Interviewing William Lopez: The Health Impacts of United States Immigration Policy in the Context of the Trump Administration and COVID-19

https://doi.org/10.56927/851334

Interview by Ella Wesson

HHPR Editor Ella Wesson had the opportunity to interview William Lopez, a Clinical Assistant Professor at the University of Michigan School of Public Health. There, he lectures about the social determinants of health. Dr. Lopez has performed research about immigration policy and its health effects, specifically in looking at the impacts of home raids and work raids on immigrant populations.

EW: You teach at the University of Michigan School of Public Health. What kind of research do you do?

WL: My name is William Lopez; I am a Clinical Assistant Professor at the University of Michigan School of Public Health. I teach a number of classes. One of the classes I’m currently teaching is Social Determinants of Health and Health Communication to the school, so there are about 200 students in that class. I also teach about the health impacts of law enforcement in the winter, and that class considers both police and immigrant enforcement violence and what it does to communities of color, specifically Latino, Black, and Muslim and Arab communities. As far as research goes, my initial research question was about the impacts of immigration home raids, specifically how do they impact individuals, families, and communities. Now, I am looking at how large-scale immigration work raids impact communities, so these are raids anywhere from around 30 to nearly 200 people.

EW: You mentioned this study that you did in 2017 about the adverse health effects of immigration home raids. Can you talk a bit about this study and some of those impacts of immigration policy that you found?

WL: Sure, so the study was a mixed-method study, and one of the methods used was survey data from a survey called the Encuesta Buenos Vecinos. We actually didn’t go out to learn about immigration home raids, this was a five month survey of a Latino community and right in the middle was an immigration raid, which by our standards was fairly big—something like a dozen people detained and something like half a dozen deported. So, we were able to see how some data changed before and after, a pretty simple study design. And at the same time, the qualitative portion: I interviewed folks who were involved or directly impacted by the raid—members of their family and close friends—and then members of community-based organizations that provided support to those folks, many of whom directly supported them, others who provide help to the mixed-status community generally. This became the topic of the book that I wrote, Separated: Family and Community in the Aftermath of an Immigration Raid. In the book what I describe is that this is an individual, a family, and a community level event. What I mean by that is that individual health is impacted, the way our families can provide support to each other is impacted, and then ultimately on the community level, how we interact with others in our community as well as the space in our community changes by events like an immigration raid. Just to give a couple brief examples, on the individual level when we think about being in a raided facility, it’s a highly traumatic event, officers are coming in there. Sometimes, as in the case of a raid that I studied, no-knock warrants are used, this was a collaboration with the police. A no-knock warrant was also the type of warrant used in the recent killing of Breonna Taylor. We see many instances in which immigration enforcement and law enforcement use similar tactics. I’ll just mention, often when folks think about these raids, it’s easier to think about individuals and family. On the family level, the immediate impact of the removal of a parent can be devastating emotionally and psychologically for children as well as for the remaining partner. It’s often women who are left behind, and mothers can be thrust in this position of providing all the parental roles: all the caregiving and all the economic support when they hadn’t previously. On a community level when these sized arrests happen, community members understandably begin to fear being racially profiled. If you are worried about being racially profiled, then public spaces like sidewalks and streets become these spaces of deportation and are avoided. When you can’t drive and you can’t walk outside your own door, you don’t see people, you don’t go to grocery stores, you don’t go to gyms, and you don’t go to churches, all things we know impact our health.

EW: In this study, you focused on a Latino immigrant community, and you mentioned community-level impacts. Could you speak a little bit more about how these impacts are magnified because not only are they immigrants, but also a minority group?

WL: Sure. In this study, that’s correct, I looked mostly at a Latino mixed-status community. Mixed-status communities are communities that are composed of mixed-status families. What we mean by that in the research is this is how communities and families look in many of these environments. There is no such thing as this large undocumented community; folks have children, marry, work alongside, go to school with, and have their kids play soccer with folks of all immigration statuses. In Washtenaw County where I live and did the work, this is largely Latino, though throughout the country there’s certainly other racial ethnic groups who are also mixed status communities. So how does being a racial ethnic minority interact with immigration status? It’s a great question and it’s also a lesson that we can take from police violence. For so long, we’ve seen the history of policing. From the very beginning, police departments operated as slave patrols, and even after that we saw police enforcing Jim Crow segregation, and what this comes down to is that they often enforced based on Black, and early in the slavery days African, folks being in white spaces, which was illegal. They attuned their vision to what was out of place and that was black skin in white spaces. We've had centuries of looking for this marker, and then it changed after Jim Crow segregation, but there is still this long history. It is no longer overtly illegal to be Black in white spaces, but that has been a notable factor for so long that it became associated with criminality in ways that researchers have called “the symbolic assailant.” This term refers to when police are attuned to a cluster of descriptors that mean that person is likely to be violent, and in a racialized world like the U.S., skin color is inherently a part of being the symbolic assailant, the thing that catches officers’ attention. This is similar to what we see within mixed status communities. There is this statistical reality that most undocumented folks are from the country next to us and their neighboring countries—Mexico and Central America—thus most happen to be Latino. When ICE is looking for someone to enforce, they often look at skin color as a cue. We see that often in our own community. ACLU research attested this as well: an intersection of skin color and class. And what this means is that if you are Latino and you “look” undocumented, ICE may pull you over. “Looking undocumented” means doing the type of labor that those without social security numbers do, so this can include folks with trucks, with ladders, with paints, or with landscaping tools, that fit into the stereotype of someone who is “likely” to be undocumented. So I would say race absolutely, both in policing and with immigration enforcement, is often the sign that enforcement officers look toward because of the history of doing this.

