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Chloe Black

Dr. Jensen

6 May 2023

Honors 400

Strategies for Health Equity in Undocumented Latinx Communities

The recent emphasis on immigration policy following the United States 2016 presidential

election has led to a dramatic decrease in healthcare access and utilization among undocumented

Latinx communities. Specifically, immigration policy Section 287(g) has instilled fear and

confusion within undocumented Latinx communities, making them less likely to risk deportation

by accessing public health facilities. The implementation of immigration policy Section 287(g)

adversely impacts public health by decreasing the utilization of healthcare among undocumented

Latinx immigrants, which calls for the application of Telemedicine among undocumented

communities to remedy this urgent issue.

Due to Section 287(g), undocumented immigrants feel as if they have a large target on

their backs which confines them to their homes and reduces their population’s health. To provide

context about the immigration policy that affects healthcare utilization, counties that implement

Section 287(g) allow for the partnership between Immigration Customs Enforcement (ICE) and

local law enforcement. The initial purpose of this immigration policy was to identify and deport

undocumented criminals; however, it turned into something much more destructive. As Beatriz

Suro notes in “The Influence of Perceived Immigration Context and Healthcare Utilization

Immigration Law Concerns on Latinx Immigrants’ HIV Testing”, corrupt local police officers

used this newfound power to justify routine house raids, drivers license checkpoints, and traffic

stops for the purpose of tracking down all undocumented individuals, regardless of criminal
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history (Suro et al. 157). Here, Suro begins a discussion on the ethics of Section 287(g) and how

detrimental the policy is to all undocumented immigrants. This policy unproportionally targets

Latinx communities; moreso, it instills a deep-rooted fear of deportation in undocumented

individuals. Not only do these individuals fear law enforcement, but they also fear/lack trust in

all public officials.

Increasing the presence of local law enforcement with the power of deportation in

undocumented communities results in reluctance to access transportation due to the enhanced

fear of being stopped by police without documentation. As stated earlier in the text, police

officers under Section 287(g) partake in routine traffic stops as well as drivers license

checkpoints; because of this, immigrants fear traveling to healthcare facilities without proper

documentation. As Scott Rhodes discovered in “The Impact of Local Immigration Enforcement

Policies on the Health of Immigrant Hispanic/Latinos in the United States”, there is a significant

difference in late prenatal care in Latina mothers pre-implementation of Section 287(g) and post-

implementation of Section 287(g) (Rhodes et al. 332). This means that Latina mothers

experienced later-term prenatal care after Section 287(g) was implemented. Further, Rhodes

states “[...] participants reported experiencing racial profiling by law enforcement while driving

and indicated that some immigrant Hispanics/Latinos avoid driving even in the case of a medical

emergency” (Rhodes et al. 332). Here, Rhodes sparks a conversation on the issue of

transportation to access medical services when Section 287(g) is implemented. Specifically,

Rhodes comments on the negative effects of immigration policies that allow for local law

enforcement to partake in routine traffic stops which unproportionally target the Latinx

population. Ultimately, then, Rhodes’ study on prenatal care allows us to contextualize why
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undocumented immigrants are reluctant to access healthcare and the adverse health effects of

such hesitation.

\ From the perspective of frontline service providers, undocumented immigrants sacrifice

their health for the sake of themselves and their families' security in the United States. As

Monika Doshi notes in “Barriers & facilitators to healthcare and social services among

undocumented Latino(a)/Latinx immigrant clients: Perspectives from frontline service providers

in Southeast Michigan”, for example, “[...] frontline service providers perceived that their

undocumented clients confront a host of factors associated with accessibility to facilities that

influence the delay in identifying and traveling to healthcare facilities, and, in turn, their own

ability to provide timely and effective services” (Doshi et al. 9). Here, Doshi starts a discussion

on how the presence and actions of local police and ICE agents affects both providers and

patients in the healthcare setting; not only does the presence of local police/ICE impede on

timely services, but it stops undocumented immigrants from accessing their scheduled

appointments completely. Specifically, the threat of being pulled over by police without

documentation is a significant deterrent in the utilization of health services. Further, Doshi states

