Donald Trump’s anti-immigrant rhetoric is preventing Latinos seeking healthcare due to safety concerns, says study
Deportation of undocumented immigrants became a cornerstone of the 2016 Republican presidential campaign, and the White House has maintained a hardline stance since then
Immigration is a heated topic in America, and new research suggests that President Donald Trump’s anti-immigrant rhetoric is now putting Latino patients' health at considerable risk.
Over a quarter of undocumented immigrants and Latino citizens reported that they were scared of the anti-immigrant remarks from the White House, and Trump in particular, and this fear prevented them from accessing emergency care and other health services, according to a new study. This includes statements about building walls, deportation, and denying services to undocumented immigrants made during Trump's 2016 presidential campaign and presidency.
The findings, says the research team, indicates that patient fears went beyond generalized anti-immigrant rhetoric, and patients reported that they were directly affected by the president's own comments.
“We found that the president's threats of deportation and denial of basic services are inducing safety concerns and anxiety in Latino populations — both undocumented Latino immigrants and Latino US citizens. Statements by the president have made immigrants fearful of coming to the hospital for emergency care, thereby creating a healthcare access barrier and compromising the public-health and safety-net function of emergency departments," says lead author Dr. Robert M. Rodriguez, a professor of emergency medicine at the University of California-San Francisco (UCSF).
According to the Pew Research Center estimates, approximately 8 million undocumented Latino immigrants lived in the United States in 2016. During this year, Trump made deportation of "illegal immigrants," especially those from Latin America, a cornerstone of his presidential campaign. As president, he has continued to promote hardline stances towards immigrants.
The researchers say given the lack of availability of other healthcare options, including primary care, emergency departments (EDs) serve as the primary healthcare access point and safety net for undocumented Latino immigrants. Even though unfettered access to emergency care — regardless of citizenship or ability to pay — is protected by law under the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, undocumented Latino immigrants face several obstacles when coming to EDs, they add.
"The emergency department serves as the sole healthcare access point for many undocumented residents. Therefore, efforts to improve their health must begin with minimizing barriers to their ED access. We need to spread the message that US law guarantees everyone, regardless of citizenship, the right to emergency care. We do not report undocumented status, and patients are safe coming to the ED,” says Rodriguez.
The research team specifically looked at the impact of statements about immigration by Trump. To gauge the public's perception of Trump's statements on immigration, the authors surveyed 1,318 people — 452 Latino undocumented immigrants, 473 Latino legal residents, and 393 non-Latino legal residents at three county emergency departments in California — between June 2017 and December 2018.
This includes Zuckerberg San Francisco General Hospital and Trauma Center in San Francisco (77,000 annual ED visits); Olive View-UCLA Medical Center in Los Angeles (60,000 annual visits); and Highland Hospital-Alameda County Medical Center in Oakland (73,000 yearly visits), where nearly half (45.3%) of all emergency department visits were by self-declared Latinos.
Compared to legal Latino and non-Latino residents, the undocumented Latino immigrants were younger, more often female, and less likely to have health insurance or access to primary care.
“While the effects of the president's immigration rhetoric on US citizens and voters have been well documented, little has been known about the impact on undocumented immigrants themselves. In this research, we have systematically evaluated this difficult-to-study group and found that threats of deportation and denial of basic services, including healthcare, are inducing safety concerns and anxiety in Latino populations — both undocumented immigrants and Latino US citizens," says Rodriguez.
Around 95% of all Latino residents and 85% of non-Latino residents had heard statements about immigrants during Trump's presidential campaign. Across all groups, says the research team, about 88% of participants believed that threatened measures to deport immigrants or deny them services were already being enacted or would be enacted in the future.
“The vast majority of participants reported hearing statements about immigrants from the current US president and most believed that measures that had been threatened were being enacted or would be in the future. Three-quarters of undocumented immigrants and half of Latino citizens reported that these statements made them feel unsafe living in the US,” says the study published in PLOS ONE.
When asked whether the president’s statements on immigrants made them feel worried or unsafe in the US, the investigators found that 75% of undocumented Latino immigrants and 51% of legal Latino residents responded "yes."
Further, when asked whether the statements made them feel afraid to seek emergency care, around 24% of undocumented Latino immigrants responded "yes," compared to about 4 percent each of legal Latino and non-Latino residents. The researchers say that fears which were similar in both recent and non-recent immigrants indicated that attitudes did not appear to wane over time living in the US.
“Given that California is a sanctuary state, we suspect that the impact of the president's statements on Latino populations may be even greater in other parts of the country. Additionally, we were only able to interview immigrants who actually came to the emergency department, not those who were too afraid to present for care. Therefore, our study represents a lower estimate of the safety concerns and fears in this population,” says Rodriguez.
The analysis shows that 55% of the undocumented respondents said that their fear had made them delay their trip to the emergency department by two to three days, on average. Similar percentages of undocumented Latino immigrants and Latino legal residents said that they had friends or family members who had not come to the emergency department because of fear of discovery, even as over 15% of non-Latino resident/citizen reported having friends/family who had not come to the emergency department.
“Outside of efforts in the political arena, what can be done to reduce undocumented immigrants’ fear of accessing emergency care? The most obvious measure is to spread the message that US law guarantees everyone the right to emergency care. Many EDs promote “Know Your Rights” education initiatives with multiple language signs in waiting rooms and verbal reassurance at triage. But these messages may not reach those in greatest need of this information — immigrants who completely avoid coming to the hospital,” says the study.