Tag Archives: Immigration

Together we are Stronger: Intersectionality of Immigration and Incarceration

Last week the Haas Institute for a Fair and Inclusive Society launched We Too Belong: A Resource Guide of Inclusive Practices in Immigration and Incarceration Law and Policy at a half-day event that brought together the contributors to share their stories, their work, and engage in meaningful dialogue.

Immigration is often thought of as a Latinx issue, and incarceration thought of as a Black/African-American issue. However, the event centered on the intersectionality of these issues and highlighted that the immigration and criminal (in)justice systems are highly racialized. For those of us who have been impacted and involved in one movement or another, this is nothing too new — we’ve experienced the entanglement.

Experiencing the entanglement of immigration and incarceration is one thing, but this event generated the necessary uncomfortable conversations about how the systems have us working in silos, pointing fingers at one another, and fighting for resources. These approaches perpetuate oppression, fuel violence, hate, and pin us against each other. Working together makes us stronger, and is a key part of the process for liberation. I believe that these conversations need to be had among groups and organizations working on social justice and public health issues.

Particularly, I want to share a few nuggets of wisdom that panelists at the event announced and that I think anyone working for a more just and equitable society could reflect on:

  • Build transformational relationships instead of just transactional ones. We need to show up as much as possible for our partners; our work is not over after we’ve completed a project.
  • Elevate lived experiences, highlight non-traditional and inspiring stories, and create unified narratives. This is quite a task to accomplish especially while also recognizing that communities are not homogenous, even within the immigrant community, for example.
  • Expand the level of human concern in the policy work we do. This means making sure we use inclusive language and check ourselves.
  • Work towards what we want, not just towards what we don’t want or what we’re fighting against. Let’s use our energies effectively!

The overarching message I took was that while we work to dismantle oppressive systems, we must remember that at the core of it all are individual humans. Yes, poverty and racism are hurting and killing us, but we should equally acknowledge that we are also strong, resilient, and powerful.

The communities most impacted by policies are the ones with the solutions, we are not saving anyone—this was very clear based on the faces, stories, and histories panelists shared. Our task in public health (or whatever sector we work in) is to elevate that strength. By elevating community strength, we elevate our collective strength.

After each presenter shared their work and their story, the event attendees repeated these beautiful phrases, that reminded us how intertwined our work together is. I invite us all to contemplate these words as we continue our work together: Thank you. Thank you for your story. Thank you for your work. My freedom is bound to yours.

It’s Time for a Feminine Perspective

Last year I wrote a blog about the stress response, explaining how chronically stimulating the fight-or-flight response to stress can have a host of impacts on health.

But there’s another, less well known, response to stress. In the animal world, females are often responsible for caring for the young. When threatened, they may not be strong enough to fight off the aggressor, and fleeing would mean leaving their young vulnerable to attack. So the females will often group together to surround the young, creating power in numbers to overcome the threat. Researchers have labeled this strategy tend-and-befriend.

This concept should be considered when we assess the impacts of policies. Whether you respond with fight-or-flight, or with tend-and-befriend, each option is a response to what your brain perceives as a threat. If you think about it, many policies are created in response to what some groups consider to be threatening situations or conditions.

Consider school discipline. Disruptions in the classroom, fights between students, bullying and other threats of violence are considered threats by many students and teachers. “Zero tolerance” policies that mandate suspension or expulsion of students who engage in these activities might be considered a fight-or-flight response, by fighting back.

On the other hand, restorative justice policies, which focus on repairing the harm caused by misbehavior and getting students to take responsibility for their actions, might be considered a tend-and-befriend response. These policies suggest that the threat of a lack of discipline (and potential violence) should be addressed by tending to those who are perpetrating the violence, as well as those who have experienced it, encouraging them to befriend each other. Research shows that this approach, and other trauma-informed approaches to improving education outcomes, are more effective – both in reducing the threats and also in improving health and education outcomes.

Let’s look at another example. Human Impact Partners recently assessed the potential health impacts of California Proposition 47, which proposed reducing six low-level, non-serious offenses of drug possession and various forms of petty theft from felonies to misdemeanors and redirecting resources to services to treat the mental health and substance abuse problems underlying many of these offenses. Labeling these behaviors as felonies is often seen as “tough on crime” – fighting the threat of criminal activity.

But providing treatment instead of incarceration tends to the needs of those with mental health and substance abuse problems rather than harshly criminalizing them. Again, research shows that providing mental health and substance abuse services is more effective in reducing crime, as well as improving physical and mental health outcomes.

