‘‘Illegality’’ as a health risk

In my continuing preparation to travel to Germany next week for my Eisenhower Fellowship, I am reading a great deal of material related to the care of immigrants in that country. A particularly interesting piece is from an anthropologist based in my home town of Tampa, Florida.  As part of an ethnographic study of a clinic in Berlin, Dr. Heide Castañeda explored, among other themes, the effect the state of "illegality" or ‘‘undocumentedness’’ has on health.  

Castañeda references a study by McGuire and Georges that found that the concept of allostatic load, defined as the accumulation of biological risk associated with persistent hyperarousal, is applicable to the lives of migrants without legal status. The investigators argued that the prolonged biological stress associated with their status worsened the health risks of migrants, in combination with variables like accessibility, affordability, and willingness to seek care.

There are already myriad reasons to provide care for immigrants, even those who are not in the U.S. legally, not the least of which is that, as a nation of immigrants, it is the right thing to do. But Castañeda's work reveals yet more evidence that by excluding immigrants from care, we may very well be contributing to the deterioration of their health which we will then have to address through uncompensated care in an emergency department or in-patient hospital setting.  This is morally repugnant and economically nonsensical.