- DACA —
- Deferred Action for Childhood Arrivals
- DREAM —
- Development, Relief, and Education for Alien Minors
Deferred Action for Childhood Arrivals (DACA) recipients are undocumented immigrants who were brought to the United States before the age of 16, lived in the United States for at least 5 years, have no significant criminal history, and were <31 years of age on June 15, 2012. They are sometimes termed “Dreamers” after the never-passed legislation known as the Development, Relief, and Education for Alien Minors (DREAM) Act. The DREAM Act would provide a path to citizenship for this population. DACA does not.
President Trump recently rescinded the executive memorandum that created the DACA program.1 Although his action does not take effect immediately, it leaves nearly a million Dreamers in limbo. Unless Congress acts by March 5, 2018, Dreamers’ legal status will expire. Starting on that date, more than 1000 DACA recipients will lose their legal status every day. If that happens, they will lose their ability to work lawfully and to take out educational loans. They will face potential deportation by Immigration and Customs Enforcement. This will have both a personal impact and a societal one. One DACA recipient (and a coauthor of this article) described the personal impact:
In the past few months, I have felt the return of that crippling fear. I feel it in my pounding heart whenever I get behind the wheel. I feel it in my numb fingers and legs when a police car drives by me. I feel it in the butterflies in my stomach when I take the train. I feel it in the darkness when I wake up from yet another nightmare of ICE showing up at my door. I feel it when I read the headlines and listen to the news about another person shot to death, another family separated, another brave soul searching for solace only to be forced into detention. And I realize this isn’t new. This has always been under the surface. We’ve been here before, before the campaign, before DACA.2
Before DACA, Dreamers were marginalized in ways that negatively impact the social determinants of health. They had limited employment and educational opportunities. The lack of lawful work opportunities coupled with few realistic hopes for pursuing higher education likely contributed to the high drop-out rates of undocumented youth at the high school level. The DACA program mitigated some of these effects and increased their wages and the kinds of employment available; it also fostered access to higher education as institutions increased scholarship and financial aid opportunities. Despite DACA recipients remaining ineligible for federal student loans, they are now enrolled in college at a rate close to that of their peers in the general population.3 The unwinding of DACA will reverse the innumerable positive trends in the lives of these young people that the program had set in motion and return the threat of removal.
The end of DACA will also have an impact on the health care workforce. Before DACA, occasional undocumented applicants had entered medical schools. But the lack of an employment authorization document (a “work permit”) made licensure and residency nearly impossible. As a result, it wasn’t until the creation of DACA that this population was given systematic consideration by any medical schools.
The Loyola University Chicago Stritch School of Medicine was the first medical school in the nation to publicly declare that DACA recipients were eligible to apply. It currently has 32 matriculants who are DACA recipients. Since then, many other medical schools and residencies have welcomed DACA recipients. More than 100 DACA recipients applied to allopathic medical schools in 2016.4 This cohort is just beginning to apply for residencies. These students will help create a more diverse and culturally sensitive physician workforce. They are usually bilingual and bicultural because of having grown up in immigrant families within the United States. They have a deep cultural understanding of the immigrant experience.5 With such important contributions to the health workforce in mind, the American Association of Medical Colleges, the American Medical Association, the American Academy of Pediatrics, and more than 300 national, state, and local child and youth advocacy organizations have supported both DACA and the DREAM Act.6
Pediatricians have a duty to advocate for children who are victimized by conditions and policies that prevent them from thriving. We need to speak out against the injustice of punishing these people who have done nothing wrong. They have grown up in the United States. For many, this is the only country they have known. We must become advocates and identify specific actions that can help these children and young adults.
What can we do? Pediatricians should call their legislators in Washington and ask them to support the DREAM Act or comparable legislation. Most members of Congress support the DREAM Act. Some want to go further and tackle comprehensive immigration reform. But in this case, the perfect may be the enemy of the good. Dreamers are a specific population with specific problems for whom there is a straightforward solution. The DREAM Act won’t solve all of our immigration problems. But it will solve 1 of the most pressing ones.
Second, we should use this occasion to advocate for several kinds of possible reforms to our immigration system. For instance, young people who are part of a family petition for permanent residency status should not “age off” the petition. As things stand now, parents of Dreamers sometimes gain relief while their children have to begin the process all over again and wait decades for their green cards.
Finally, as health care professionals who deal with the lived realities of our patients and their families, we must contribute to a more humane narrative concerning undocumented immigrants. The tradition of medicine dating back to Hippocrates is for doctors to care for all who are in need, regardless of their legal or social status. We must advocate for a better understanding of our patients and the many difficult conditions that cause people to emigrate. As respected professionals within our communities, we must use every local and national platform to let people know that our undocumented patients -- and our undocumented students and colleagues -- are typically hard-working, brave, family-oriented people. They are not criminals, even though, for political purposes, they are often portrayed as such. Our experiences with undocumented immigrants within the health care environment provides us insight into a counter narrative. Inclusion leads to increased contribution from the undocumented population. Exclusion only detracts from their good and the good of society, including our health care institutions.7 We must spread the word.
- Accepted October 24, 2017.
- Address correspondence to John D. Lantos, MD, Children’s Mercy Hospital Bioethics Center, Kansas City, 2401 Gillham Rd, Kansas City, MO 64108. 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.
- Department of Homeland Security
- Patel Z
- Capps R,
- Fix M,
- Zong J
- O’Reilly KB
- Children’s Defense Fund
- Kuczewski MG
- Copyright © 2018 by the American Academy of Pediatrics