“[...] undocumented clients deferred their healthcare needs out of fear of being targeted while

driving, often missing critical health appointments'' (Doshi et al. 10). Here, Doshi illustrates how

big of an issue transportation is in the utilization of health services; undocumented immigrants

have a higher chance of being pulled over due to racial profiling during routine traffic

stops/drivers license checkpoints. Ultimately, Doshi’s work allows us to understand how being

caught without documentation is like a death sentence for these individuals because it very likely

ends in deportation; in turn, they sacrifice their health and the health of their families.
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Implementing Telehealth into undocumented communities would eradicate the stress of

transportation and, in turn, increase the utilization of healthcare among undocumented

immigrants. Health services that eliminate the risk of law enforcement interactions are ones that

are feasible and don’t require the patient to leave their home, which is why Telehealth is a logical

solution to this healthcare crisis. As Doshi states, for example, “The threat of immigration

enforcement engendered changes in behavior (e.g., increased self-confinement) that promoted

safety and security but impeded timely access to healthcare and social services'' (Doshi et al. 14).

Here, Doshi notes how the fear of immigration policy leads to self-confinement in undocumented

immigrants; more specifically, this highlights the urgency for a healthcare service that is

accessible to undocumented individuals without the threat of an in-person visit that requires risky

transportation. Doshi’s work allows us to contextualize why Telehealth is an optimal solution for

undocumented Latinx immigrants.

There is a large proportion of undocumented immigrants that are unaware of their rights

and what health services they are eligible for; moreso, this lack of knowledge compounds when

Section 287(g) is implemented in nearby counties which results in self-confinement and self-

medicating. As Rhodes notes, for example, “Participants in our study reported knowing that

enforcement was increasing, but many lacked information about actual programs; many did not

know whether the county that they lived in implemented Section 287(g)” (Rhodes et al. 336).

Here, Rhodes calls attention to how the lack of outreach to undocumented communities results in

a complete lack of information about policies that can potentially affect these individuals.

Specifically, Rhodes highlights how the presence of immigration policy in nearby counties can

deter undocumented immigrants from accessing services that they could be eligible for. When

word of deportation circulates a population, it creates hesitancy and hostility within those
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communities; in fact, this results in self-confinement, which creates a significant delay in

accessing care and leads to risky alternatives to care such as self-medicating. Further, a

participant from Rhodes’s study states “That’s the reason why many people bear it or look for

medicine in the Mexican stores. [...] It’s because they are afraid to go to the doctor. They look

for alternatives” (Rhodes et al. 335). Here, Rhodes illustrates how immigration policy leads to

self-medication, which is not only dangerous but extremely unethical for the standards of the

United States. Fundamentally, Rhodes’s work allows us to understand how a lack of outreach to

undocumented Latinx communities has a multitude of negative consequences such as deterring

individuals from accessing eligible services and self-medicating.

Telehealth would improve the health of undocumented Latinx communities by providing

relaxed and easily-accessible health services which would allow for undocumented immigrants

to end their self-medicating, and would create a safer, less stressful environment in their

communities. Having the ability to access quality medications straight from established

pharmacies could benefit undocumented individuals’ mental health. An interview participant in

Rhodes’s study notes, “Many of us no longer have that desire to fight. [...] I did get into a

depression. It was an ugly depression, and I didn’t know when it would be over” (Rhodes et al.

335). Here, Rhodes sparks a discussion on the mental health issues that undocumented

immigrants suffer as a result of being excluded and isolated from the rest of the United States

population. Not only could Telehealth remedy the stress of accessing medication, but it could

also provide the mental health services that are crucial to undocumented communities.

