Pediatricians Explain How Immigration Policy Intersects with Public Health and Health and Well-Being of Children

As pediatricians, we have the privilege of celebrating with families when a child is healthy, and supporting them through difficult and sometimes heartbreaking situations. We are especially moved to empathize with, and advocate for, families facing seemingly insurmountable challenges. Recently, our thoughts have been with our immigrant patients and families, in particular those who will be affected by the President’s decision to end the Temporary Protected Status program, or TPS. One particular family comes to mind.

Jason and Samantha* grew up in El Salvador. After an earthquake in 2001 devastated their hometown, the best option available for them and their baby Isabella was to uproot completely from their homeland. The United States had opened its doors through the TPS program to give them a chance to create a safe home and earn a living. While initially deemed a temporary solution, they were allowed to stay each year with the same legal protections. Now, in 2018, the family has fully integrated into their Washington, D.C. area community. They had another child, Samuel. Both children attend public schools and have grown up speaking English. The family is involved at a local church. Jason and Samantha both have full time jobs, he in construction and she as a daycare provider. Over time they begin to realize there was no home to return to. Home is here now.  

Now imagine yourself as Jason or Samantha, and overnight all this is taken away. The protections that this country has given you for the past 17 years will end, with no rational alternative. Go back to El Salvador? What is there for you? Your children have their roots here; your youngest is a United States citizen. El Salvador has become one of the most dangerous places in the world, with murder rates as high as war-torn countries and a gang presence that threatens daily life. Remaining here undocumented means losing the legal protection to work and support your family, all while living in constant fear of deportation. The result is fear interacting with authority figures, including police, leading to less crime reporting and ultimately making our neighborhoods less safe. As physicians, we worry that the sick will hesitate to seek medical care. This not only poses public health risks, but will end up being much more costly when those who should have sought care earlier arrive at the ER with life-threatening illnesses. The children of undocumented parents live with toxic stress knowing that their parent could be deported at any moment. Just ask the 6-year-old boy in our office last week who complained of daily stomach aches in order to stay home from school and avoid having to leave his mother each morning.

This story is similar to over 300,000 people from El Salvador, Haiti, Nicaragua, and Sudan affected by the Administration’s decisions to end TPS programs. Each one with their own story of resilience. Each with their own family. These are our neighbors, our colleagues and our children’s friends at school. They are our patients. Ending TPS without a viable alternative will also have a heavy financial impact. While TPS gives people the legal protections to work, it also means that they pay taxes. At the same time, TPS recipients do not qualify for most public benefits like Medicaid or food stamps. They are net-positive contributors to our economy. Ending TPS would mean an estimated loss of over $45 billion to the United States economy over the next decade. It is projected to cost taxpayers over $3 billion if all those with expired TPS were deported1. Places like Maryland, Washington, D.C., Virginia, Florida, California and Texas, where TPS recipients comprise a large portion of the workforce, will be hit the hardest.

Each day in our pediatric practice, we interact with these families as they bring their children for medical care. They are hard working. They love their children just as we love ours. They love the United States, a country that many call home. As reforms to our immigration system are being considered, we can only hope that our nation’s leaders include a bit of empathy in their decision-making and that they understand the financial implications of their decisions on all Americans.

*Names have been changed to protect privacy.

Daniel Newman, MD and Olanrewaju Falusi, MD are pediatricians at the Children’s National Health System.