There are many other examples. For instance, it often costs less and is more effective to take care of people by providing paid sick days, protecting against wage theft, and keeping families intact – tending to their needs – than to deny access to resources or enforce harsh immigration policies and then deal with the domino effect of more expensive public resources required afterward.

Tend-and-befriend policies, reflecting a traditionally feminine perspective, can be equally, if not more, effective than the flight-or-fight approach. If we’re truly interested in improving health outcomes, we should look to them more often.

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.

Practitioner or Renaissance Woman?

I’m in the final stretch of completing a Health Impact Assessment, and I’m struck by how many different skills are needed to do it right. Our model at Human Impact Partners – combining rigorous research, evidence-based analysis, community participation and a strong focus on equity – requires HIA practitioners to master an array of roles:

  • Project manager. Every successful project has a strong manager. A typical HIA must be coordinated with a variety of stakeholders, cover a range of topics, and be done on time (often more quickly than you’d ideally like). As project manager, you outline the tasks, who’s responsible for them, and how long each task should take to stay on time and budget. You coordinate with all team members and partners so everyone is clear about the plan. Throw in a changing timeline and super-busy community partners, and your management skills are really tested.
  • Technical expert. HIA is inherently multidisciplinary, so you’ll need to learn about the subject of your study. You may be unfamiliar with your target, available policy options, your partners’ positions, or the broader political context. You may need to explore a social determinant of health you’ve never researched before, such as critical race theory, cross-race understanding, or parental deportation. By the end, after doing a literature review, sourcing and analyzing the data, and communicating to partners about what you found, you’ll be an expert in something new.
  • Meeting facilitator/public speaker. These skills come into play as you uphold the values of democracy and equity. Stakeholder engagement is critically important; to do this, you’ll need to communicate about your HIA, get people engaged in the process, and facilitate input from stakeholders in a public forum. You’ll need input and agreement on your scope, the impacts you’re predicting and the recommendations you are making. It helps if you’re comfortable in front of a group and have creative ways to keep people engaged.
  • Diplomat. One of the most difficult tasks is prioritizing and limiting your research while still responding to stakeholder and partner concerns. For many HIAs, you can’t examine everything, and to attempt too much means compromising depth for breadth. It takes diplomacy to be strategic with the most compelling findings and recommendations while striking a balance between what your partner wants and what the budget allows.
  • Research designer and analyst. To recognize and analyze the pathways through which your proposal may impact health requires an understanding both of how individuals respond to changes in their environment and how on a larger scale those changes influence an entire population’s behaviors, outcomes and inequities. You start by conceiving the impact pathways. Then you must identify indicators and measures of behavioral, social, and environmental factors. After you and others on the team collect and analyze the data, you still must visualize how you’re going to present it.
  •  Communications expert. Communications are the icing on the cake. The final report is a record of all your efforts, presented for the affected populations, collaborators, decision-makers, journalists and the public to see. As editor of the report you must be strategic about what you include, exclude, and highlight and how you disseminate the results so your HIA has an impact.

You may not be an expert in each of these skills, but being an HIA coordinator does require familiarity and some level of proficiency in all of them. This incredible variety is one of the reasons I love my job. It is never routine, you’re always learning, and you bring people together through the very important shared value of health.

Overcrowded Prisons, Immigration Reform and the Power of the Presidency

In his fifth State of the Union Address, President Obama declared that he would defy a do-nothing, obstructionist Congress and use his executive authority to address the ever-growing gap between the richest Americans and the rest of us. “America does not stand still,” the president said, “and neither will I. So wherever and whenever I can take steps without legislation to expand opportunity for more American families, that’s what I’m going to do.”

Raising the minimum wage for federal contract workers and other executive actions to fight inequality are important steps, and they are directly connected to improving public health. But there are other crises the president can tackle with the power of his office. Two of the most serious are, like inequality, strong determinants of public health.

In an op-ed in The New York Times, Bill Keller points to “the famously shocking numbers of Americans behind bars.” With 2.3 million prisoners, the incarceration rate in the United States is by far the highest in the world – with only 5 percent of the world’s population, we have locked up nearly one-fourth of the prisoners on earth.

Much of the increase in incarceration has come from harsh mandatory sentences for non-violent drug offenders and people with mental health issues – people who need treatment, not punishment. HIP’s Health Impact Assessment on reducing the prison population in Wisconsin found that sending non-violent offenders to treatment rather than prison would mean healthier lives, stronger families and safer communities. Treatment is much more likely to help people recover from substance abuse, reduce the need for future psychiatric care, and improve the health of children by keeping their parents at home, not behind bars.