For those in opposition of allowing undocumented immigrants safe access to healthcare

facilities, consider this: their non-utilization of healthcare actually negatively affects US born

citizens. Suro notes, for example, “[...] perception of enforcement of immigration laws may
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interfere with public health strategies to reduce HIV transmission as HIV testing is an essential

step in the seek, test, and treat (STT) U.S. strategy aimed at curbing the HIV epidemic” (Suro et

al. 162). Here, Suro calls attention to how the perception of enforcement of immigration laws is

detrimental to society. This tells us that due to an anticipated anti-immigrant rhetoric in the

healthcare system, undocumented immigrants avoid public health facilities and in turn suffer

consequences such as late HIV diagnosis which not only contributes to the advancement of HIV

into its deadly form of AIDS, but the increased spread of HIV in the United States. This is a big

reason why the utilization of healthcare is so urgent in undocumented communities; not only do

their specific populations suffer, but the entirety of the US population reaps the consequences as

well. Suro’s work allows us to see how the distrust of public officials due to Section 287(g) is

exceptionally detrimental to public health, and is dangerous to those needing preventative care.

The livelihood and productivity of future US citizens are at risk because of the

enforcement of immigration policies such as Section 287(g). The decline of infant-health is

another consequence of undocumented immigrants’ non-utilization of healthcare on US citizens.

As Romina Tome notes in “Heightened immigration enforcement impacts US citizens’ birth

outcomes: Evidence from early ICE interventions in North Carolina”, for example, “After the

policy was implemented, birth outcomes [...] worsened: infants weighed less and were more

likely to be small for gestational age” (Tome at al. 6). Here, Tome begins a discussion on how

children born to undocumented Latina mothers, who under the 14th Amendment are US citizens,

reap the consequences of immigration policy. Further, Tome states “Lower birth weight has been

related to worse outcomes later in life. [...] Small gestational age has been related to poorer

performance at school and lower income” (Tome et al. 10). Tome highlights a direct and

indisputable link between local law enforcement acting as ICE and the health of US citizen
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children born to undocumented Latina mothers. Ultimately, then, Tome’s work illustrates how

all of society, regardless of documentation, is impacted by undocumented Latinx immigrants'

non-utilization of healthcare.

Less-educated immigrants are unproportionally targeted by immigration policies because

of their high likelihood of being undocumented; in order for Telehealth to successfully target

less-educated immigrants, it would have to come at a lower cost than the standard in-person visit

and must not require specific documentation. Not only are less-educated immigrants more likely

to be unaware of their rights, but their health is more likely to be impacted by the implementation

of immigration policy Section 287(g). Tome notes, for example, “The negative impacts

estimated here were concentrated among less-educated foreign-born parents, a group that is most

likely targeted by immigration enforcement” (Tome et al. 10). Here, Tome illustrates how less-

educated immigrants are more likely to be undocumented, which gives them a higher chance of

being impacted by immigration policy; in turn, less-educated immigrants are less likely to utilize

healthcare services. These individuals are also less likely to have access to healthcare insurance.

Telehealth should aim to treat any individual, regardless of documentation or financial status.

There are some very notable pitfalls of providing Telehealth as the main solution for the

health crisis in undocumented Latinx communities. Telehealth is only a keyhole solution; that is,

it is only of use to those who have access to reliable internet. As Alexis Cherewka notes in “The

Digital Divide Hits U.S. Immigrant Households Disproportionately During the COVID-19

Pandemic”, for example, “One-tenth of families headed by Hispanic immigrants had no access to

the internet in 2016 [...]” (Cherewka 2). Cherewka comments on immigrants’ lack of internet

access, which would undoubtedly only exacerbate in undocumented communities where income

is generally very low. Specifically, this emphasizes a very big flaw in providing Telehealth as the
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main solution since internet access is required for its use; however, the solution’s scope is not

large enough to apply to every single undocumented immigrant. The only way to permanently

fix this ongoing issue is my structural revision of immigration policy. Increasing the emphasis of

ethics in public policy would be great; however, it is not an applicable nor quick community-

level solution for this health crisis.