EW: Thank you. Mixed status immigrant populations, specifically undocumented immigrants, can often face difficulties in accessing health insurance. When coupled with immigration policies, such as raids, does this lack of access to healthcare exacerbate these negative health effects?

WL: We often think of health as illness that needs to be treated, but it's also access to the places we need to treat illness. Part of what happens in mixed-status communities is this ambient stressor that at any moment, I as an undocumented immigrant, or any member of my community that is undocumented, can be removed. We know what happens when there are ambient stressors: we are hypervigilant and in a constant state of arousal, and we know this impacts our immune systems and our endocrine systems. There’s all of this stress that can lead to physical illness and can exacerbate other conditions. If we think about general GI issues or diabetes, nothing is made better by chronic stress. So when it’s time to get something treated or just to get a check-up, immigrants are often faced with this choice: should I go to my doctor or should I just wait? For many other people that dilemma is well, I’ll just go and take 2 hours off of work, and it’s still kind of annoying. Sometimes we don’t do it, but ultimately, often, we do it. But what is really important to understand is the folks who are undocumented end up being worried about will this end up with my deportation? This is not only because they are worried about the government sharing their healthcare information, which generally does not happen but is a fear when folks are scared of the government, but because they are worried about driving on streets or walking on sidewalks where they could be racially profiled. It’s one of the larger aspects of immigration enforcement that we miss. It’s not simply a fear of using facilities that are government facilities, but that by being racially profiled, the thought that I could be picked up anywhere. So this decreases going until a health issue is emergent and it decreases using a range of types of healthcare, therefore just using ones that are most necessary. The best way that I have of thinking about it is when we are faced with a choice like go for a checkup or lose 2 hours of work?, it is relatively innocuous. For folks who are undocumented, they don’t think either go to a doctor or get sicker, it’s often if I go to a doctor, I risk leaving my children without a breadwinner or without a caregiver. So the decision is fundamentally rooted in what could this possibly do for my family unit? I will continue to emphasize this—the worst possible scenario that many of these mothers attest to is leaving their children without care should they be deported. So given the option of going to get a checkup versus that possibility, even though it is a slight possibility, you can see why the decision often leads to neglecting medical care.

EW: Moving on, COVID-19 has been disproportionately affecting immigrant populations. Do you believe that these negative health effects from immigration policy play a role in this?

WL: Yes, in a number of ways. I think one thing that is important to remember is the explicit and overt policy of our government to find and deport people. Folks aren’t making this up and they're not just inventing something to be scared of. This is something on which our current president was elected. So all the hypervigilance and constant arousal is absolutely a safety mechanism, and an appropriate one. To suddenly switch to we want to remove you but we don’t want you to catch disease is a hard mental shift that often feels ridiculous. We know that deportation is bad for health, we have tons of data on that. We know that a coherent family is good for health. But nonetheless, you are trying to deport me anyway, and now you are telling me that you don’t want me to catch COVID. It’s hard to wrap your mind around. There is this sense of why should I suddenly trust the government? Nonetheless, folks will and do trust the government when local health departments speak the language and are integrated with the communities. But, we have run into other issues, such as simply a lack of Spanish speakers in health departments or a lack of getting the material out in the ways that are most accessible. And then, there is the reality that lots of immigrants are frontline workers, so they are constantly exposed to the virus in ways that their white peers and more upper-class peers are not. There is very little that they can do about that. I heard the quote “you can’t pick strawberries over zoom.” You can’t clean hotels over zoom. You have to be there, and thus your kids have to be somewhere. Kids either have to go to school or you have to find somebody to babysit them. So, do immigration policies make this worse? I think immigration policies that invoke fear always make it hard to trust the government. Another thing is that COVID-19 stipends were not given to undocumented immigrants, which is a direct way in which the money we are using to maintain our own homes is not there for those kinds of families.

EW: Do federal and state governments each have their own immigration policies?

WL: Yeah, absolutely. Federal policies and state policies, as well as local policies, tend to be very different. There’s lots of range on the state and local level to impact immigration enforcement and the climate toward mixed-status families. To give two examples, driver's licenses are hugely influential to life, for the reasons we just talked about. If you can be racially profiled and pulled over, and not have a driver’s license, that can cascade into your deportation. But, if you have a driver’s license, there is at least one more layer of protection, which is up to states. The other example is that sheriffs control their local jails. Jails through the Secure Communities Act provide the information of those who are detained to other government services, including ICE. What this means is that when you are booked into a jail, ICE gets that information. This happens everywhere in the country. ICE can then ask for the jail to hold the person for 48 hours beyond their release so they can come pick them up, but that’s up to sheriffs. If sheriffs don’t want to hold detainees for ICE, they don't have to. That’s a huge influencer to who is going to and who is not going to get deported. Sheriffs are also elected, so you can see that at a local level, there is also some ability to shape how welcoming or supportive a county is to undocumented folks.

