Why would a blog about medicine and science need to address what appears to be a purely political question? Promotion of science-based medicine shouldn’t be obscured by unnecessary forays into partisan politics. But our current political crisis affects every facet of our public health environment.
Public health is always political, but does not have to be partisan—there is clear evidence that the current public health policies are broadly unpopular across the political spectrum. While we may disagree on policy goals and methods, we do seem to agree that masked secret police operating with complete impunity is a bad thing. And whatever the political consequences, it is bad for public health. And we have the science to back that up.
The ICE crackdowns affect public health directly, indirectly, and synergistically with other policies. They aren’t separate from the administration’s attacks on public health. It may seem strange at first to link ICE activities with the dismantling of our public health infrastructure by Kennedy et al. but these are inseparable. The gutting and politicization of the CDC and NIH cannot be separated from violent immigration enforcement and policing. For example, if the CDC and NIH don’t track data related to law enforcement violence, it’s hard to study. And if people are scared away from seeking healthcare due to immigration actions (and I had to stop myself from typing “Aktions”) people will sicken and die.
Shock and confusion
Since the Trump Administration’s transformation of ICE into a masked secret police force, much of (white) America has stared at their screens in shock. Nothing that has happened has surprised minority communities that have always been subject to police abuses. But the egregious and unpredictable scenes of masked, militarized forces invading peaceful neighborhoods have awakened even the most complacent among us. At the same time, Americans are wondering where to turn for health data, vaccinations, and reliable advice as the usual sources are torn down and/or turned into Kennedy’s private playground. For now, let’s focus on the potential effects of the current ICE actions on public health.
Police violence is an established public health issue, with its associated experts and academic literature. There are many barriers to studying police violence, perhaps the biggest being the lack of mandatory reporting. Most importantly, when the state that perpetrates violence is also responsible for collecting public health data, there is an inevitable conflict of interest, and as recent events have shown us, public health is very much subject to political censorship. Again, the gutting of public health and violent policing are a mutually dependent part of our current political situation.
Our modern life in which everyone has a camera makes it hard for the state to hide. Pictures of chemical weapons being used outside of schools, children being torn from their parents, people being murdered in what amount to concentration camps, and (white) people being murdered and vilified have made our current crisis hard to ignore. (As an aside, this one hit home since he is a fellow healthcare worker. But Trump’s policies were already harming my colleagues. Many of our hospital nurses and ancillary staff are immigrants and therefore under threat. Many of our doctors are immigrants—so many that many of our hospitals could not survive without them. And the US does not produce enough doctors to fill the gap.)
You’re not from around here, are you?
Recent ICE crackdowns take invasive policing to a new level. There is plenty of social science literature showing the negative effects of invasive policing on individual and population health. Before the current crackdown, there were about 75,000 hospitalizations caused by interactions with police every year, and about 600 deaths.
Digging deeper, a 2016 study looking especially at “Terry Stops” (snagging people for “looking suspicious”) showed significant negative health effects not only for those who were subject to “stop and frisk” but also those living in the neighborhoods where this sort of policing is used. Another systematic review showed adverse outcomes on Black youth who had contact with police.
Knowing this, we should be able to infer the negative effects of so-called “Kavanaugh Stops” where ICE officers (I consciously stopped myself from typing “goons”) are supposedly allowed to stop anyone who they think may look like an “illegal immigrant”. The Supreme Court decision that allows this is either supremely naive, intentionally oppressive, or both. The results were completely predictable based on both data and common sense, and our doom-scrolling certainly highlights the inevitable abuses. Kavanaugh’s decision in Noem v. Vasquez Perdomo implies that ICE grabbing up “suspicious” people is not particularly harmful:
[A]s for stops of those individuals who are legally in the country, the questioning in those circumstances is typically brief, and those individuals may promptly go free after making clear to the immigration officers that they are U.S. citizens or otherwise legally in the United States.
—Noem V. Vasques Perdomo
The news belies this as we see citizens and non-citizens alike hauled off in a typically not-so-brief way. And public health research shows us wider harms.
[D]irect exposure to police physical, psychological and sexual violence is associated with multiple health-related harms, including suicide attempts and suicidal ideation, psychotic experiences, anxiety, depression, distress, and post-traumatic stress symptoms, and can adversely impact health-related behaviors.
