Posted on May 16, 2019 at 3:48 PM
I teach a course on migration at a public college in the least healthy county in my state. Residents of the Bronx have lower household income, higher rates of poverty, and spend more of their income on housing, compared to the city’s other boroughs. Most Bronx residents are Latino, and more than a third are foreign-born. I thought of my students when I heard about the most recent move by the U.S. federal government against immigrant households: the proposed rule from the Department of Housing and Urban Development to disqualify income-eligible families from public housing if any family member is undocumented.
Last semester, our class read Matthew Desmond, the sociologist of low-income renters in American cities, through the lens of migration. Desmond explains how eviction traps families in poverty, their lives reduced to scrambling for shelter. Students with firsthand knowledge of the threat or reality of eviction as children or young adults described this profoundly destabilizing experience.
For the past eight years, I’ve analyzed the longstanding problem of access to appropriate health-related services for undocumented immigrants, who are excluded from federally funded benefits such as Medicare, Medicaid, the Children’s Health Insurance Program, food stamps, and public housing subsidies. For the past two years, the escalation of immigration enforcement and of policies and messages aimed at discouraging legal immigrants from using public benefits for which they qualify have increased health-related insecurity in immigrant households. Until now, “mixed-status” families that include undocumented immigrants as well as legal residents and/or U.S. citizens have been permitted to live in public housing, just as these families have been able to use food stamps and Medicaid for eligible family members. Children rely on their parents for housing, food, health care, and other basic needs. Even if a parent or other household member is ineligible for public benefits, the household itself supports the child. To be effective as well as humane, public policy should recognize this reality.
HUD officials acknowledge that the proposed rule amounts to eviction of mixed-status families, who will likely be unwilling to cast out an undocumented family member who may be the mother or father of citizen children. HUD estimates that the implementation of this rule will result in the displacement of 55,000 children.
This rule will trigger immense harms to these children by inducing housing insecurity. As Desmond wrote in Evicted, his Pulitzer Prize-winning study of the effects of chronic housing insecurity on low-income families: “ . . . many evicted children wind up homeless. The substandard housing and unsafe neighborhoods to which many evicted families must relocate can degrade a child’s health, ability to learn, and sense of self-worth.” Evicting families from publicly subsidized housing will force them into the private housing market where eviction is a business model: “The time and emotional energy [parents] spent making rent, delaying eviction, or finding another place to live” will be time stolen from becoming “better parents, workers, and citizens.”
The health effects of housing insecurity on children and their families have been catalogued by Children’s HealthWatch, a network of pediatricians and public health researchers in Boston, Baltimore, Minneapolis, Philadelphia, and Little Rock. These effects include developmental delays in children, poorer infant and maternal health outcomes, and household food insecurity. As Desmond writes, families “who spend more on housing spend less on their children.” As a family’s situation becomes more precarious, hospitalizations of infants increase. Children living in shelters are exposed to environmental hazards. Housing insecurity severely disrupts school attendance and therefore children’s access to school-based nutrition and health care.
The consequences of this rule will fall on cities. Pew data show that immigrants are a “highly concentrated” urban population, with most undocumented immigrants living in 20 metropolitan areas. When immigrant families are forced out of urban public housing, a federally-created problem will be turfed to municipal shelters and health systems. Safety-net hospitals and clinics already responsible for health care for undocumented uninsured immigrants and for homeless individuals also see families who have nowhere else to turn. The American Academy of Pediatrics has long recognized that that homeless children and immigrant children have a common need: for a stable medical home.
The forced migration of immigrant families from public housing is a shameful policy. By introducing preventable housing insecurity into the lives of low-income families, it harms the health of children and stunts their ability to flourish.
If this policy is implemented, urban health systems, public and nonprofit, will be the frontline of our collective response to these children and their parents. Medical-legal partnerships (see here, here, and here) that work to resolve patients’ housing, immigration, and other social needs are a key resource for health systems caring for immigrant and other families experiencing housing insecurity. Strategies to mitigate the chilling effects of anti-immigrant policies and messages on children’s access to health-related services will need to account for this additional burden.
Nancy Berlinger, PhD, is a research scholar at The Hastings Center, where she codirects the Undocumented Patients project, and an adjunct professor in the Department of English at Lehman College, City University of New York (CUNY).
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