Another pitfall of Telehealth is that it requires a certain level of digital skill, which

immigrants are not usually trained in. Cherewka notes, for example, “[...] immigrants make up

more than one-third of the workforce without digital skills. [...] Among Hispanic immigrants

with children, 20 percent said in 2016 they do not use the internet at all” (Cherewka 2).

Undoubtedly, this problem only worsens in undocumented communities where statistics are hard

to gather. Here, Cherweka starts a discussion on how undocumented communities are extremely

underserved and underrepresented, which means they are not usually trained in the usage of

digital devices or networks. Undocumented individuals are also more likely to be considered

essential workers, which accounts for why they aren’t digitally skilled. Ultimately, Cherweka’s

work helps us be conscious of the digital divide that is present in the US between the foreign-

born and native citizens. While implementing Telehealth, an online health service, in

communities where often the Internet is inaccessible or digital skills are lacking seems like a

pretty ineffective solution, keep in mind this is only a temporary solution to a much bigger

problem. The goal is to provide as much relief to these communities as possible to create a

healthier and safer undocumented Latinx population. As long as some benefit from Telehealth, a

dent is made in decreasing the health disparities in undocumented communities.

In-home visits from physicians is a further solution for those without Internet access and

without fear of in-person visits by healthcare providers. On the community level, this would
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consist of partnerships between local healthcare facilities that provide mobile physicians or nurse

practitioners to enter directly into undocumented immigrants homes and treat them on the spot.

While this would fix the issue of undocumented immigrants' hesitancy to travel to access

healthcare, it doesn't remedy their fear of healthcare providers. Healthcare providers are deemed

untrustworthy in undocumented communities because of their ability to report a lack of

documentation to local law enforcement. Suro notes, for example, “Fear of deportation was

associated with greater concerns that using publicly funded healthcare services could have

negative ramifications for immigration prospects. These concerns were related to reduced yearly

HIV testing [...]” (Suro et al. 162). Here, Suro touches on how government funded healthcare

facilities increase undocumented immigrants' fear of being exposed by healthcare workers. While

Telehealth doesn’t require undocumented immigrants to go face-to-face with public providers,

in-home visits would be in-person which is why in-home care isn’t the most impactful solution.

However, since there is such a large percentage of immigrants without access to the Internet, in-

home care is a feasible solution for those that are willing to be treated directly by healthcare

providers.

There must be successful strategies for outreach to undocumented communities in order

to effectively implement these solutions. Outreach strategies that demystify the healthcare

process and provide information about healthcare services that undocumented immigrants are

eligible for, such as Telehealth or in-home visits, would work to increase the utilization of such

services. As Rhodes suggests, for example, “Using Spanish-language media, including radio,

may be a strategy to increase knowledge of rights, eligibility, and health care access” (Rhodes et

al. 336). Here, Rhodes highlights a unique outreach strategy to undocumented communities.

Since undocumented immigrants are oftentimes weary about accessing healthcare, they don’t
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fully understand what steps to take when they do utilize health services. Specifically, Rhodes’s

work sparks outreach ideas for communities that aren’t integrated into society, such as

undocumented ones. Implementing Spanish-language radio stations could inform undocumented

immigrants about Telehealth services and in-home providers from the safety of their own home,

which would make the process of accessing these services much less daunting.

Book libraries that contain pamphlets outlining specific healthcare services offered by in-

home providers would work to reach undocumented communities without access to radio-

stations. The details in these pamphlets must be extremely specific and up-to-date in order for

them to be beneficial. As Rhodes notes, for example, “[...] organizations such as the American

Civil Liberties Union have created pamphlets to educate immigrants about their rights, but there

is a need to get these types of materials, and materials like them, into the hands of those who

need them” (Rhodes et al. 336). Rhodes sparks an intriguing discussion on the importance of

distributing informative pamphlets; in fact, this highlights the need of implementing book

libraries so that pamphlets can reach undocumented communities in an efficient manner. These

pamphlets could work to educate immigrants about their lawful rights, provide information about

how to make healthcare appointments by in-home providers, what financial assistance is

available, etc. Not only would this create more of an understanding of the healthcare process but

it would build undocumented immigrants capability of overcoming the challenges of accessing a

healthcare clinic. Providing vital information to undocumented communities has always been a

challenge in the United States. Counties that have a large population of undocumented

individuals must take charge and implement these community-level outreach strategies so that

healthcare is utilized in a timely manner.

