Is fear of deportation impacting immigrant health? Primary care and emergency department provider perspectives

Along with the rapid growth and diversification of the US immigrant population which occurred over the last two decades, there has been a concurrent rise in Immigration and Customs Enforcement (ICE) efforts. This activity has fueled deportation fears and left many immigrants living in a state of hypervigilance. The resulting fear may be increasing health care disparities in already disadvantaged populations.

To determine the impact of ICE activity on immigrant health, we conducted an electronic survey with primary care (PCPs) and emergency department (ED) providers serving immigrants in an ethnically diverse community, Everett, MA. Everett has experienced a rapid growth in the size and diversity of its immigrant population from countries such as Brazil, Haiti, El Salvador, and Morocco. The presence and activity of ICE in Everett is well known to community members.

The immigrant health survey was emailed to over 300 providers from two large hospital systems serving the Everett community from June-August 2009. It consisted of questions focused on the impact of ICE activity on chronic disease, mental health, and health care compliance. Providers who noted health impacts of ICE activity were also asked to provide illustrative examples.

Bivariate and multivariate analyses were conducted to identify predictors of the main outcome: agreement with the question “Have you observed any negative effect of immigration enforcement on the health status of your immigrant patients?” Thematic analysis of qualitative responses was conducted by the research team.

Of the 326 providers surveyed, 163 (50%) responded. Forty percent observed negative effects of ICE enforcement on the health of their immigrant patients. Only 10% of ED providers compared to 54% of PCPs noted ill effects. On average, PCPs were 8.405 times more likely to see an impact on immigrant health status than other providers and female providers were 2.595 times more likely than male providers to report a negative impact on the health of patients.

Over 40 providers gave illustrations of their perceptions. Themes from these stories included the impact of fear on emotional health (depression and anxiety), on one's ability to comply with health care recommendations (follow-up or care when needed) and perceived barriers to access (cost, documentation requirements)

Health care providers are witnessing the impact of ICE enforcement on their immigrant patients' psychological and physical health. From a social justice perspective, providers must understand the context in which their patients live to provide appropriate care and act as advocates on their behalf.