June 21, 2024
Docs, community health workers worry about health effects of immigration bill

By Vibhav Nandagiri

Griselda Alonso remembers the home visit well. It was around 2008, a few years after she had started as a community health worker in Wake County.

On typical visits, she focused on children’s health, telling families how to get vaccines, outlining healthy eating habits for them and sharing information about diabetes or asthma medications. 

During this visit to a family’s home in Fuquay Varina, something seemed off. The woman who welcomed her said she had not been able to sleep the previous night, and she had no interest in talking to Alonso about the health of her children.

The previous day, the woman’s husband had been driving home from work when a police officer stopped him. He was undocumented, had no criminal history and hadn’t committed a traffic violation other than driving without a license, Alonso recalled. In 2006, North Carolina legislators passed a law preventing undocumented immigrants from obtaining driver’s licenses. 

The next day, the woman learned her husband would be deported.  

“She was absolutely devastated,” Alonso said. That experience was not unique for the people Alonso and others saw when making home visits. “The majority of community health workers found ourselves seeing the same stories,” she told NC Health News.

Now a community organizer advocating for immigrant’s rights, Alonso fears these situations may become more common if the legislature passes House Bill 10, or HB10, a proposal that would require sheriffs across North Carolina to cooperate with Immigration and Customs Enforcement, or ICE. 

“Us community health workers are going to be the first who will notice the aftermath of HB10,” Alonso said last week during a meeting of LATIN-19, a group founded by concerned Duke Health providers in 2020 to highlight systemic health care access issues that affect North Carolina’s Latino community. 

If passed, HB10 would create a statewide path for increasing the reach of federal immigration officials, putting North Carolina more in line with such states as Florida, Texas and Iowa, which immigration law experts say have some of the harshest enforcement policies in the country. Experiences in other states show that these policies have a negative impact on health outcomes and access to care. Fear of deportation in immigrant communities can lead to distrust in public services — including health care, studies show. 

Immigration enforcement policies not only affect access to care for undocumented people, but their health implications also extend to loved ones and communities, research shows. This has led many researchers to consider immigration enforcement to be a public health issue. 

“The community has started to feel panic, and with panic comes a lot of health issues,” Olivia Moreno, a community health worker with El Centro Hispano said on the LATIN-19 call last week.

Forgoing care and more

For families with undocumented members, immigration enforcement policies can affect access to health care, and providers often see these effects firsthand.

“Folks stop driving. Folks stop going to the hospital when they need to,” Viviana Martínez-Bianchi, a physician from Durham and co-founder of LATIN-19, said toward the end of last week’s meeting.

“They don’t get out of the house,” Edith Nieves Lopez, another primary care physician from Durham, told NC Health News. 

Nieves Lopez explained that since undocumented immigrants cannot obtain driver’s licenses in North Carolina, they can’t always get to clinics and hospitals for care. Researchers in Michigan found that undocumented immigrants may forgo care instead of risking the drive to their appointment, especially in areas with high immigration enforcement or police activity.

Immigration enforcement also can have a negative impact on enrollment in public benefits programs, including WIC and Medicaid — a trend observed even for U.S.-born children of noncitizens who are eligible for these benefits. Researchers found deportation enforcement can have a chilling effect on immigrant communities, reducing participation in public benefits and health care. 

HB10 “adds another layer of fear and terror to community members to access basic needs,” said Iliana Santillan, executive director of El Pueblo, an advocacy group for the N.C. Latino community, in an interview with NC Health News.

“I see patients every day who have delayed the health care they need because of fears related to anti-immigrant sentiments and unjust immigration enforcement,” Narges Farahi, a family physician from Durham, said in an email to NC Health News.  

Farahi highlighted a study where, in the months after an immigration raid, Latina women were more likely to give birth to babies prematurely or with lower birth weight. 

In 2014, researchers from Wake Forest University and El Pueblo found that Latina immigrants in areas with the 287(g) immigration enforcement program (see box below) were less likely to seek prenatal care. 

“Many women stopped going to the hospital,” Alonso, the community health worker, said about the 287(g) program.

In a 2018 study of Latino men in North Carolina on the health impacts of immigration enforcement, the fear of racial profiling and deportation were linked to poorer cardiovascular health, excessive use of alcohol, and higher rates of depression, anxiety and PTSD.

Young people on the front lines

Children and adolescents are especially vulnerable to feeling stress due to immigration policies, which can manifest as physical symptoms.

