By Barbara Ferrer, American Journal of Public Health

The nexus between policy actions and immigrant health is central in this issue of AJPH in two articles by Young and Wallace (p. 1171) and Rothstein and Coughlin (p. 1179), serving as a reminder of the need for public health practitioners to adopt a framework that explicitly connects the dimensions of social determinants of health with population health outcomes. Such a framework incorporates a root cause analysis to elucidate the factors contributing to observed health results, including the centrality of economic, social, and environmental conditions.

Young and Wallace show how policies that marginalize and criminalize immigrants can minimize the effect of actions taken to ensure access to health-affirming resources. Their essay provides a critical discussion of the public health implications of states’ complex, contradictory contexts in which immigrants may, for example, simultaneously benefit from public programs while living under the specter of immigration enforcement. Their research points to the need to account for interactions across the broad dimensions that affect both individual and community well-being.

Rothstein and Coughlin note that for a quarantine to succeed, there must be a set of protections in place that minimize the legal, economic, and social effects on vulnerable individuals who need to be quarantined. One strategy for dealing with the unintended consequences of public health actions is to enact as few regulations or practices as possible that restrict individual liberty. Rothstein and Coughlin offer an alternative to this approach in their notion of “safe harbor provisions,” which can complement actions and regulations enacted to protect population health; such provisions make it both more likely that individuals will comply with public health directives and more likely that compliance will not cause additional harms. The concept of safe harbor provisions can be broadened, creating the strategic imperative to ensure that community members have access to the resources and opportunities that prevent transmission of an infectious disease; this allows policies related to quarantine to align with a much deeper set of actions that ensure economic well-being, protect from discrimination, and attend to social connections. In Los Angeles County, California, this includes creating safe and welcoming places for immigrants (regardless of citizenship status) to access a full range of free health services (including vaccinations), establishing a legal assistance fund for immigrants, and decriminalizing economic activities such as street vending.

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