Immigration Policing and Health: A Conversation with Dr. Nolan Kline

https://doi.org/10.56927/709264

Interview by Ella Wesson

HHPR Editor Ella Wesson had the opportunity to interview Nolan Kline, an Assistant Professor and Co-Coordinator of the Global Health Program at Rollins College. Dr. Kline, a medical anthropologist, researches the social and political determinants of health. He recently published a book, “Pathogenic Policing: Immigration Enforcement and Health in the US South.”

EW: Would you mind introducing yourself and telling us a little bit about what you study and teach?

NK: Sure. I’m Dr. Nolan Kline. I’m Assistant Professor of Anthropology and I co-coordinate the Global Health Program at Rollins College. My research overall, in a nutshell, is all about the social and political determinants of health. I look at the ways in which the social world and policy ultimately have health-related consequences. Much of my work focuses on the hidden health-related consequences of immigration enforcement policy and police practices and how these policies all come together to affect undocumented immigrants and the broader communities in which immigrants live.

EW: Thank you. You recently published a book titled Pathogenic Policing: Immigration Enforcement and Health in the U.S. South. Could you give a brief overview of some of the major themes that you write about in this book?

NK: Sure. In the book, I look in particular at the combination of state-level immigration laws in Georgia—though these laws have passed in several U.S. states, not just in Georgia. I look at how those state laws that have really focused on aggressively responding to immigrants converge with federal policies that allow for local police officers to essentially become mini ICE agents, so mini federal agents who are able enforce federal immigration laws. Then, I look at how that convergence of state and federal laws also combines with local police practices that most people are pretty familiar with, like getting stopped for going a little too fast, or not fully stopping at a stop sign. I look at how those police practices and other practices, like setting up roadblocks or checkpoints, all come together to create an immigrant policing regime. In the book, I describe how this combination of state and federal laws and police practices all come together to affect undocumented immigrants’ individual health behaviors, their family relationships, and the healthcare settings where they seek services, and also how they have hidden impacts on hospitals and clinics that all people rely on.

The book looks at this major theme of fear. It outlines how immigration enforcement policies and police practices all come together and attempt to control immigrants through fear and make them too fearful of seeking certain kinds of health services. They ultimately end up avoiding care in some places or going to sources of care that are actually associated with greater degrees of exploitation. This is commonly economic exploitation, and if they go to these places they don’t always get the care that they need or that actually responds to a problem they have. This kind of fear, fear of encountering law enforcement and fear of deportation, not only results in people avoiding certain sites of care and going to sites of care that are worse for them, but also then shapes family relationships. The way it does that is through, for example, being afraid of calling police if you’re in a situation of intimate partner violence or any kind of family violence situation.

One of the other themes I look at is the unintended consequences of immigration enforcement. One of those unintended consequences is the way that health providers are controlled through these immigration policies. One example of this is how one Georgia law required that when renewing their professional licenses, all providers provide proof of their immigration status during that renewal, which resulted in Georgia not being able to keep up with the backlog of people renewing. That backlog ended up resulting in over 1200 providers losing their ability to practice simply because Georgia couldn't keep up with the requirements that were totally unnecessary and arbitrary.

These unintended consequences—another theme—also extend beyond health providers and include healthcare facilities like hospitals. This is a particularly important point that I get at because I look at how immigration policies merge with other health policies to ultimately weaken healthcare facilities in the United States, including these publicly funded hospitals. The way that works is through this situation I describe called patient dumping. As a result of these aggressive immigration laws, hospitals in the Atlanta area would sometimes get patients they thought were undocumented, decline service, and send them to a public hospital through this process of patient dumping. Meanwhile, this public hospital was facing financial troubles because the Patient Protection and Affordable Care Act (also referred to as Obamacare) had this assumption built into it that hospitals were going to be seeing fewer patients who were uninsured because Medicaid would be expanded in all states. Therefore, it was assumed that hospitals wouldn’t have indigent patients anymore, but states like Georgia decided not to expand Medicaid. Ultimately, this public hospital had an influx of undocumented patients because these other hospitals were sending their patients there. Meanwhile, they were simultaneously losing funding to treat indigent patients. They were getting more uninsured indigent patients and losing money to reimburse the forms of care for them, so that ended up creating what the hospital providers there explained as a situation where things were made worse for everybody. There were longer wait times and the hospital was more financially strained.

So, the long answer to your question is that immigrant policing has these multiple hidden health-related consequences that affect not just undocumented immigrants, but all people including their families and the hospitals on which all of us rely.

EW: You mentioned earlier layered immigrant policing in Atlanta and other cities and states in the South. Could you speak about the interactions of these layers?

