Healthy Communities: Shifting Toward Inclusive Immigration Policy
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Healthy Communities: Shifting Toward
Inclusive Immigration Policy
J. Raul Gutierrez, MD
In this issue of Pediatrics, Cholera et a1 immigrant families.3,4 In a study
used a controlled interrupted time reported by the Urban Institute,
series design to examine differences in researchers found that in 2019, 1 in
health care use of Latinx children as it 5 adults in immigrant families with
relates to federal immigration policy children avoided public benefits and
enacted in 2017. Electronic medical 31.5% did so in low-income families.5
record data from four major health care
systems in North Carolina were Although there was no chilling effect
analyzed before and after restrictive found in the use of services by insured
immigration policy was enacted after Latino children in this study, Cholera
the 2016 election. Among Latinx et al1 add to the many past and, likely,
children in the outpatient setting, future studies that continue to reveal
they found a sustained increase in that policies of exclusion have negative
visit cancellation for the uninsured impacts on the health of immigrant
Department of Pediatrics, School of Medicine, University of
subgroup, a proxy for undocumented communities.6,7 Cholera et al1 remind California, San Francisco, San Francisco, California
immigrant children in North Carolina.1 us that such policies can further
marginalize low-income undocumented Opinions expressed in these commentaries are
those of the author and not necessarily those of the
One aim of the study was to explore immigrant communities and that the American Academy of Pediatrics or its Committees.
whether restrictive immigration policy relationship between immigration
DOI: https://doi.org/10.1542/peds.2020-045880
resulted in a “chilling effect” for all status and health requires further
Latino children. A chilling effect is investigation from a social Accepted for publication Nov 25, 2020
defined as a deterring effect on the determinants of health framework to Address correspondence to J. Raul Gutierrez, MD,
Children’s Health Center, Zuckerberg San Francisco
behavior of an individual or group truly appreciate inequities created by
General Hospital and Trauma Center, 1001 Potrero
through fear of legal action.2 Widely social structures, policies, and Ave, Floor 06, Room 6E07, San Francisco, CA 94110.
used during the 1996 welfare reform, institutions.8 Furthermore, that the E-mail: juan.gutierrez@ucsf.edu
today, like then, it refers to immigrant Latino community was chosen to PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
families’ decision not to participate in explore immigration policy effects on 1098-4275).
the use of public benefits and services health speaks to institutional racism Copyright © 2021 by the American Academy of
out of fear, confusion, or perceived driving immigration reform and Pediatrics
threat. This phenomenon is of enforcement. Using a criminal FINANCIAL DISCLOSURE: The authors have indicated
particular concern for the public charge framework that describes and they have no financial relationships relevant to this
rule changes that were enacted in 2019 categorizes people as “illegal” allows article to disclose.
(but leaked to the public in 2018), for the systematic and intentional FUNDING: No external funding.
which broadened the reasons why dehumanizing of Black, Latino, and POTENTIAL CONFLICT OF INTEREST: The authors have
immigrants may be denied legal other racialized immigrant indicated they have no potential conflicts of interest
permanent residence or extension of communities. Black immigrants are to disclose.
a temporary visa on the basis of their more often detained and deported on COMPANION PAPER: A companion to this article can
use or possible use of public benefits, criminal grounds, made to pay higher be found online at www.pediatrics.org/cgi/doi/10.
including Medicaid. Several bail bonds, and denied asylum.9,10 1542/peds.2020-0272.
organizations estimated the impact to Restrictive and punitive immigration
be far reaching in that it includes the policy and enforcement is highly To cite: Gutierrez J Raul. Healthy Communities:
Shifting Toward Inclusive Immigration Policy.
10.5 million children, mostly American racialized, targeting low-income
Pediatrics. 2021;147(2):e2020045880
citizens, in benefits-receiving communities and people of color, and is
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PEDIATRICS Volume 147, number 2, February 2021:e2020045880 COMMENTARYrooted in the forced displacement of licenses to undocumented drivers 5. Haley JM, Kenney GM, Bernstein H,
Indigenous people and human supports mobility and, potentially, Gonzalez D. One in five adults in
trafficking of African people for improves traffic safety.26 We should immigrant families with children
chattel slavery as well as the continue to explore these benefits reported chilling effects on public
continued restrictions and violations and use the evidence to extend the benefit receipt in 2019. Available at:
https://www.urban.org/research/
of their rights as citizens.11,12 compassion and respect that
publication/one-five-adults-immigrant-
immigrant communities deserve. families-children-reported-chilling-
By focusing their investigation on
North Carolina, Cholera et al1 also We are invested in the health of
effects-public-benefit-receipt-2019.
remind us that federal immigration Accessed November 20, 2020
immigrant and refugee children and
policy effects on health can be their families because they are our 6. Perreira KM, Pedroza JM. Policies of
mitigated or exacerbated by state- patients and have the right to the exclusion: implications for the health of
level actions. The use of resources same level of care as any other immigrants and their children. Annu
and health services may differ Rev Public Health. 2019;40:147–166
person. We should continue to
between citizens and noncitizens explore health inequities fueled by 7. Martinez O, Wu E, Sandfort T, et al.
and between documented and immigration policies of exclusion and Evaluating the impact of immigration
undocumented noncitizens, specifically name discrimination and policies on health status among
depending on how state policies racism as drivers of such policies. By undocumented immigrants:
influence inclusive versus exclusive a systematic review. [published
investing in and studying inclusive
climates. The cumulative outcome of correction appears in J Immigr Minor
policies, we are investing in the future
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PEDIATRICS Volume 147, number 2, February 2021 3Healthy Communities: Shifting Toward Inclusive Immigration Policy
J. Raul Gutierrez
Pediatrics originally published online January 7, 2021;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2021/01/03/peds.2
020-045880
References This article cites 16 articles, 3 of which you can access for free at:
http://pediatrics.aappublications.org/content/early/2021/01/03/peds.2
020-045880#BIBL
Subspecialty Collections This article, along with others on similar topics, appears in the
following collection(s):
Immigration
http://www.aappublications.org/cgi/collection/immigration_sub
Federal Policy
http://www.aappublications.org/cgi/collection/federal_policy_sub
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Downloaded from www.aappublications.org/news by guest on January 23, 2021Healthy Communities: Shifting Toward Inclusive Immigration Policy
J. Raul Gutierrez
Pediatrics originally published online January 7, 2021;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2021/01/03/peds.2020-045880
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2021
by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
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