizens will have a parent taken away from them.

Other examples of what we can expect in the next year under that scenario:

• An estimated 43,000 children will suffer a deciline in physical health, and over 100,000 will show signs of withdrawals, a behavioral problem that leads to poor school performance

• Over 125,000 children will live in a food insufficient household, and may experience hunger or malnutrition

We supplemented our research with surveys and focus groups of people living in mixed-status families. Although it wasn’t a representative survey, we were able to confirm our findings and understand how the immigrant community experiences these policies on a day-to-day basis. Our survey data showed that undocumented parents are deeply aware of how their lack of legal status and the constant threat of detention or deportation affects their children.

•  Nearly 30% of undocumented parents reported that their children were afraid either all or most of the time, and nearly half reported that their children was anxious.

•  Furthermore, when we analyzed responses to a series of specific questions about stressful experiences, our findings showed that almost three-fourths of parents reported that a child had shown symptoms with post-traumatic stress disorder.

Interviews with physicians who work with immigrant communities also confirmed that many undocumented immigrants would not seek medical help for their children out of fear that their legal status will be detected. This was borne out in our survey as well: almost 40% of children of undocumented parents had not seen a doctor in the past year.

When the children of undocumented immigrants live daily with the effects of losing a parent, or anxiety about losing a parent, they are fearful that arrest, detention or deportation will tear their families apart. The trauma of actual separation – or simply just the fear of it – can really imprint on a young child’s brain. This can result in what researchers at Harvard call toxic stress response. 

It’s clear that effects of immigration policy matter not just to children’s health today, but pose risks to their health as adolescents and adults far into the future. As policymakers debate the specifics of immigration reform, a proposal that puts family unity first is the best opportunity to turn around the wide range of health harms we identified.