The usual suspect medical and science journals have featured far fewer columns promoting progressive politics of late. Alas, it couldn’t last forever.
The usual suspect medical and science journals have featured far fewer columns promoting progressive politics of late. Alas, it couldn’t last forever. The New England Journal of Medicine just published two opinion articles decrying immigration enforcement as inimical to public health.
The first column focuses generally on the adversity the author believes is caused to illegal immigrant communities by enforcing the law:
Current immigration enforcement is disrupting medical follow-up, exacerbating mental health symptoms, causing more patients to skip preventive care, and deepening mistrust in public institutions. In my clinical practice, I have seen sharp increases in anxiety, school absenteeism, deferred visits, and acute psychiatric symptoms after enforcement events. These effects are both predictable and preventable. Clinicians, health systems, and policymakers should recognize immigration enforcement as a social determinant of health currently implicated in a public health crisis and act accordingly. [Citations omitted.]
In other words, don’t enforce the law.
The doctor describes the psychological impact on the illegal immigrant community caused by enforcement operations:
The psychological consequences are equally striking. Research has linked exposure to immigration enforcement with elevated rates of depression, trauma-related symptoms, and chronic stress in children and adults. Clinically, children present with psychosomatic symptoms, sleep disturbances, behavioral regression, and refusal to attend school; some develop headaches, abdominal pain, chest tightness, or panic attacks. Adults, especially parents, describe hypervigilance, nightmares, and the strain of trying to maintain stability when their family’s future feels precarious.
You know, I don’t doubt that, and it really is a shame. But who is primarily to blame? Those who traveled here illegally and try to stay knowing the risks they continue to incur? The Biden administration that opened the illegal immigration spigot? How about sanctuary city and state policies that seek to thwart ICE, pushing the agents into higher visibility enforcement actions? Or the Democrat politicians that call ICE agents the “Gestapo”? How about the media that focuses intensely on every seeming enforcement injustice they can find?
Of course, these questions are not discussed. Rather, according to the good doctor, enforcing the law itself is detrimental to public health:
The medical community must recognize immigration enforcement as a powerful determinant of health. Although immigration status is rarely included among the classic social determinants, its influence rivals that of housing instability or food insecurity. Enforcement reshapes the lived environment of entire neighborhoods — restricting mobility, altering help-seeking behavior, and hindering access to essential public services. Research on structural vulnerability shows how multipronged anti-immigration policies consistently affect health, not only by way of enforcement fears, stress, and trauma, but also by producing structural constraints on employment, income, and access to legal protections, thereby embedding health risk within the social and economic environments in which immigrants live. . . .
Ultimately, immigration enforcement is not merely a legal or political issue; it is a public health issue with measurable consequences in blood-pressure readings, glycated hemoglobin levels, school attendance, and psychiatric symptoms. The uncertainty created by routine immigration-enforcement practices deepens fear and destabilizes immigrant communities’ ability to access care.
But what would be the moral hazard and psychological costs to the country if millions of people who entered the country illegally are exempted from the laws? I think they would be severe and pervasive. We often see the same “don’t enforce the law” argumentation around homelessness, and look what a mess that has created. Eventually, if we are not careful, only those who abide by the law will be expected to obey and have the law enforced against them when they don’t.
The second article, focusing more specifically on children, makes almost identical argumentation as the first column — even going so far as to compare immigration law enforcement with natural disasters:
Public health researchers routinely measure the secondary effects of disasters, community violence, and pandemics. Immigration policy rarely receives the same research attention, yet the spillover effects of the inflicted trauma are clinically visible and widespread. . . .
Use of medical services declines and food insecurity rises as families avoid public benefit programs for fear that service providers will share their data with immigration authorities or that they’ll be arrested on the spot. Clinicians report missed vaccinations and deferred medical care among immigrant families. Residents retreat from public life, and neighborhoods effectively disappear: empty playgrounds, vacant church pews, shuttered small businesses — patterns similar to those in disaster-affected communities.
Again, whose fault is that? The enforcers or the law breakers and their enablers?
The authors argue for less general enforcement and greater reliance on targeted arrests:
The key policy question is not whether to enforce immigration laws; it is how enforcement decisions should be informed by the costs inflicted on children’s safety, mental health, and development. All law-enforcement agencies exercise prosecutorial discretion. Federal immigration agencies should do so as well, by shifting from sweeping, indiscriminate arrests
But that would require ending sanctuary policies that protect criminal illegal aliens when they are released from jails and prisons. As in the previous article, this author does not even broach that issue. That’s too bad because the emotional trauma about which they are so concerned are unlikely to be ameliorated without ending sanctuary policies.
Or, I guess, we can decide that rigorous law enforcement is too mean, throw up our hands, and surrender to the many social problems caused by mass migration. Based on the one-way street arguments exhibited by these two columns, that would seem to be the preferred answer of the NEJM‘s editors and these authors.