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Implementing Telehealth into underrepresented, undocumented communities is

desperately needed because of immigration policies that are more destructive to society than they

are constructive. As Lena Geraghty notes in “State of the Digital Divide in the Hispanic

Community”, for example, “As of 2020, there are 44.8 million immigrants living in the U.S.,

making up 13.7 percent of the population. About 10.5 million (23 percent) of those immigrants

are undocumented” (Geraghty et al. 5). Here, Geraghty illustrates the significance of

undocumented immigrants in the United States. Not only do undocumented immigrants make up

a significant percentage of the US population, but they also represent a large fraction of essential

workers because of their likelihood of being less-educated. Undocumented immigrants take the

jobs that are undesired which increases the risk of working long hours and being exposed to

unsanitary working conditions; in fact, they often work under-the-table jobs which gives them a

higher chance of being exploited by their employer. These individuals urgently need to be better

represented and better informed about their rights in healthcare for the sake of their populations’

health as well as the health of the general public.

In this essay, I have argued for the implementation of Telemedicine in undocumented

Latinx communities because of Section 287(g) that deters immigrants from accessing healthcare.

The threat of local police acting as ICE agents confines undocumented immigrants to their

homes and reduces the probability of them accessing transportation, which is why Telemedicine

is a valuable solution to this much larger problem. There is a significant double standard for

undocumented, or better known as “illegal”, immigrants in the United States. These individuals

are indispensable to the American economy, yet they enjoy none of the public benefits that come

with working essential jobs. Because undocumented immigrants generally don’t have access to

health insurance, their livelihood deteriorates the longer they stay in the United States. On top of
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this, these individuals, who mostly are non-criminals with low-paying jobs, are constantly faced

with deportation. Rather than guiding undocumented immigrants who contribute to the American

economy on the path to citizenship, the United States government seeks to rid them all. Until

immigration policies are revised and ethics are taken more seriously in public policy, keyhole

solutions such as Telemedicine are crucial to relieve undocumented populations of their

repression and narrow the gap in healthcare utilization among immigrants. Future studies should

test if outreach strategies, such as Spanish-language radio stations and book libraries, influence

undocumented immigrants utilization of healthcare services.

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Works Cited

Cherewka, Alexis. “The Digital Divide Hits U.S. Immigrant Households Disproportionately
during the COVID-19 Pandemic.” Migration Information Source, September 2020, pp. 1-
10.

Doshi, Monika, et al. “Barriers & facilitators to healthcare and social services among
undocumented Latino(a)/Latinx immigrant clients: Perspectives from frontline service
providers in Southeast Michigan.” PLOS One, vol. 15, no. 6, June 2020, pp. 1-18.

Geraghty, Lena et al. “State of the Digital Divide in the Hispanic Community.” National League
of Cities, 2021, pp.1-11.

Rhodes, Scott, et al. “The Impact of Local Immigration Enforcement Policies on the Health of
Immigrant Hispanics/Latinos in the United States.” American Journal of Public Health,
vol. 105, no. 2, February 2015, pp. 329-337.

Suro, Beatriz, et al. “The Influence of Perceived Immigration Context and Healthcare Utilization
Immigration Law Concerns on Latinx Immigrants’ HIV Testing.” Journal of Latinx
Psychology, vol. 10, no. 2, 2022, pp. 156-167.

Tome, Romina, et al. “Heightened immigration enforcement impacts US citizens’ birth

outcomes: Evidence from early ICE interventions in North Carolina.” PLOS One, vol. 16,

no. 2, February 2021, pp 1-15.