And yet, writes Keller, Obama – a former community organizer in inner-city Chicago – “has had surprisingly little to say about the shadow cast by prisons on the families left behind, about the way incarceration became the default therapy for drug addicts and the mentally ill, about the abject failure of rehabilitation.” Although Attorney General Eric Holder has recently been more bold about urging states to rethink the cruel consequences of incarceration, the Administration has done little to reduce drug prosecutions or provide more money for treatment programs. Of the 8,000 people in federal prison because of outdated crack cocaine laws, which affect young black men disproportionately, last year Obama pardoned only three.

In the same issue, the Times reported on the annual congress of United We Dream, a national network of immigrant youth, many of whom were once undocumented themselves and whose parents are undocumented. Many Dreamers live in daily fear that their families will be torn apart by the arrest and deportation of their parents.

During his presidency, Obama has deported almost 2 million undocumented immigrants, more than any other president. HIP’s recent HIA on immigration reform found that if deportations continue at the present rate, each year more than 150,000 children will have a parent taken away, pushing more than 80,000 households into poverty and triggering poorer health or behavioral problems for approximately 100,000 children.

The Dreamers called on the president “to cut back programs that have greatly expanded the reach of federal immigration authorities” and grant deportation deferrals to parents of the more than 520,000 youth who have also received deferrals. In words that echo our HIA, United We Dream’s Cristina Jimeniz said: “These deportations are ripping our families apart; this has to stop. And we know the president has the power to do it.”

Health Impacts of Upward Mobility

The link between more education, higher income and better health is well established. But now, new research suggests that the process of upward mobility can also be taxing to the health and well-being of people of lower socioeconomic status.

In a New York Times op-ed, Can Upward Mobility Cost You Your Health? Gregory E. Miller and Edith Chen of Northwestern University and Gene H. Brody of the University of Georgia report findings from a long-term study of 489 African-American youth from rural Georgia: “Those who do climb the ladder, against the odds, often pay a little-known price: Success at school and in the workplace can exact a toll on the body that may have long-term repercussions for health.”

The article struck a personal chord with my own experiences in college. Because of my undocumented status, I paid my own tuition, but was denied research opportunities and participation in some programs. Many of my experiences parallel those of the young people in the study.

For example, the researchers write: “In our studies, most participants are the first in their families to attend college. . . Many feel socially isolated and disconnected from peers from different backgrounds. They may encounter racism and discrimination.” I, too, was the first in my family to attend college. When my mother was deported I felt a responsibility to get additional jobs to help with my family’s income, and still continue as a full-time student while actively participating in a support and advocacy group for undocumented students. My school, work, personal, and family obligations left me drained and with a poor sense of belonging.

The study also found that “behaving diligently all of the time leaves people feeling exhausted and sapped of willpower. Worn out from having their noses to the grindstone all the time, they may let their health fall by the wayside, neglecting sleep and exercise, and like many of us, overindulging in comfort foods.”

My experience with the undocumented student group confirms this; it was both demanding and empowering. We relied on our limited time to strategize ways to demand the same treatment and opportunities as our non-undocumented peers, advocated for state and federal policy related to immigrant rights, and worked to increase knowledge to high students about higher education opportunities.

Despite our diligence, ambition, and dedication, our fight-or-flight responses were always on. The next meal was sometimes uncertain, so as a natural stress response we often filled up at events with free food. This illustrates how stress, sleep deprivation, poor exercise, and inadequate nutrition affect weight, blood pressure, and other chronic illnesses—as the article explains.

The researchers offer ways to mitigate the harms of being in this situation — better health education, more checkups, classes in stress management. But I personally believe that those suggestions are like putting a Band-Aid on a deep gushing wound.

Problems brought on by inequitable institutions, such as education, cannot be solved solely through health education, health screenings, and mentorship programs. My peers and I knew plenty about health education, healthy eating and exercise, and stress management. The veil of chronic stress lifted only when I got my green card, when I stopped feeling like a pariah in constant fear of deportation, and when the doors to better job opportunities opened.

Understanding the social determinants of health — our living and working conditions, and the social, economic, political, and cultural environment — is not enough unless we also act to address them.  Health Impact Assessment is one of the tools that can gradually help us reach health equity because it aims to uncover the root causes of poor health.

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.