EW: The current presidential administration has rolled out many new immigration policies. Can you speak about how these new policies specifically are impacting the mental health of immigrants?

WL: Yes, it’s an interesting situation because when you think about what can impact mental health, it’s not a specific policy as much as the climate the policy creates. While if we wanted to talk about individual policies we could, I would say that what shapes health much more is a climate of fear and of overt hostility, and this continued attempt to be visible with immigration enforcement, which we see in hugely visible and frightening work raids. Folks have always worried about being deported since deportation existed, but certainly the aggressive enforcement tactics of Trump, regardless of the individual policies, have impacted mental health. How does it impact mental health? There’s a few mechanisms, the most obvious of which are just the potential hypervigilance and stress of the possibility of your own removal, but also the possible removal of others. This constant balancing act of making these health decisions exists too. It’s stressful to everyday decide if you should drive on the road, if you should get your prenatal care, and what you're risking when you’re getting your vaccines.

EW: We recently heard some deeply disturbing news about hysterectomies which are being performed on women at a United States migrant detention center without proper consent. This is a very sensitive topic. Do you feel comfortable making any comments on this?

WL: Yes. I think to many folks, it wasn’t particularly surprising. The United States has a long history in the medical system, and in my own field of public health, of testing and performing medical procedures on disenfranchised folks, including prisoners, including women who were sterilized in my home city of San Antonio, including the Tuskegee trials. We are well aware of these histories. The US also has a long history of saying that immigrants’ children are going to overrun the country. You hear words like “pests”, which we saw when folks were crossing the border. Additionally, terms like “waves” and “pestilence” were used, perpetuating this metaphor of mothers producing the next generation of immigrants who would “overwhelm” the country being a constant part of immigration rhetoric. That the detention center would do it without consent, it’s objectively horrifying and disturbing, especially by an administration that claims to be pro-life and pro-family. I think one of the things that’s often hard for the public to wrap their heads around is that there are lots of acutely violent and disturbing situations that only happen because the public doesn’t get offended by situations that are slightly less disturbing. For instance, we were angry about the hysterectomies and we were angry about the separation of children at the border, but as a country, we’re really not that angry about separating children because their parents are driving without a license. We kind of shrug our shoulders with those, and we really aren’t that mad that women stop getting prenatal care because they are worried about deportation. Once we let those situations happen, then it’s much easier for the administration to go all the way down the more radical routes. What I always try to advocate is that it’s one thing to oppose the separation of children at the border, but are we opposing separation of children in our everyday midwestern counties where everyone’s just driving like other parents are? It’s the same with police violence. Are we opposing police violence but being silent about all the thousands of instances of stop and frisk that happened before then?

EW: Right. Speaking about the public, do you believe that most Americans are aware of immigration policies and the negative health impacts that they cause?

WL: That’s a good question. It’s so utterly intuitive that the removal of a parent or the removal of a community member is bad for your health, I have to imagine most folks either know or within a few minutes could understand it. We certainly have all been children to a parent, and many of us are parents. I think that most people can understand that if you have a fear of going to the doctor, your health is going to get worse. What this often comes down to is similar to the Black Lives Matter movement—until you value that type of life, you don’t really care about what policies do to it. We see this with body cams: we worked so hard to get police to wear body cams, but if we don’t care about the person being killed on film, then it doesn’t matter if it's being filmed. We know that deportation is utterly bad for health, and if we don’t know we can imagine it, but we just don’t care. It’s a matter of policy before humanity, often.

EW: Do you have any other comments you would like to add?

WL: Thanks for doing this work. One thing I often think about is that I compare the Latino and the Black communities with immigration and police violence, and I certainly want to acknowledge that there other communities there, one of them being the Arab and Muslim community. We see high instances of racial profiling after them as well. For instance, being stopped in the airport, which happened immediately following 9/11 and continues to happen to this day. It’s also a good example through these three communities of the way in which law enforcement presents this image of the hyper-violent male, though we often also see women who are having children being positioned as the ones who are “ruining” our country. What this does is allow law enforcement to act with violence quickly, so they see the “terrorist” and react with force in a way they would not if they were simply white and did not have that archetype, or stereotype, to fit around them. I would say it gets ridiculous when we see white school shooters who I don’t imagine were being racially profiled and pulled over in those communities in the following weeks. I don’t imagine there were any white men who were stopped and held at the airports. As a matter of fact, the irony of all ironies is that school shootings, mostly perpetrated by white men, actually lead to calls for more healthcare. On the other hand, if there is any violence or suggested violence, not even real violence, by people of color, we respond by increasing our law enforcement force and our instances of violence. Thanks for doing this.