FXB Health and Human Rights Research Fellow Dr. Margaret Sullivan recently submitted written testimony in support of Massachusetts Legislature bills S.1579 and H.2418. The bills are known as the Safe Communities Act and aim protect basic rights and ensure every resident can seek health care, protection and emergency assistance without fear of deportation or detention.
Sullivan, an instructor and family nurse practitioner at a community health center, shared her immigrant health expertise and urged lawmakers to swiftly pass the Safe Communities Act.
Read her submitted testimony:
Honorable Members of the Joint Committee on Public Safety and Homeland Security,
Thank you to the Joint Committee on Public Safety and Homeland Security, especially the Joint Committee’s co-chairs Senator Timilty and Representative Gonzalez, for the opportunity to provide testimony in support of S.1579 and H.2418, jointly known as the Safe Communities Act, which would end our Commonwealth’s voluntary involvement in civil immigration matters, protect basic rights, and encourage all state residents to confidently seek help and medical care without fear of deportation or detention.
My name is Maggie Sullivan and I am an instructor at the François-Xavier Bagnoud (FXB) Center for Health & Human Rights at Harvard University, where I received my doctorate in public health. I am also a family nurse practitioner at a community health center in Boston, where I have been providing primary care since 2009. The critical importance of passing the Safe Communities Act (S.1579 and H.2418) cannot be overstated.
Public health and safety depend on community members’ ability to trust public institutions. As long as we continue to have state and local authorities involved in deportations, there will be patients, workers and community members who fear going to court or interacting with police officers, and who are reluctant to provide personal information to public health officials during the pandemic. While the consequences of this policy are wide and expansive, the following are a few arenas in which this burden is most greatly felt and experienced in Massachusetts.
COVID-19: There has been a well-documented disproportionality of COVID-19 infection rates,[i] testing gaps,[ii] and fear of contact tracing[iii] among immigrant communities in Massachusetts., Hospitalization and mortality rates are also disproportionately high among Hispanic/Latinx state residents who are essential workers and live in crowded households.[iv],[v],[vi] During the first surge in 2020, while Massachusetts General Hospital’s COVID-19 hospitalizations rose 7-fold, limited English proficient (LEP) patients increased nearly 20 times, comprising over 40% of all MGH COVID-19 hospitalizations.[vii] Perhaps more disturbing, aggressive immigration enforcement and detention have increased transmission of COVID-19 in Massachusetts. Among the 25 states experiencing the highest impact of net additional COVID-19 cases because of U.S. Immigration and Customs Enforcement (ICE) detention facilities, our state is number eleven.[viii] And anecdotally, I have been asked numerous times by immigrant patients and co-workers during the pandemic if it was safe for them to provide their contact information to public health officials after testing positive for COVID-19. These structural issues have exacerbated the spread and severity of COVID-19 from the beginning of the pandemic and have impacted the health and well-being of the entire Commonwealth.
COURTS, SCHOOLS & HOSPITALS: Arrests of immigrant individuals on courthouse steps,[ix] near schools,[x] or near hospitals[xi] in Massachusetts have significantly damaged trust in public institutions. In many cases, these arrests lead to detention and deportation, family separation, and foster care placement.[xii] We know this is detrimental to the health and well-being of children and families in our Commonwealth.[xiii] As a health care worker, my colleagues and I have had to invest considerable time into education and counseling about safety planning, information privacy, and health care rights for our immigrant patients. This is time that should be focused on the diagnosis, treatment, and management of patients’ health conditions. Instead, local immigration policy has crept into health care and significantly interferes with our ability to deliver needed services.
911 CALLS & INTIMATE PARTNER VIOLENCE: Many immigrant individuals decline to report instances of intimate partner violence for fear of deportation, increasing their exposure to further violence, trauma, and isolation.[xiv] There is a widespread fear in many immigrant communities that involving law enforcement or being sent to correctional facilities, however briefly, carries a high risk of deportation. This fuels fear of family separation (including losing custody of children), retaliation from the perpetrator, and loss of income leading to impoverishment. Calling 911 for any emergency must be disentangled from immigration enforcement.
The widespread impact of anti-immigration policies on population health is well documented. Researchers can point to low birthweight[xv] and preterm births,[xvi] increased risk of cardiovascular disease,[xvii] and reduced health-seeking behaviors, even among Latinx individuals who are exempt from these policies.[xviii],[xix] Health outcomes, including mental health, of our Latinx communities are suffering because of anti-immigration policies that can and must be changed.[xx],[xxi]
Until this bill is passed, no amount of reassurance can be given to patients that it is entirely safe for them to call 911, report intimate partner violence, or entrust health departments with personal information. Everyone deserves the right to be safe and seek medical care, regardless of their immigration status. I urge you to report the Safe Communities Act (S.1579 and H.2418) favorably out of committee for consideration by the full State Legislature.
[i] Figueroa JF, Wadhera RK, Lee D, Yeh RW, Sommers BD. Community-Level Factors Associated with Racial and Ethnic Disparities in COVID-19 Rates in Massachusetts. Health Affairs. 2020 Nov;39(11). doi: 10.1377/hlthaff.2020.01040.
[ii] Dryden-Peterson S, Velasquez GE, Stopka TJ, Davey S, Lockman S, Ojikutu BO. Disparities in SARS-CoV-2 Testing in Massachusetts During the Pandemic. JAMA Network Open. 2021;4(2):e2037067. doi:10.1001/jamanetworkopen.2020.37067.