NK: Sure. One example I can immediately offer is how immigration enforcement regimes ultimately result in, again, some immigrants avoiding certain types of care and then how that impacts clinical settings. I remember, for example, one provider who operated a clinic explaining to me that as a result of all these immigration laws, they now have more no-shows than they've ever had. I asked him to explain why. He explained that now he gets phone calls from people saying “I can’t make my appointment because there’s a cop car sitting in my driveway.” People don’t want to leave the house because they know that as a result of some of these immigration laws that require police to stop anyone they suspect of being undocumented, if they leave the house an officer might stop them and that can result in their deportation. So, here we’ve got this situation where the provider now has this no-show and has to figure out how to deal with that. That provider ended up starting new practices for the clinic that had never been in place before. They started triple-booking, so for any appointment slot, instead of only having one patient booked, they would book two or three because they assumed that there would be this increased no-show rate. Here we’ve got a few things at work. We’ve got this immigration policy that is constraining people, making them not want to leave their house even just to go to the doctor, and then we’ve got this economic constraint on providers who have to pay their own expenses. We have this market-based medical system in the United States where we think of healthcare as a commodity, and when we do that, we end up with really interesting tensions like this one between providers needing to pay their expenses and immigrants fearful of seeking care.

EW: Enforcement of federal law falls to the President of the United States. What do you speculate could be some notable changes in terms of immigration policing with the incoming presidential administration in contrast to the past 4 years?

NK: I should note that there’s only so much a President can do. It’s really up to Congress to actually change immigration laws, so I want to point out that we need to look to our Congressional leaders to make the changes that we need to see on immigration. But what I will say is what a difference an administration can make. In current research that I’m doing in Orlando, I’m hearing from undocumented farmworkers that as a result of the Trump administration’s hostile anti-immigrant rhetoric, people are not only fearing seeking services, but they are noticing non-immigrants are harassing them more. When they go to places like grocery stores and department stores, people are telling me that a white person will come up to them and start yelling “speak English,” “go back to where you came from,” and what they’re saying is that this never happened before Trump. They’re attributing this to the way the Trump administration has emboldened an already-existing racist sentiment and has almost given permission for people to express that.

What I think could happen is perhaps a retrenchment. Maybe we will see people rolling back in their emboldened racist sentiments. And a little more specifically, what I think we could see is a limited way of acting from the Executive Branch, so from a Biden-Harris Administration. We remember the Deferred Action for Childhood Arrivals Executive Action from the Obama Administration was a temporary reprieve from deportation, like a pause. Maybe what we might see in the Biden-Harris Administration is an expansion of that, or something like that. It is no substitute, though, for Congressional action, because Congress has the power to make law. What we end up seeing with the Executive Branch is the authority to not enforce certain policies, which is problematic because that is temporary and changes with each administration, and what we need is something more permanent.

EW: As a medical anthropologist, you engaged with immigration rights by joining organizations and working closely with leaders and members of some of these groups, in addition to conducting interviews with people who see immigration policing and its impacts firsthand. How do you suggest increasing the general person’s engagement with these issues on a national scale?

NK: First it starts with fact-checking. Anytime I give a talk about undocumented immigrants, I always do some myth-busting. For example, myth number one is that undocumented immigrants don’t pay taxes. Well, that’s not actually true—they do. They pay taxes in the form of property taxes, as a lot of undocumented folks own property, and even if they’re renters they are paying rent and the property owners pay those taxes. They also pay sales tax and income tax. There’s this myth that undocumented people don’t pay income tax and that’s not true. A lot of people will get tax ID numbers and pay taxes. Another myth that I always try to bust is this idea that undocumented immigrants use more social services than they receive, and that is patently false. So, I think it first and foremost begins with some correcting of these long-standing and outdated notions.

That can be challenging, though, in our current political climate that resists facts and data. So when that’s the case and we cannot start in the here’s the data place, then I think we do have to go to this people are human beings place, and that’s not always convincing either, but the way I’ve seen it work is through collaborating with organizations like I do here in central Florida. One of them is called Hope CommUnity Center, and we do these homestays and service learning projects where students and community members come in and pick alongside farmworkers in fields, and they’ll sometimes have overnight stays with families and get to know them. By the end of those experiences, students come away having their eyes opened and thinking “I never knew it was like this; this wasn’t who I had in mind when thinking undocumented immigrants.” I don’t know how we do that on a national scale other than by continuing to push against these assumptions and try to correct them, but I think that’s where we have to start: by certainly starting with facts but then also saying, hey, people are humans.