Anti-immigrant remarks from the White House are taking a substantial toll on Latino patients' perceptions of their personal safety and are affecting their access to emergency health care, researchers report in a new study led by emergency medicine physicians at UC San Francisco.
The study specifically looked at the impact of statements about immigration by the current U.S. president, using a survey of adult undocumented Latino immigrants and Latino citizens, with a control group of non-Latino citizens who were emergency department (ED) patients at three urban, county hospitals in California.
Investigators found that 75 percent of undocumented Latino immigrants and 51 percent of Latino citizens reported feeling unsafe in the U.S. because of the president's comments about building walls, deportation, and denial of basic services. Approximately 24 percent of undocumented Latino immigrants said these statements made them afraid to come to the ED for care, delaying two days on average. A quarter of undocumented immigrants and Latino citizens reported that they knew relatives or friends who did not go to the ED out of fear of being discovered as undocumented.
The study indicates that patient fears went beyond generalized anti-immigrant rhetoric -- patients reported that they were directly affected by the president's own comments. The paper publishes Oct. 30, 2019 in PLOS ONE.
"The emergency department serves as the sole health care access point for many undocumented residents; therefore, efforts to improve their health must begin with minimizing barriers to their ED access," said lead author Robert M. Rodriguez, MD, a professor of emergency medicine at UCSF. "We need to spread the message that U.S. 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."
"While the effects of the president's immigration rhetoric on U.S. citizens and voters have been well documented, little has been known about the impact on undocumented immigrants themselves," Rodriguez said. "In this research, we have systematically evaluated this difficult-to-study group and found that threats of deportation and denial of basic services, including health care, are inducing safety concerns and anxiety in Latino populations -- both undocumented immigrants and Latino U.S. citizens. Statements by the president that have made immigrants fearful of coming to the hospital for emergency care are creating a barrier, and compromising the public health and safety net function of emergency departments."
According to the Pew Research Center, approximately 8 million undocumented Latino immigrants lived in the United States in 2016. Deportation of undocumented immigrants became a cornerstone of the 2016 Republican presidential campaign, and the White House has maintained a hardline stance since then.
The study of 1,318 people was conducted from June 2017 to December 2018 at three emergency departments: 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 annual visits) where nearly half (45.3 percent) of all emergency department visits were by self-declared Latinos. The ED patients surveyed were approximately evenly divided among undocumented Latino immigrants, Latino legal U.S. residents/citizens, and non-Latino residents/citizens.
The vast majority of participants reported hearing statements about immigrants from the current U.S. 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 United States.
Nearly a quarter of undocumented Latino immigrants said these statements made them afraid to come to the ED for care. Fears were similar in both recent and non-recent immigrants, indicated that attitudes did not appear to wane over time living in the United States.
Unfettered access to emergency care -- regardless of citizenship or ability to pay -- is protected by federal law, but the research shows that rhetoric from the president may hinder undocumented immigrants from seeking that care.
"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," Rodriguez said. "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."
Authors: From UCSF, besides Rodriguez, the authors are Jesus R. Torres, MD; Carolina Ornelas; Mayra Cruz, MD; and Angela Wong. From Highland Hospital Alameda Health System, authors are Jennifer Sun; Harrison Alter, MD; and Leah Fraimow-Wong. From UCLA School of Medicine, the authors are Alexis Aleman; Luis M. Lovato, MD; and Breena Taira, MD, MPH.
Funding: The study was supported in part by a grant from the University of California Institute for Mexico and the United States (UC MEXUS).The authors declare no conflicts of interest in this research.
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