A Public Health Crisis May Be On The Way

Oct 4, 2018

Dr. Mitchell Katz spoke at a recent CUNY Journalism School event
Credit NYC H+H Press Office

In the first 21 months of President Donald Trump's term he has made good on his pledge to crack down on immigration. Now, some public health officials are warning his policy poses a significant risk to the public health of all Americans because immigrants are now avoiding seeing the doctor. That, experts warn, sets the stage for outbreaks of communicable diseases like tuberculosis that would impact the entire population.

WBGO's Bob Hennelly sat down with Dr. Mitchell Katz, CEO and President of NYC's Health + Hospitals, the largest public health care system in the nation. Dr. Katz told WBGO his staff has already seen immigrant families refuse medical care for fear that it will be grounds for their removal from the country.

HENNELLY: Thanks for joining us doctor. I was talking with you about what concerns you had about Washington. We were in the midst of issues related to funding and financing. You surprised me when you said one of your more emergent concerns was the tone being set by the White House as regards immigrants. Your concern you had was with the way this negative attitude about immigration could complicate the work of Health and Hospitals when it comes to making this population of undocumented feel comfortable in a public health setting. Could you expound on that?

DR. KATZ: Sure. What we want at Health + Hospitals is for people to feel that they can come forward when they are ill regardless of their immigration status. What I worry is that all of the anti-immigrant rhetoric will keep people from coming forward. They may be completely legal immigrants. And, so people may not follow the distinction between somebody who was here on a tourist visa, somebody that over stayed their tourist visa, somebody who has a green card, somebody who is a citizen from another country. And so, it is a much broader group than simply the undocumented. What I really want is for people to remember when It comes to infectious diseases there are no boundaries. A disease like tuberculosis is easily spread in close quarters if someone is on a bus for a long journey or the people sitting next to them are coughing. A cough is one of the most common symptoms. Usually when someone has a cough they have a cold. But occasionally, when someone has a persistent cough it doesn’t go away. Accompanied by a fever and weight loss they might have tuberculosis. We want all people to feel they can come forward for medical care. But what if we change the equation and people are now worried ‘if I go to the hospital, perhaps I will get public charges’—which means their care will be covered by the government. And then that charge will be seen as a reason ‘that I can’t become a legal immigrant here in the U.S. so I better not come forward.’ Families are complicated. Families include often children who were born here. One parent may legally be here. One parent may not be a documented person. People may worry about coming forward for any member of the family for healthcare for fear that a charge will be seen as a reason to separate their family. So, I want us to have a world where everybody with a serious cough feels that they can come forward. I think there are tremendous risks to the public health if we are in an environment where people fear coming forward even to caring physicians like we have here at Health + Hospitals.

HENNELLY: Is there any evidence, anecdotally or otherwise, that you are getting from your team that this is happening---where people are reluctant to come forward?

DR. KATZ: Yes, absolutely. There have been families that have specifically spoken that they will not come forward to seek health care because of fears about how a public charge could be used against them in the future or fears that immigration authorities are at our facilities, of which there are none. But that’s the thing about fear. It doesn’t always have to be rationale. That’s why I worry so much that some of these issues may only pertain to the undocumented but that doesn’t mean that other immigrants feel safe. You have to have a legal understanding to know which of these groups you are in.”

HENNELLY: We have had some success for a quarter of a century in New York City reducing tuberculosis. It plateaued and now we have seen a spike of ten percent. Are you concerned about a perfect storm, where we have seen cutbacks on free testing and this other aspect you describe, when people will be hiding in the shadows? Does that concern you?

DR. KATZ: It does concern me. In general immigrants are healthy people. You have to be a rugged individual to be able to survive as an undocumented person in this country. But It only takes one person who becomes exposed to tuberculosis, is sick and exposes other people and all of the sudden you have a whole group of cases, It can also be about the flu, right? It can be about whether or not people are coming forward to have flu diagnosed, whether they are getting their flu shots or are avoiding getting shots because they don’t want to risk a public charge. They have fears about who is in the hospital. There are a whole range of things. What the country needs to say is that when it comes to healthcare there are no barriers around immigration because there are no barriers between people on the bus, no barriers between people on the subway or on the street. And therefore, we want everybody to be as healthy as possible.

HENNELLY: In your past positions you have done some innovations. We have talked about the lines of political boundaries. But in terms of class and social circumstance you have done some work regarding the homeless to bring them in and bring in a kind of wellness regime for them. Is there interplay here with this issue as well in terms of keeping the broader body politic healthy?

DR. KATZ: My feeling is when it comes to health we all have an investment in each other and therefore what a thoughtful society does is try to keep each other healthy. I understand our country is having some ambivalence at this moment about immigration, which seems to me surprising about a country that is all immigrants except for the Native Americans. We live in a city where everybody is out there welcoming everyone. That’s certainly how I think about New York. I find this chill that comes from Washington distressing. I hope we return to a country that really welcomes immigration.

HENNELLY : So, in a sense science tells us that the fate of one family is totally integrated into the wellness of the whole?

DR. KATZ: Yes, I think that is well stated. Just as you and I, as we do this interview are across from one and another, we as a society are tied in all sorts of complicated ways.

HENNELLY: Thanks for taking the time.