Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds
Abstract
:1. Introduction
2. Literature Review
2.1. History and Background
1980 Refugee Act
2.2. The Medical Exam
2.2.1. Overseas Medical Examination
2.2.2. U.S. Domestic Medical Examination for Newly Arriving Refugees
2.2.3. Medical Examination for Adjustment of Status
2.3. Health-Related Grounds for Inadmissibility
2.3.1. Communicable Diseases
2.3.2. Physical or Mental Disorder with Associated Harmful Behavior
2.3.3. Drug Abuse or Drug Addiction
2.3.4. Vaccination Requirement
2.3.5. Waivers
2.4. Historical Changes in the Medical Exam: The Human Immunodeficiency Virus (HIV) Ban
“I am Haitian and my brothers, mother and stepfather are all in the U.S. I didn’t know anything about HIV until I was forced to get tested as part of the visa application process. When I found out I had HIV, I was afraid to tell my family ... I found out [about] the HIV waiver ... Officials at the Embassy are rude to people with HIV, and anybody who works at the Embassy knows that you have HIV/AIDS because there are only certain days people with health problems can come to the Embassy. Even on those days, there are special lines inside the Embassy for people with HIV/AIDS.”
2.5. Risk Communication
2.5.1. Perception of Disease Migration and Refugee Displacement
2.5.2. Risk Communication in the U.S.: Populist Case Studies
Case Study: “Public Health Officials Silent on Possible Connection between Measles Outbreak and Resettled Refugees” 12 May, 2016 [28]
“The lack of immunization requirements for refugees entering the United States is deeply troubling to me. For months now, I have called on the federal government to halt our refugee resettlement program in its entirety and voted against last December’s omnibus bill because it failed to make these needed reforms. As we look ahead to this year’s funding bills, I am proud to have signed a letter to the House Appropriations Committee asking that the Fiscal Year (FY) 2017 Homeland Security appropriations bill force tighter controls on our refugee resettlement program. Open borders and unverified refugees from radical Islamic hotspots are a threat to our national security, our public health, and our very way of life.”
“The Office of Refugee Resettlement is but one of many federal departments that not only needs to be completely defunded but abolished. As with the illegal immigration problem, Congress has repeatedly reauthorized and expanded [the President’s] initiative to bring Muslim Refugees from radicalized Islamic countries into Tennessee”.
“We (news outlet) asked why state and local health officials have not taken the next obvious investigative step: to identify the immigration and vaccination status of the individual who was at the Masjid Al-Noor Mosque on 15 April—most likely an adult Muslim—who was, if not the first person infected with measles, then was one of the first...”
Case Study: “Health Expert Blasts CDC: Ignores own study, allows refugees into U.S. without latent TB screening. May 20. 2016”[29]
“Admitting people who might cause an epidemic makes no sense whatsoever from a public health standpoint … It suggests that those who favor it do not care about the cost in suffering, death and expense to Americans.”
“If for humanitarian reasons we wish to help people fleeing persecution, there is still no need to release them into the general population of susceptible individuals. Officials who place politics above the health of Americans need to be held accountable and removed from positions of authority.”
2.6. TB Infection and LTBI: Factual Risk
2.7. Measles: Factual Risk
2.8. Consequential Risk Communication from Expert and Non-Expert Debate: Federal Rule-Making
2.8.1. Rule-Making in the United States
2.8.2. Executive Administration and Rule-Making
2.9. Current Developments Regarding Immigration Health
3. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Hong, M.-K.; Varghese, R.E.; Jindal, C.; Efird, J.T. Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds. Int. J. Environ. Res. Public Health 2017, 14, 1107. https://doi.org/10.3390/ijerph14101107
Hong M-K, Varghese RE, Jindal C, Efird JT. Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds. International Journal of Environmental Research and Public Health. 2017; 14(10):1107. https://doi.org/10.3390/ijerph14101107
Chicago/Turabian StyleHong, Mi-Kyung, Reshma E. Varghese, Charulata Jindal, and Jimmy T. Efird. 2017. "Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds" International Journal of Environmental Research and Public Health 14, no. 10: 1107. https://doi.org/10.3390/ijerph14101107