Reimagining immigration with public health as a guide

Last Sunday, President Biden made his first visit to the U.S.-Mexico border since assuming the presidency. It is good to see the Biden administration keeping attention on the issue of migration, which remains a critical part of the American demographic landscape. The U.S. has more immigrants than any other nation. Over 40 million people living in the U.S. were born beyond our shores. Each year, over 1 million immigrants arrive here.

Ever since the U.S. became a destination for immigrants, migration has shaped our culture and politics, as Americans have balanced competing impulses. On one hand, we are the land of “Give me your tired, your poor, /Your huddled masses yearning to breathe free.” On the other, we are the country of Benjamin Franklin arguing against German immigration, the country of “No Irish need apply,” and the country of “When Mexico sends its people, they’re not sending their best … They’re bringing drugs. They’re bringing crime. They’re rapists.” 

The tension between the instinct to welcome immigrants and the willingness to demonize them has kept migration a political flashpoint for most of American history.

Often lost in the migration debate is the human element of this issue. Migration is fundamentally about people, not political abstractions. It is about the lives and wellbeing of vulnerable populations who often face great difficulty in their pursuit of a better life for themselves and their families. It is important that we keep this reality front-and-center in our conversation about immigration, to avoid the rhetoric that dehumanizes migrants and produces the kind of bad policy that puts them at further risk.

My recently published book, “Migration and Health,” co-edited with colleagues Catherine Ettman and Muhammad Zaman, aims to balance the science of migrant health with an understanding of the people at the heart of migration and its aftermath. The process of producing this book underscored the powerful influence of migration on the health of migrants themselves and on the communities around them. 

Given this influence, public health has a crucial role to play in shaping the conversation about migration. From this perspective, three recommendations emerge for shaping a better engagement with migration, toward supporting better health for migrants and communities.

First, we need to stop demonizing migrants in the national conversation. No political issue is ever solved by calling the people it affects less than human. Yet we routinely hear migrants characterized in terms better suited to describing animals and insects than real people with hopes, dreams, fears and vulnerabilities. This needs to stop. Time and again in recent years, we have seen how health is undermined by hate and dehumanizing rhetoric. We need to ask ourselves: Are we interested in addressing the challenge of fixing a broken immigration system to shape a better, healthier status quo, or are we willing to risk the health of migrants to score political points?

Second, we should pursue policies that support the health of migrants. There are currently enormous legislative gaps in how we address immigration in the U.S. (a good summary can be found here). There is much room for compromise, for bipartisan consensus, if we are willing to turn away from the bad faith that has long characterized this issue. Migration policy affects a diverse range of stakeholders, from migrants themselves to businesses, religious groups, academic institutions and local communities where migrants are our friends, neighbors and families. United around an approach to immigration that prioritizes the health and wellbeing of migrants, these stakeholders could play a key role in advancing policies that truly make a positive difference. 

Third, we need to have a national conversation that welcomes immigrants, reengaging with the better angels of our nature on this issue. We can widen the scope of our moral imagination on immigration, just as we have widened it on many issues in the past.

Both liberal and conservative administrations have embraced policies that are compassionate to migrants, and immigrants are central to life throughout America, transcending red-blue divides. America does not have to be governed by its worst impulses when it comes to migration. 

The present influx of migrants at the Southern border, and the Biden administration’s engagement with the issue, is a chance to resist the old temptations towards xenophobia and embrace approaches that prioritize the health of the real people who risk much in the hope of a better life. We can do so guided by a truly universal aspiration — the goal of better health for all.

On each of these points, public health can help guide the national conversation toward a more humane engagement with the issue of migration. A healthy world is one in which all can access the resources that support health. We are fortunate to live in a country where these resources are abundant for many. We should not shut the door to sharing what we have. Instead, we should extend a hand in welcome. In doing so, we can create a better, healthier country for everyone who calls it home, whether native-born or not.

Sandro Galea, MD, DrPH, is the dean of the School of Public Health at Boston University. His recent book, “Migration and Health,” was published by University of Chicago Press in November. He is an immigrant.