- DACA —
- Deferred Action for Childhood Arrivals
What happens to a dream deferred? Does it dry up like a raisin in the sun?. . . Or does it explode?
On June 15, 2012, the Obama administration issued a memorandum providing protection from deportation for a group of immigrant adolescents and young adults who were brought as children to the United States without authorization. This memorandum, Deferred Action for Childhood Arrivals (DACA), has to date protected nearly 800 000 of the 1.9 million potentially eligible individuals (Table 1), including 228 000 children <15 years old who would age into eligibility.1 Over half of DACA recipients are <21 years old, one-quarter are parents of US-citizen children, and 70% have family members who are US citizens.2 Although DACA does not provide a permanent lawful immigration status and is only a piece of policy needed to support immigrant families, DACA allows youth to receive Social Security numbers, obtain driver’s licenses, seek higher education, and become legally authorized to work. DACA permitted those who consider America their home to finally feel at home. However, on September 5, 2017, the Trump administration announced it would end the program. As a result of this decision, nearly 800 000 current DACA beneficiaries and their families now face legal jeopardy, creating a climate of fear and psychological turmoil. Sadness, shock, anger, and opposition have also emanated from communities and professional organizations that value the DACA program and have witnessed the contributions of DACA recipients to our collective prosperity.
Immigration status, including DACA, is a social determinant of health that intersects with other determinants, including access to care, mental health, educational attainment, and poverty. Emerging data reveal the protective benefits of DACA.3–6 With qualitative findings, researchers have shown that DACA recipients reported increased ability to seek needed medical care because of decreased fear of deportation and higher economic stability.5 DACA-eligible individuals are nearly 40% less likely to experience moderate-to-severe psychological distress compared with those ineligible for DACA.6 Similarly, compared with those who have not received DACA, DACA recipients have reported reduced odds of stress, negative emotions (fear, anger, sadness), and worry about the need to leave the United States.4 In a recent survey of over 3000 DACA recipients, researchers found that the vast majority were employed (91%) and almost half were currently enrolled in school (45%).2 The positive impact on income-earning potential and attainment of higher educational status suggests that DACA may mitigate poverty for recipients and their families.
DACA also provides major benefits to our economy and society. After receiving DACA, recipients reported opening a bank account, acquiring their first credit card, and obtaining a job with health coverage.2 They have purchased their first cars and homes, and they have started their own businesses. DACA recipients have pursued professional licenses in education and have attended medical school.1 Almost 20 000 DACA recipients currently have jobs in the health care industry,1 including those in residency training programs across the country. In addition, DACA recipients, compared with undocumented immigrants of the same age, are more likely to have white-collar, indoor occupations (such as office and administrative support), whereas the latter were often in more manual, lower-skill occupations.1
Just as the benefits of DACA extend far beyond direct beneficiaries, its termination threatens the health and well-being of children, families, and communities. The health disparities experienced by the ∼1 million undocumented immigrant children and adolescents living in the United States (ie, those not enrolled in DACA) allude to the potential impact of ending the program. Parents’ unauthorized status creates stress for children that can threaten their health, development, and general well-being.3 The economic losses would be enormous, with a reduction of an estimated $460 billion in our GDP over the next decade because of lost revenue from employed DACA recipients. States with the highest numbers of DACA recipients, like California and Texas, would be affected most greatly, with estimated losses of $11.6 and $6 billion, respectively.7
Pediatricians care for children, regardless of where they or their parents are born. As physicians, we took an oath to “first, do no harm.” Now we question the possible harm of having reassured our patients and their families when they shared that they were applying for DACA.
We encourage pediatricians to recognize the powerful impact of family immigration status as a social determinant of health. Identifying legal concerns during visits, including those regarding immigration, can help to start the conversation in a setting often considered a rare “safe space” and reinforces the value of medical-legal partnerships that assist families with immigration concerns. Identifying mental health problems and providing care with referrals can support youth coping strategies and improve their psychological well-being. Connecting families to resources addressing social needs can reduce stress and enhance health outcomes. Making pediatric practices welcoming to all patients, including children in immigrant families, can foster trust in the health care system.
Outside the clinical setting, pediatricians can more broadly engage to support children in immigrant families. Become familiar and collaborate with both national organizations (eg, National Immigration Law Center, Young Center for Immigrant Children’s Rights) and community-based organizations (eg, public health departments, faith-based organizations, grassroots organizations) that provide families with support and connect them to services. Spread awareness about how immigration policies affect children by writing an editorial and participating in social media. Work with the American Academy of Pediatrics at the state or national level to advocate for change. Lastly, share with elected officials both the evidence supporting DACA and the stories of children in your care whose health is impacted by immigration policy. We encourage pediatricians to urge Congress to support bipartisan legislation that prioritizes family unity, improves health outcomes, mitigates stress, promotes health equity for immigrant youth, and provides a permanent solution to DACA.
DACA is by no means a panacea for recipients or their families. These youth remain ineligible for any federal benefits, including health programs. Recipients still report high levels of stress regarding possible deportation of family members or friends.4 For some communities, DACA may create divisions between recipients and the ineligible.5 However, at its core, DACA represents a natural experiment that has proven that immigration policies that transition qualified undocumented individuals toward legal status can promote long-lasting societal and economic benefits, including family unity, general well-being, and economic stability. Therefore, DACA is a critical first step in a movement toward comprehensive immigration reform.
Children should never be used as a political bargaining chip. Ending DACA without a more permanent legislative solution in place has augmented the stress and fear that families with mixed-citizenship status have increasingly faced. Now is the time for pediatricians to take action. We must collectively exercise our privilege as health care professionals to use scientific evidence from DACA to advocate for one common dream: a pathway to legal status that the children and families for whom we care rightfully deserve.
We thank Jennifer Nadga, JD, Daniel P. Krowchuk, MD, FAAP, and Tamar Magarik Haro for their thoughtful review of this manuscript.
- Accepted September 25, 2017.
- Address correspondence to Omolara T. Uwemedimo, MD, MPH, Department of Pediatrics, Cohen Children’s Medical Center, 269-01 76th Ave, New Hyde Park, NY 11040. E-mail:
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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- Copyright © 2017 by the American Academy of Pediatrics