“We get children with headaches, with abdominal pain because they’re absolutely terrified that their parents are going to get deported any day,” Martínez-Bianchi told listeners on the LATIN-19 call.  

Nieves Lopez added that these symptoms can be “long term … because you’re adding a significant amount of stress and trauma in a community.” 

Research into long-term effects of childhood stressors is growing and shows that long-term exposure to stressors puts kids at higher risk for developing heart disease and depression. Children whose family members are detained or deported experience worsening mental health and can end up at a higher risk for developing chronic conditions such as diabetes, cancer and heart disease, studies show.

Stress can have an impact on education as well, a link that has been studied in the Latino community. In areas of the country experiencing high levels of deportation, absenteeism rates are higher among Latino students. Another study found worse school performance in Latino students compared with their white peers in school districts with large numbers of deportations. 

‘A tool for abusers’

Advocacy groups for domestic violence survivors are also opposed to HB10. According to Kathleen Lockwood, policy director at the NC Coalition Against Domestic Violence, the bill would “create an additional force and tool for abusers.” 

Exploiting immigration status is a tactic that abusers of undocumented victims use, she said. Many fear that HB10 would make it more difficult for people to seek justice, Lockwood added. Challenges also exist if the abuser is undocumented, as victims may not want to risk family members getting deported if they report to local law enforcement. 

Lockwood calls it an “all-or-nothing approach,” where victims cannot seek justice without potentially setting off a deportation proceeding.

Alonso highlighted another root of domestic violence in her community, which is that the majority of undocumented immigrants are men. According to her, this has led women to enter into abusive relationships out of economic necessity. For many immigrant families, a deportation means losing a primary source of income. 

A group of people, immigrant's rights advocates across North Carolina, are seated on two rows of wooden benches. Some are holding paper folders. They are in a gallery looking down on the North Carolina House of Representatives.
Community health workers and immigrant’s rights advocates including Alonso (front row, third from the right) attend the vote on HB10 at the NC House of Representatives. Credit: Mujerxs Organizando Oportunidades Notables (MOON)

She and her fellow community health workers have already started preparing for what life could be like if HB10 becomes law. Alonso mentioned organizing “Know your Rights” workshops to prevent the spread of misinformation and teach individuals how to respond to law enforcement. 

Given North Carolina’s history of patchwork immigration enforcement policies, community health workers like El Centro Hispano’s Moreno have learned to adapt to changing circumstances. Many are using the past adversity as a strength. “The only advantage we have today compared to a few years ago is that we have a fantastic communication network. Information is reaching the communities faster,” Moreno said.

Where immigration enforcement laws stand in N.C.

On May 15, HB10 hit a roadblock when members of the state House of Representatives rejected the measure 108-3 due in part to sheriffs’ objections to changes made in the Senate. Key lawmakers from the state House and Senate will now go to a conference committee to try to reach agreement on the bill.

North Carolina sheriffs already are required to look into the immigration status of individuals accused of a felony or impaired driving offense. If that status cannot be determined, they are supposed to notify federal immigration officials who review the case and may issue a 48-hour  immigration detainer request.

“They’re not mandatory. They’re not signed by a judge,” said Rep. Marcia Morey, a Democrat from Durham and a former district court judge. 

If HB10 becomes law, sheriffs in all 100 counties would be required to comply with carrying out detainer requests. 

Some sheriffs — clustered in North Carolina’s largest counties — do not comply with immigration detainers and have signaled their opposition to HB10. In a statement from 2023 — when the bill was originally introduced — Wake County Sheriff Willie Rowe said that  “HB10 will make us less safe by fomenting distrust in local law enforcement.” 

In an email to NC Health News, a representative from the NC Sheriffs’ Association said that the organization currently is not taking a position on the bill.

Fifteen North Carolina sheriff’s departments are part of the federal 287(g) program, partnering with federal immigration officials to give police officers powers to act in their stead. 

While the 287(g) program was meant to identify those with serious criminal offenses, North Carolina researchers found that in five N.C. counties under the 287(g) program, 87 percent of undocumented immigrants detained were charged with misdemeanors, with the most common charge being a traffic violation.

There have been multiple accusations that the 287(g) program has empowered law enforcement offices to engage in racial profiling. Sheriff’s departments in North Carolina have been subject to those allegations.

NC Health News editor Rose Hoban contributed reporting for this story.

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