[iii] Choi HY, Sudhinaraset M. Analysis of Attitudes About COVID-19 Contact Tracing Guidelines Among Undocumented Immigrants in the US. JAMA Network Open. 2021;4(12):e2137719. doi:10.1001/jamanetworkopen.2021.37719.
[iv] Hsu HE, Ashe EM, Silverstein M, Hofman M, Lange SJ, Razzaghi H, Mishuris RG, et al. Race/Ethnicity, Underlying Medical Conditions, Homelessness and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety Net Medical Center – Boston, Massachusetts, 2020. US Department of Health and Human Services, Center for Disease Control and Prevention, Morbidity and Mortality Weekly Report. 2020 July;69(27):864-869.
[v] Hawkins D. Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study. Journal of Preventive Medicine & Public Health. 2020;53(4):220-227.
[vi] Krieger N, Waterman PD, Chen JT. COVID-19 Overall Mortality Inequities in the Surge in Death Rates by Zip Code Characteristics: Massachusetts, January 1 to May 19, 2020. AJPH. 2020 Dec;110(12):1850-1852.
[vii] Knuesel S, Chuang W, Olson E, Betancourt J. Language Barriers, Equity, and COVID-19: The Impact of a Novel Spanish Language Care Group. Perspectives in Hospital Medicine. 2021 Feb;16(2):109-111.
[viii] Detention Watch Network. Hotbeds of Infection: How ICE Detention Contributed to the Spread of COVID-19 in the United States. Washington, DC. 2020 Dec.
[ix] Lawyers for Civil Rights-Boston. Federal Lawsuit to Block Immigration Arrests in Courthouses: Prosecutors, Public Defenders, and Community Groups File Federal Lawsuit to Block Immigration Arrests in Courthouse [Internet]. 2019 [cited 2021 Jan 25]. Available from: http://lawyersforcivilrights.org/our-impact/immigrant-rights/federal-lawsuit-to-block-immigration-arrests-in-courthouses/.
[x] Cadenhead R. The State of Surveillance in Boston Public Schools [Internet]. The Harvard Crimson. 2021 Nov [cited 2021 Jan 25]. Available from: https://www.thecrimson.com/article/2021/11/11/boston-school-surveillance/.
[xi] Dooling S. American Medical Association Takes Stance Against ICE Patrolling Inside Hospitals [Internet]. WBUR (National Public Radio). 2017 Nov 15 [cited 2021 Jan 25]. Available from: https://www.wbur.org/news/2017/11/15/ama-stand-ice-in-hospitals.
[xii] Amuedo-Dorantes C, Arenas-Arroyo E. Immigration Enforcement and Foster Care Placements. Institute of Labor Economics: IZA DP No. 10850. 2017 June [cited 2021 Jan 25]. Available from: http://ftp.iza.org/dp10850.pdf.
[xiii] Hacker K, Chu J, Leung C, Marra R, Pirie A, Brahimi M, et al. The Impact of Immigration and Customs Enforcement on Immigrant Health: Perceptions of Immigrants in Everett, Massachusetts, USA. Soc Sci Med. 2011;73(4): 586-594.
[xiv] Medina J. Too Scared to Report Sexual Abuse. The Fear: Deportation [Internet]. The New York Times. 2017 Apr 30 [cited 2021 Jan 25]. Available from: https://www.nytimes.com/2017/04/30/us/immigrants-deportation-sexual-abuse.html?_r=0.
[xv] Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. International Journal of Epidemiology. 2017:1-11. doi: 10.1093/ije/dyw346.
[xvi] Krieger N, Huynh M, Li W, Waterman PD, Van Wye G. Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 August 2017. Journal of Epidemiology & Community Health. 2018;0:1-6. doi:10.1136/jech-2018-211077.
[xvii] Torres JM, Deardorff J, Gunier RB, Harley KG, Alkon A, Kogut K, et al. Worry about Deportation and Cardiovascular Disease Risk Factors among Adult Women: The Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) Study. Ann Behav Med. 2018 Feb;52(2):186-193.
[xviii] Love KA, Gershon R, Sullivan M. The Final Public Charge Admissibility Rule: Implications for Massachusetts [Internet]. Blue Cross Blue Shield Foundation of Massachusetts. 2020 Sep [cited 2021 Jan 25]. Available from: https://www.bluecrossmafoundation.org/sites/g/files/csphws2101/files/2020-10/Public_Charge_Report_final.pdf.
[xix] Barofsky J, Vargas A, Rodriguez D, Matos E, Barrows A. Putting out the ‘unwelcome mat:’ The Announced Public Charge Rule reduced safety net enrollment among exempt noncitizens. Journal of Behavioral Public Administration. 2021 Oct;4(2). doi.org/10.30636/jbpa.42.200.
[xx] Vargas ED, Sanchez GR, Juarez M. Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes. J Health Polit Policy Law. 2017 Jun;42(3):459-483. doi: 10.1215/03616878-3802940.
[xxi] Wang JS, Kaushal N. Health and Mental Health Effects of Local Immigration Enforcement. Working Paper 24487. National Bureau of Economic Research. Cambridge (MA). 2018 Apr. doi: 10.3386/w24487