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Ensuring access to public health services is one of the most fundamental health equity issues. Since November of 2016, public health staff have expressed increased concerns there may be a chilling effect of accessing services due to proposed immigration policies and feared repercussions. With recent changes to the rules around Public Charge, these concerns have only been exacerbated.

California Health Departments have begun reporting early, anecdotal reports of clients dropping out of or not enrolling in Women and Infants with Children (WIC), CalFresh, and other programs that help ensure adequate health and nutrition.

The fear of deportation, in particular, inhibits critical health supportive behaviors like attending medical appointments or enrolling in public services. It has also been linked to post-traumatic stress syndrome in choldren, low birth weights, and other health conditions.

Rapid Response Survey: Health Impacts of Federal Immigration Policy Initial Findings, May 2017

BARHII has joined with The Public Health Alliance of Southern California, also a coalition of health departments, to better understand the health impacts of changes in federal immigration policy. Collectively, our members are charged with protecting the health of 80% California’s population. Together, we are analyzing program participation data and conducting key-informant interviews with immigrant serving organizations. Additionally, we have conducted a rapid-response survey of the health impacts of changing immigration policy observed by local health department staff. While the survey and analysis are ongoing, we have released our initial findings here.

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Public Health Sanctuaries

BARHII is supporting public health departments to ensure access to health-promoting services to immigrant communities. BARHII is also helping health departments promote healing to mitigate the stresses that emerge from more vocal messages of hate and exclusion

On January 20th, 2017, over 45 Bay Area public health staff joined BARHII and the ACLU for a discussion of public health’s rights and responsibility to maintain safe space for clients.  The session included opening comments from Immigrant Rights organization SIREN, who spoke about growing fear in immigrant communities and new state legislation to ensure their safety.

Since November, we’ve heard anecdotal reports that calls for deportation have reignited a fear of government.  The threat to public health and safety are huge when people are unable to access the services they need and are afraid to report victimization to police.

Resources for Action:

  • Guide PowerPoint by Public Health Awakened, a national coalition of public health agencies that includes BARHII. BARHII can also deliver training as is needed.

  • Distribute welcoming communications to immigrant communities

  • Welcoming communities communication examples for non-Sanctuary Cities

  • Share information with immigrants about their rights (Red Card)

  • Determine how to appropriately manage your data.

    • Consider the data you collect on immigration status, and get legal counsel on your rights and responsibilities to protect that information.

    • Your front line staff are your eyes and ears: closely monitor and track anecdotal comments about immigrant experience or declines in program participation

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Previous Changes to Rules Relating to Public Charge

On Saturday, September 22nd, a Public Charge press release from the Department of Homeland Security was released with proposed changes. BARHII’s members have been concerned about proposed changes to Public Charge since last year, and this section of the website provides useful resources for BARHII counties who are seeking to ensure access to services in this changing policy environment.

BARHII wants every child and family to have a chance to thrive. Healthy conditions are not distributed equitably across our communities, and the lowest income people of color suffer most. The hard work of Bay Area’s public health staff and the quality public health services they provide are essential to creating a society where we all live longer, healthier lives. We applaud the work of public health to reduce the disparities in access to services that cause shorter, sicker lives.

Model Messaging on Public Charge

BARHII is releasing Model Messages in response to changes to the Public Charge rule. All the messages proposed in this document follow Berkeley Media Studies Group’s three key components of message strategy: Problem Statement (What’s Wrong?), Policy Objective (What Should be Done?), and Values Dimension (What Does it Mean?).

Public Health Resources on Public Charge

At the BARHII General Membership Meeting that took place on August 17, 2018, local public health departments shared what they have done or plan to do in response to changes in Public Charge. We have collected the materials shared amongst the group and have made them available here for public health staff.


These resources from the Immigrant Legal Resource Center give easy to understand definitions of Public Charge, information on who the rules apply to, and information on where to find free or low-cost immigration help.

Linking Immigrants to Benefits Resources and Education (LIBRE) and Legal Aid Society of San Mateo have designed this fact sheet which contains information on who Public Charge rules apply to and is geared toward on the ground sharing between public health clients and staff.

This FAQ created by the Alameda County Social Services Agency provides clarity around potential changes to Public Charge and one’s participations in public benefit programs.

This infographic from the Alameda County Social Services Agency is designed to decipher who is eligible for which public benefits program depending on their immigration status.

Protecting Immigrant Families released this short analysis of what Public Charge is and detailing the proposed changes to the rule.

This 2-Pager gives an easily accessible introduction to Public Charge, as well as suggestions about where to follow up for additional information.

Policy Action and Advocacy

The Protecting Immigrant Families Campaign issued this e-mail that provides broad guidelines to follow in drafting public comments related to Public Charge.

Protecting Immigrant Families has released this FAQ that details the notice and comment period of the regulation process. It not only contains information on how to submit your comments, it also includes model language.

This guide includes messaging created by the Protecting Immigrant Families Campaign for communication with policymakers, journalists, and the public. It includes both short, 30-second versions and more extensive messaging.

This Toolkit contains links and sample social media posts for Facebook and Twitter. It also includes graphics that can be posted to your website to get the information out.

SEIU has put together this guide with sample language and writing prompts for creating comments on Public Charge.

This letter written by the County Administrator of Alameda County is directed to their Board of Supervisors and voices the County’s opposition to changes to the rules around Public Charge.

Data and Methods

The San Francisco Department of Public Health has released this memo that provides a brief overview of analysis methodology for the county’s Medi-Cal population, safety net system, and local economy.

Alameda County Social Services Agency produced this estimate of annual impacts to the County if immigrant populations disenrolled from select public benefits.

Language and Data from BARHII

This letter to California’s Attorney General supports SB54, a law that would limit local assistance with immigration enforcement, contains language and findings that encourage the development of model policies for the state.


BARHII has created this brief utilizing interviews with Bay Area Public Health Departments and Behavioral Health Services staff. It includes information on the current needs of immigrant communities and recommendations for activities that local health departments and private funders can take to address those issues.

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