Viewpoint

Beyond Borders: How Migration and Public Health Are Inextricably Linked

It is crucial to develop a holistic approach that emphasizes migration as a public health issue, not a political one, writes Joaquin Moreno, a 2023 SPH graduate, in a new Viewpoint.

Joaquin Moreno is a 2023 graduate of the School of Public Health. Viewpoint articles are written by members of the SPH community from a wide diversity of perspectives. The views expressed are solely those of the author and are not intended to represent the views of Boston University or the School of Public Health. We aspire to a culture where all can express views in a context of civility and respect. Our guidance on the values that guide our commitment can be found at Revisiting the Principles of Free and Inclusive Academic Speech.

As most Americans celebrated the end of the COVID-19 public health emergency on May 11, the simultaneous end of Title 42 has brought great uncertainty to the United States-Mexico border region. The Centers for Disease Control and Prevention (CDC) issued Title 42 in March 2020 with the goal of preventing the spread of the coronavirus outbreak by limiting travel and immigration into the US. However, this COVID-era restriction received harsh criticism given its ability to quickly remove migrants from US territory, including unaccompanied minors and asylum-seeking families. The unintended consequences of Title 42 sparked a call to action by top public health experts and physicians across the country, who considered it an override of humanitarian laws and treaties that could prevent the life-saving protection of many individuals.

While the media have recently covered the politics of the issue extensively, it is crucial not to overlook the health implications of the situation. In 2020, I wrote about the detrimental impact of the COVID-19 pandemic on cross-border populations and how it exposed prevalent health inequities across the US-Mexico border region. As Title 42 comes to an end and the uncertainty grows, the prevalent health inequities across the border region continue to become more apparent. The lack of a contention plan for when thousands of individuals come knocking at the door of the United States underscores a major flaw in immigration policy reform which concurrently fail to prioritize the health of the US-Mexico border populations.

It is vital to remember that migration is a public health issue. The challenges that migrants face during their journey and upon arrival have significant impacts on both individuals and the wider population at the border. Growing up in Ciudad Juarez, Chihuahua, and migrating to El Paso, Texas at a young age allowed me to appreciate the significant interdependence of two border cities. The US-Mexico border is the most frequently crossed international boundary in the world, with approximately one million border crossings each day. This further suggests that an issue on one side of the border cannot be ignored by its neighboring state.

Last month’s tragic fire at a migrant processing center in Ciudad Juarez underscored the urgent need to address the public health implications of migration and border policies. The overcrowded living conditions at the facility were a major factor in the severity of the tragedy, as dozens of migrants were trapped and unable to escape. These challenges are not unique to the processing center in Ciudad Juarez and have since continued to become more widespread across many areas of the border region.  

It has been well documented that migration can have significant economic advantages for both the countries of origin and their destination. However, in order to achieve these benefits, safe, orderly, and humane migration practices must be set in place. Though recent reports from local newspapers, such as Ciudad Juarez’s El Diario de Juarez, suggest that many migrants are unaware of the dangers and difficulties they will face on their journey to the border. During the long and treacherous trip from the southern point of Mexico to the northern border, adults and children fall ill due to harsh living conditions and limited access to healthcare. Despite these risks, many individuals still attempt to enter the US because they see it as a better alternative to their home conditions.

To ensure migration policies maintain health-centered strategies, studies have highlighted the importance of staying away from an approach that ‘exceptionalises’ migration and migrants. Integrating migration into the overall health systems research, design, and delivery of healthcare in the US may be a better alternative than the status quo. My current research at Boston Children’s Hospital has explored how Hispanic youth often experience more negative health outcomes compared than their Non-Hispanic White counterparts in the context of chronic pain. These findings parallel the broader implications of the social determinants of health, which suggest that limited health resources, increased risk across the life course, and stress may result in long-term health consequences, further perpetuating health disparities. 

There are significant concerns about the implications associated with individuals belonging to underrepresented racial/ethnic minority (URM) groups who undergo the journey of migration. A recent study highlighted the difficulty in assessing the downstream health effects or unintended consequences that immigrants may suffer from their displacement once they reside in the US. Through ethnographic methods of exploration the study also establishes the inextricable relationship between illness and a migrant’s life after assessing life narratives of immigrants living in the US.

It is difficult and unfair to provide a simplistic answer to the issues occurring at the US-Mexico border region, especially if it overlooks the complex interplay between health, migration, and social determinants of health. However, it is clearly unacceptable that the United States has failed to develop a contention plan that addresses the urgent need to accommodate those who seek refuge at its doorstep. The end of the COVID-19 public health emergency must not overshadow the critical public health issue posed by the current situation at the US-Mexico border. As recent events have shown, the end of Title 42 brings uncertainty for migrants looking to seek refuge in the US and for individuals living at the border region. It is crucial to remember the inextricable link between migration and public health, and most importantly, to develop a holistic approach that emphasizes migration as a public health issue, not a political one.