Bioethics Forum Essay

El agua no es potabo: Immigration and Public Health Policy in Flint

The public health catastrophe known as the Flint water crisis is also a textbook case about the consequences of immigration policy, including the federal stalemate concerning reform and state-level policymaking, on the health of undocumented immigrants living in this low-income city. This population is vulnerable under normal circumstances, as well as during public emergencies. They fear interaction with authorities or a knock on the door. They are usually unable to produce identification as proof of eligibility for services, and they avoid situations in which they fear that they will be asked to produce ID. They are often unable to obtain information in the languages they understand. They live below the radar, and public officials may be blind, or hostile, to their presence in the community.

In Flint, home to an estimated 1,000 undocumented immigrants, reporters from Michigan Radio and Think Progress  have described the challenges of getting clean water and timely, accurate information to this Spanish-speaking population.  People who don’t answer a knock on the door can’t receive supplies and information being provided in that way by the National Guard. People who fear engaging with authorities or who cannot provide ID will have great difficulty obtaining supplies and information that requires going to a public place (and showing ID). People who lack reliable sources of information in their own language will rely on word of mouth, or conclude that there is no problem.

Door to door canvassing coordinated by a community-based Hispanic/Latino organization found that in late January most immigrants still had no idea that they should not drink the water: the message known to the nation simply had not reached them. This low-income population’s underlying lack of access to health care and the means to pay for health care are other foreseeable challenges to identifying, testing, and providing ongoing health care to infants and children who may have been exposed to high levels of lead. Even when U.S.- born children are eligible for public insurance, children whose parents are undocumented tend to be less likely to be enrolled in insurance or to receive primary health care, compared to children whose parents are citizens or legal residents.

One of the many lessons of the failure of public officials to protect the people of Flint is that public health and population health is affected by immigration policy, which itself does not seem to be about health. Because undocumented immigrants are part of this nation and its economy, and live in every state and in urban, suburban, and rural communities, public health planning and emergency response systems should always account for this population, which may be reluctant to call attention to itself, or unaware that a crisis is unfolding.

Nancy Berlinger is a research scholar at The Hastings Center, where she codirects the Undocumented Patients project. Caroline Rath is a physician assistant and public health consultant who has worked with immigrant populations in New York City and the Arizona/Mexico border region; in 2013, she completed an internship with the Undocumented Patients project as part of her MPH degree from the City University of New York.


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