Migration, Public Health and the United States

Does migration pose a health risk to domestic populations? The Trump administration has argued that “public health concerns” associated with migration are so serious that they justify extensive border security measures in the United States, such as the creation of a wall on the southern border. For anyone interested in a detailed look at the literature on migration and health, I recommend the work of Abubaker (2018) and colleagues listed in the references below. The relationship between health and migration is complex, and this work provides an evidence based assessment of the issues. Of course, migrants often face health challenges that are linked to the conditions that inspired them to migrate in the first place, as well as the physical challenges of migration itself (Carballo & Nerurkar, 2001). There are a small number of infectious diseases associated with migrants from Latin America, such as Chagas’ disease (Darr & Conn, 2015). With Chagas the possibility of transmission is readily managed in areas where this is a health concern through measures such as blood screening, and testing organs before donation (Schmunis & Yadon).

Diseases have always been brought by travelers. But the reality is that of all the major public health issues in the United States related to infectious diseases, none are being driven by migration. HIV/AIDS and STDs are spreading in tandem with the opioid epidemic. Hepatitis A is a significant issue in some West Coast cities because of homelessness, and the basic lack of sanitary facilities for this population. The danger posed by our most serious threats -an avian influenza outbreak or a pandemic caused by MERS- are not driven by migration from Latin America. Indeed, one of the most serious public health issues in the United States in my opinion is the rise of vaccine refusal. The people that are bringing measles to Disneyland are not poor refugees. It is mainly in communities of the relatively privileged middle and upper class that measles and whooping cough have spread.  It is a stunning fact that in many U.S. states vaccination rates are better amongst children at the lower end of the economic spectrum than their wealthier peers.

There is simply no data to suggest that there is a serious public health risk posed by migration from Central America or Mexico. What is important is to have a well-resourced public health system to address real threats, by funding needle exchange programs, sexual health education in the public schools, HPV vaccinations, the development of a universal influenza vaccine,  and clinics to vaccinate and care for the homeless. We need good public health policy to limit the overuse of antibiotics, particularly in agriculture. We also need to continue to focus on nutrition as well, as the rise of factory farming, corn syrup, and fast food has helped to fuel rising rates of diabetes and heart disease. These do not receive the same media attention as infectious disease but kill far more people.

Recently, US Customs and Border protection has announced that it is not offering influenza vaccinations to migrants held in detention facilities near the border. While populists and nationalists have warned about the threat posed by migrants, they have refused to vaccinate people held in cramped, poorly ventilated facilities in which influenza is circulating.  These are people who lack access to showers, sufficient blankets and other sanitary needs. Worse, the U.S. Customs and Border Protection decision applies not only to adults but also children. Maryn McKenna has an excellent essay on this topic in Wired, in which she points out that three children have died of flu while in detention. My hope would be that as a society we could agree that whatever our beliefs regarding immigration, we could agree to provide basic needs -such as vaccines- to children in detention facilities. As if influenza wasn’t enough, there have been five cases of mumps in detention facilities, which could have been readily prevented by vaccination. Sooner or late these people will be moved from these holding areas. When they do, if they have diseases circulating amongst them they will move too. The rise of nationalism and populism has fostered rhetoric that stigmatizes the poor, people of color and migrants of all kinds. What it has not done is led to better public health outcomes. And it’s worth remembering that there has never been a wall built that could protect the United States, Canada, Europe or China from the viruses and bacteria that threaten us.

References

Abubakar, I., Aldridge, R., Devakumar, D., Orcutt, M., Burns, R., Barreto, M., . . . Sheikh, K. (2018). The UCL-Lancet Commission on Migration and Health: The health of a world on the move. The Lancet (North American Edition),392(10164), 2606-2654.

Carballo, M., & Nerurkar, N. (2001). Migration, Refugees, and Health Risks. Emerging Infectious Diseases, 7 (7). Retrieved from https://wwwnc.cdc.gov/eid/article/7/7/01-7733_article. doi:10.3201/eid0707.017733

Darr, J, Conn, D. (2015). Importation and Transmission of Parasitic and Other Infectious Diseases Associated with International Adoptees and Refugees Immigrating into the United States of America. BioMed Research International, 2015. https://doi.org/10.1155/2015/763715.

Leung, J., Elson, D., Sanders, K., Marin, M., Leos, G., Cloud, B., … & Marlow, M. (2019). Notes from the Field: Mumps in Detention Facilities that House Detained Migrants—United States, September 2018–August 2019. Morbidity and Mortality Weekly Report, 68(34), 749.

Schmunis, & Yadon. (2010). Chagas disease: A Latin American health problem becoming a world health problem. Acta Tropica, 115 (1), 14-21. https://doi.org/10.1016/j.actatropica.2009.11.003

Shawn Smallman, 2019

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