Sanctuary Cities Save Lives

Much has been made of the ongoing game of chicken about sanctuary cities in the United States. From threats to cut off federal funding by the Trump Administration, to affirmations of continued sanctuary city status by Mayors, to the consideration of sanctuary states, and even a redefinition by my very own Mayor, establishing Philadelphia as the country’s first “Fourth Amendment city.” Even given the dizzying confluence of worst-things-ever and best-things-ever, and all of the conflict associated with it when a proposed policy is simultaneously described as both of these things, the battle over sanctuary cities has continued to be a simmering issue throughout.

As politically-charged stories are wont to do these days, the rhetoric has been ratcheted through the roof. At the most basic level, a sanctuary city is one that, in any of a number of legal or procedural ways, refuses to cooperate with a standing request (not requirement) by the federal Immigrant and Customs Enforcement agency to detain undocumented people they come in contact with. Some cities never ask about immigration status, while others will cooperate with federal authorities when dealing with violent detainees, and other cities are just about every gradation in between. The Lowdown has a pretty good overview here.

At it’s most simple level — purely black and white — the idea of sanctuary cities being harmful can make some sense. If someone is breaking the law they should be punished and deportation is the punishment for being being in this country without the proper documentation. We live in a world, however, full of vibrant colors and each of those colors has an infinite number of shades. Anyone who feels this issue is simple, or black and white, has no understand of the myriad interconnected ways that it affects cities who have adopted the sanctuary, or “Fourth Amendment,” moniker.

Completely ignoring the unfunded mandate part of this argument (which is probably the most legally compelling argument for the continued existence of sanctuary cities), and the fact that immigration makes the United States less dangerous, and the fact that sanctuary cities are safer than non-sanctuary cities, there is another compelling argument for the continued refusal to cooperate with ICE:

Sanctuary cities save lives.

While I’m sure there are myriad other ways that the above statement might be true, I’ll be writing from a purely public health perspective.

Cities the world over depend on public health to flourish and grow and survive. With so many people packed on top of each other, breathing the same air, drinking the same water, eating at the same places, sharing germs, good public health saves lives. Good public health, however, doesn’t happen in a vacuum. Public health practitioners depend wholly on cooperation with their charges, with the public.

Imagine two scenarios. One in a sanctuary city (say, Philadelphia), and one in a city that detains any undocumented immigrants they find with the intention of deportation (say, Miseryland).

In Philadelphia, a young woman, June, falls ill. She is feverish and coughing. She has a rash. Because of the world we live in these days, we’ll even say she doesn’t have health insurance and lives in a one bedroom apartment with the four other people in her family. She’s a server at a local restaurant. She’s also an illegal immigrant. She goes to one of the eight government-run primary care Health Centers in the city. The doctors there quickly diagnose her with measles and implement isolation protocols, keeping her away from her four-month-old niece who was living two doors away in the apartment building. Little Sally, who’s too young to be effectively vaccinated against measles, never gets it. Neither does the immuno-compromised fellow who comes into the cafe where she works. The Health Department stops by the apartment building and does contact tracing of the other thirty people living in the building, ensuring that the disease doesn’t spread any further. (And because of the city’s liberal sick time law, June is even able to make rent this month.)

In Miseryland, a young woman, May, falls ill. Her situation is similar to our friend in Philadelphia, except she doesn’t go to the local Health Center because she’s also in the country illegally. She’s feverish with a cough, and her rash is spreading. Because her family does not have all of their vaccinations, the measles spreads throughout her apartment. Little Sally, from down the hall, catches it, is admitted to the hospital and dies. That wonderful older man at the cafe? He dies. May’s little brother spreads the disease like wildfire through his school, with every child who is under-immunized or not at all immunized getting sick, some even being admitted to the hospital. They, in turn, spread it to their families, and very quickly, you have an epidemic the likes of which we haven’t seen in the United States for decades.

Why didn’t May just go to the doctor? Because if she did, she would be detained. Investigated. Her whole family, at best, wondering where she’d gone, shipped back to a country she hasn’t seen in a decade. At worst, her entire family uprooted and sent across the ocean. Her landlord, with an empty apartment, or several. Her cafe, down a server, or several.

It’s called a chilling effect. When something stops someone from taking an action because they are scared of the consequences. May didn’t go to the doctor because she was scared of the consequences. The consequences in May’s mind were very real, being deported. The cascade effects of her illness were more abstract in her mind, but are no less real.

The thing to be terrified of is that the actions that will keep folks from seeking care when they — no, when WE — really need it, are already happening. Two instances came through the wire this week alone. Luckily they weren’t of the infectious type, but they don’t need to be. They just need to make folks think that they might get in trouble from approaching the authorities.

And public health aside, both of these cases will cause people to die.

Six men were taken into custody after leaving a hypothermia shelter. People will refuse to go into hypothermia shelters in the future, and will freeze to death.

A woman was taken into custody while in an El Paso courthouse while seeking a protection order from her abusive boyfriend. The man who turned her in? The abusive boyfriend. Open season on terrified women. You like to beat women? Start dating an undocumented immigrant. You can beat her black and blue and she can’t go to the cops for fear of being deported. This will happen. Women will die.

Sanctuary cities save lives. They stop epidemics before they start. They make sure that abusers get the justice they deserve. They allow the least among us to sleep at night.

Is the system perfect? Of course not. Can violent criminals game the system to continue to commit crimes? Of course, but that happens anyways. But at least when undocumented immigrants can feel safe, they can make sure the rest of us actually are safe.

Sanctuary cities save lives. Even threatening political punishments for cities that care for their residents creates a chilling effect that kills people.