S-Comm Immigration Initiative Is Bad for Our Health – Karen Hacker, Jennifer Kasper, and Juliana Morris
Karen Hacker,1,2 Jennifer Kasper,1,3 and Juliana Morris1
1Harvard Medical School, 2Institute for Community Health, 3Massachusetts General Hospital
After much deliberation, Massachusetts Governor Deval Patrick decided this month not to sign the Secure Communities (S-Comm) program, following the lead of New York, Illinois, and other states. While this is a significant step in protecting immigrants’ rights, health care providers need to be vigilant. It is important to understand the potential negative health implications of this program, which could affect all communities in Massachusetts and across the United States.
Under S-Comm, a program of the U.S. Immigrations and Customs Enforcement (ICE), fingerprints of arrestees in local police precincts are automatically cross-checked against a central ICE database. If there is a “hit,” indicating that the individual is in the US without authorization, ICE is automatically notified and may detain him or her and/or initiate deportation proceedings. This can occur even if the individual is only arrested and never convicted of any criminal act. States are refusing to sign on because they say it does not meet its stated goal of deporting hardened criminals. ICE’s own statistics reveal that more than half of people detained by the program are non-criminals. There is also concern that signing onto S-Comm will negatively affect the relationship between immigrant communities and local law enforcement since immigrants will be less likely to work with local and state police to fight crime.
The S-Comm implementation carries serious health and public health implications for some of the most vulnerable communities. In particular, we are concerned about three negative health-related outcomes: the effects of stress and anxiety on the physical and mental health of immigrants; immigrants’ increased vulnerability to crime; and decreased health care utilization by immigrants.
A recent study conducted by the Institute for Community Health in Everett, a small city north of Boston, found that ICE presence in the community led to increased levels of fear of deportation, not only among undocumented immigrants, but also among their U.S. citizen children and networks of families and friends. This pervasive fear leads to social isolation, health care avoidance, stress and anxiety, all of which have profound effects on physical and mental health. Chronic stress contributes to increased cardiovascular disease, gastrointestinal problems, chronic pain, and decreased immune function. ICE activities, such as workplace raids and detentions, have already increased fear among immigrants. The implementation of S-Comm statewide may exacerbate fear, stress, and anxiety in immigrants, and whole communities may suffer negative health consequences. Psychologists, teachers, and family members report that the children of these immigrants (the majority of whom are U.S. citizens) experience health, emotional, behavioral, and academic problems.
The second major concern for public health is S-Comm’s impact on public safety in immigrant communities. The Everett study found that increased ICE presence caused immigrants to be more fearful of all people in authority, including police officers. Mistrust between police and immigrant communities can lead to the underreporting of crime, leaving these communities vulnerable to violence and impairing officers’ ability to investigate and solve crimes. Formal police/ICE collaborations through S-Comm may lead to additional mistrust. While some say S-Comm helps fight crime by streamlining deportation of undocumented immigrants who have committed offenses, in reality many people being deported under S-Comm have never even been charged with a crime. In Boston, where the program began operating in 2008, more than half of those deported under S-Comm were classified “noncriminals.”
A third major public health impact of S-Comm will be its effect on health care utilization. In the Everett study, the pervasive fear of apprehension by authorities and deportation led to decreased utilization of appropriate health care services. Immigrants reported being afraid to leave their homes to attend their medical appointments for fear of being stopped by police. In one instance, a man did not go to his clinic appointment because there were police cars in the street outside the clinic. Decreased utilization limits patients’ ability to prevent disease onset; avoid costly, catastrophic health problems; manage chronic disease; and minimize the spread of contagious diseases that pose public health threats (tuberculosis, flu, etc). S-Comm poses serious risks to the health of individuals as well as the general public.
Although the effects of S-Comm will be felt most acutely by immigrants and their families, its health impact could extend far beyond individual immigrants and may pose consequences for the health of entire communities. Immigrant health and well-being are important to all. As health professionals concerned about the health of both our patients and our communities, we strongly advise our colleagues to remain vigilant and advocate for policies that will promote the optimal health and well-being of our patients and our communities.
Karen Hacker, MD MPH is Executive Director of the Institute for Community Health in Cambridge, MA. She is also an Associate Professor at Harvard Medical School. Her research interests include immigrant health, adolescent health, child mental health promotion and screening, and primary care.
Jennifer Kasper, MD, MPH is an attending pediatrician at Massachusetts General Hospital for Children, an Instructor at Harvard Medical School, and the Chair of the International Volunteer Committee for Doctors for Global Health. Her areas of expertise include health service delivery; rural community development; complex humanitarian emergencies; field-based operations research; health system strengthening; and curriculum development, training and mentorship of community health workers and other health professionals.
Juliana Morris, BA is a second-year student at Harvard Medical School pursuing a career in family medicine. Before entering medical school, she worked for three years with immigrant-serving non-profits in the U.S. and Mexico. Her research interests include immigrant health, access to care issues, and social determinants of health.
The Institute for Community Health, Cambridge, MA: http://www.icommunityhealth.org/
US Immigration and Customs Enforcement – Secure Communities info page: http://www.ice.gov/secure_communities/
Uncover the Truth – Resources and info from the national movement to resist S-Comm: http://uncoverthetruth.org/
National Immigration Law Center – Spotlight on Local Law Enforcement Issues: http://www.nilc.org/immlawpolicy/locallaw/index.htm
 Hacker, K., J. Chu, C. Leung, R. Marra, A. Pirie, M. Brahimi, M. English, J. Beckmann, D. Acevedo-Garcia, and R.P. Marlin. In press. “The Impact of Immigration and Customs Enforcement on Immigrant Health: Perceptions of Immigrants in Everett, Massachusetts, USA.” Social Science & Medicine.
 For more on the link between fear of deportation and stress for both documented and undocumented immigrants see: C. Arbona, N. Olvera, N. Rodriguez, J. Haga, A. Linares, and M. Wiesner. 2010. “Acculturative Stress Among Documented and Undocumented Latino Immigrants in the United States.” Hispanic Journal of Behavioral Sciences. 32(3): 362-384.
 D. Williams, S. Mohammed, J. Leavell, and C. Collins. 2010. “Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities.” Annals of the New York Academy of Science. 1186: 2009.
 Dorsey and Whitney LLP. 2009. Severing a Lifeline: The Neglect of Citizen Children in America’s Immigration Enforcement Policy. A Report to the Urban Institute.
 T.R. Tyler and J. Fagan. 2008. “Legitimacy and Cooperation: Why Do People Help the Police Fight Crime in Their Communities?” Ohio State Journal of Criminal Law 6: 231-271.
Hacker, Karen, Jennifer Kasper, and Juliana Morris. 2011. S-Comm Immigration Initiative is Bad for Our Health. AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed (date) at https://accessdeniedblog.wordpress.com/2011/07/21/s-comm-immigration-initiative-is-bad-for-our-health-karen-hacker-jennifer-kasper-and-juliana-morris/