Violence breeds fear
As noted above, we know that invasive policing affects not only those who have direct interactions with police but also the larger community. This probably happens in a number of ways but there are some specific harms that we see. And I want to state explicitly, again, that these practices disproportionately harm people and communities of color. It is now, when the effects are “bleeding over” into the majority community that it makes headlines.
Aside from harms from direct physical assault and incarceration, how does police violence harm the health of communities and individuals?
The most obvious effect of state violence is injury to the individual. As noted above, hundreds of people die at the hands of law enforcement annually and tens of thousands are hospitalized. But there are broader effects.
It seems obvious that if you are afraid that going to the hospital will get you snatched up by ICE, you’ll stay away, and studies back this up. Immigration actions (ugh, again I almost typed “Aktions”) deter people from seeking health care. This could lead to, for example, worsening of diabetes, hypertension, heart disease, and other common health problems. It can also lead to the spread of infectious diseases. For example, justice-involved youth were less likely to be vaccinated against COVID-19 during the height of the pandemic.
The myth that immigrants are the problem
Immigrants in general are at risk of under-vaccination. Many of the current leaders at CDC and NIH are, in fact, directly responsible for discouraging vaccination in immigrant communities. (Their good friend Andrew Wakefield who, incidentally, is not a great friend of SBM, helped start a measles outbreak in Minnesota.) If you pair avoidance of vaccination in marginalized populations with increasing attacks on vaccination from the current administration, you can see where this will lead.
Which leads me to a healthcare myth I hear nearly every day: “Doc, we need to stop these immigrants from bringing all these diseases here.” No, immigration, legal and otherwise, is not responsible for disease outbreaks in the US. Take, for example, tuberculosis (TB). Most cases are in immigrants. However:
As it stands, incident TB among migrants is less likely to be associated with local disease outbreaks than TB arising among US-born individuals, and the large majority of new non-US-born TB cases arise from [latent TB] reactivation rather than recent infection.
TB may enter the country with migrants, but most outbreaks belong to us.
Measles
And then there’s measles. Imported cases have been steadily dropping—around 90% of measles cases are in US residents. Measles outbreaks often occur when a traveler to the US (resident or otherwise) comes into contact with an under-vaccinated community, which, thanks to years of attacks on vaccination by our current NIH and CDC leadership, is most of us.
And now we see measles emerging as a direct result of US immigration crackdowns. It was recently announced that there is a measles outbreak in one of the immigrant crackdown detention centers.
When you build warehouses and camps to imprison tens of thousands of ordinary folks, you not only create fear, you also create epidemics. This is a perfect storm—an administration that doesn’t believe that measles vaccines are a good thing, and shoves people together under terrible conditions—this is how epidemics launch. What are the chances that ICE would make sure everyone they imprison is healthy and vaccinated?
The government announced that they have basically locked down the prison but this won’t stop measles—it’s too contagious for that. It will cause worsening morale and worsening health as people are confined to cages and cells and can’t move around. And guards will take it home with them.
A History Lesson
This is all going to get much, much worse before it gets better.
During World War I in the US, men were crushed together in half-built army bases and then sent overseas. Flu spread like wildfire. In the “Spanish flu” pandemic of 1918, about 5% of the world’s population died of flu. Try to wrap your head around that one.
In the Nazi labor and concentration camps (but not the death camps), about 30-40% of people killed died of disease due to deliberate overcrowding, starvation, and poor sanitation.
We know how these things work. If you institutionalize people in poor conditions, they start to sicken and die. It doesn’t matter if it’s in a Soviet gulag, a US army base, or a Nazi concentration camp–dead is dead. It’s a matter of degree–for the Soviets and Nazis, death and disease was a feature, not a bug.
When an antivaccine government imprisons an already under-vaccinated population under conditions that are perfect for spreading disease, well, you get the idea.
My patients are not well
It would be too easy to end up going on a Gorski-length analysis. But I’m driven to write this, after a very long absence from the blog, because of what I am seeing in my clinic. My patients are not well. Every day, I hear fear—not necessarily fear of personally being deported, but the over-arching sense of unease and danger from knowing that the current administration not only doesn’t want to protect you from disease but promotes it; not only from direct interactions with ICE but just knowing that families are being torn apart and people tortured and murdered all in our name.
So while this is not a political blog, politics is part of public health, and the current political landscape is very, very unhealthy.
The ICEmen Cometh
The potential effects of the current ICE actions on public health