On February 24, 2017 Health & Medicine Board Member Linda Rae Murray M.D. MPH testified before the Cook County Health & Hospitals Board in response to changes in immigration policies in the County.

Good morning. On behalf of the Board of Health & Medicine Policy Research Group, I ask that you take prompt actions to address the rapidly changing situation with immigrants, both those with and without documents; and other marginalized groups such as Muslims, LGBTQ people, and communities of color.

Our County government, and its health system, are to be congratulated for progressive policies designed to protect the rights of all people and treat everyone with dignity and respect. These longstanding policies and procedures were designed for an atmosphere that no longer exists. In a short few weeks the new President and his administration have taken actions designed to create division, fear, and terror in the communities you serve.
Cook County has an estimated 307,000 undocumented residents. The majority of immigrants in our County originate from Mexico and other nations in Latin American; however, all parts of the world are represented. In addition to Latino neighborhoods, people from our Polish, Asian, and African communities are staying home. They are afraid to get groceries, send children to school, and keep doctor’s appointments. You can see this if you look at retail sales on 26th street or clinic visits in the Cook County system.

Since slavery, Black Americans have been stigmatized, incarcerated, shot like dogs in the streets by a system of structural racism and a criminal justice system that views us as sub-human. It should come as no surprise that data from Homeland Security show undocumented immigrants of African descent have been disproportionately turned over to Immigration and Customs Enforcement (ICE ) for deportation. Some estimate that the deportation rate for those of African descent is five times higher than others. Black immigrants make up only 7% of the total immigrant population; however, 20% of all immigrants in deportation proceedings due to criminal convictions are of African descent.

President Trump has greatly expanded the definition of who will be prioritized for ICE raids. Furthermore, any non-prioritized people caught up in such raids may be subject to detention and deportation. These actions have included young people with DACA status. A woman seeking justice in our courts on matters of domestic violence has been arrested. Earlier this week ICE returned to detention a young woman with a diagnosis of a brain tumor in need of surgery.

We urge this board to respond to these rapidly changing and unpredictable new policies of the Federal government. Such action would be completely in line with the County’s long standing policies and our traditional of caring for all regardless of status or ability to pay.

The Cook County Department of Public Health has been a national leader on health equity for well over a decade. They play a leadership role in the National Association of City and County Health Officers (NACCHO), the National Collaborative for Health Equity (through the Collaborative for Health Equity – Cook County) and other national leadership bodies around health equity. Most recently Human Impact’s national leadership group around health equity issued an important document we have included in your packet. (“Public Health Actions for Immigrant Rights: A Short guide to protecting undocumented residents and their families for the benefit of public health and safety.”) This document has been extremely well received around the nation. The guide benefited from the contributions of Mr. James Bloyd MPH, a member of the Cook County Department of Public Health, and a national leader on Health Equity. We encourage the Health and Hospitals System to make use of this excellent guide.

We know that both the City and County governments are actively exploring ways to respond to the new administration and protect our residents. However, only this Board, the leadership, and staff of the Health System are capable of responding with the specialized level of detail to protect patients and the public. We do NOT wish to increase the level of panic in our communities. We believe a thoughtful, prompt, and transparent process will help reassure patients and the communities you serve. We urge this board to form a special Task Force to protect marginalized communities. The most important goal is to assure that the spirit of the Health System presents policies to protect our patients and public health so the safety of all residents of Cook County can be realized. This Task Force should include members of this board, leadership of the health system, rank and file workers, and community organizations familiar with immigration issues. The Task Force should be empowered to consult with appropriate sister agencies (e.g. States Attorney, Sheriff) as well as outside experts. The Task Force should begin by address the following points:

1. To review and clarify (and recommend modification if necessary) present System policies designed to protect our patients. For example, is the present collection of social security numbers necessary ? When none is offered and recorded as such in the electronic medical record does this serve as an inadvertent way to identify vulnerable populations? What should staff do if police or ICE appear without a legal warrant seeking access to patients? What steps should be taken to protect patients who are referred outside of our system for services? Health System staff working on visas need to be afforded legal counseling. The details of such scenarios need to be carefully examined and appropriate revisions and clarifications made.
2. Train all staff about the truth and myths around immigration and the details of the clarified System policies and procedures. Staff need to understand the history of immigration in the United States, the rights people enjoy, and the health and safety impact of immigration policy. Clinical staff, in particular, may need refresher training on how to provide services to vulnerable populations without causing additional trauma around immigration status.
3. There needs to be abundant and clear signage in multiple languages reassuring staff, patients, and visitors that we are a welcoming institution. One example can be found here.
4. The Health System needs to be prepared to refer patients for legal and other services they might need.
5. The Health System needs to monitor show rates, utilization of its services, and other indicators of neighborhood distress in immigrant and marginalized communities.
6. The Cook County Department of Public Health should prepare a policy brief detailing the threat of Trump’s immigration policies to the public health and safety of all who live in the county.
7. The Health & Hospitals System board and management should continue to play a visible leadership role by designing and implementing best practices for medical and public health providers in our state.

We are confident that this Board and our Health System will rise to the occasion. The staff and board of Health & Medicine stands ready to assist in any way we can.