Raids, Fear, and Forgone Care: ICE Enforcement-Driven Healthcare Avoidance and Behavioral Withdrawal in Los Angeles County, 2024–2025
This 2024–2025 Los Angeles County study demonstrates that exposure to ICE enforcement acts as a structural determinant of health, significantly driving healthcare avoidance and behavioral withdrawal among Hispanic and foreign-born communities regardless of citizenship status.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Health is not just a matter of biology or personal choices; it is deeply shaped by the environment in which people live, including the laws and policies that govern their daily safety. When a community feels threatened by government actions, such as police raids or immigration enforcement, the fear can ripple outward, changing how people behave even if they are not directly targeted. This phenomenon is known as a structural determinant of health, meaning that the organization of society itself can create barriers to well-being. Researchers have long observed that when people feel unsafe, they often pull back from public life, avoiding places like schools, clinics, and transit systems. The question that drives this new research is whether a sudden, intense surge in immigration enforcement creates a new wave of this fear, causing people who previously sought medical care to suddenly stop, or if it simply reveals problems that already existed. Understanding this distinction is vital because it tells us whether the solution lies in fixing old inequalities or in addressing a fresh crisis caused by recent policy changes.
In Los Angeles County, a team of researchers set out to measure exactly how a massive escalation in immigration enforcement in 2024 and 2025 affected the health behaviors of residents. They focused on a specific period starting in January 2025, when immigration operations increased dramatically, and tracked the same group of people over time to see what changed. The study followed 1,182 adults who had been surveyed before the surge began and then again several months later, allowing the scientists to compare their behavior before and after the fear took hold. The researchers asked participants if they had personally seen immigration officers conducting arrests, questioning, or raids in their neighborhoods. They also asked a series of questions about whether these residents had started avoiding needed medical care, work, school, public transportation, or legal services because they were afraid of being caught or harmed.
The results painted a clear and stark picture of a community retreating into itself. The study found that witnessing immigration enforcement operations was a powerful predictor of people stopping their daily routines. Those who saw these operations were significantly more likely to avoid seeking medical help, regardless of whether they were citizens or not. The fear was not limited to the people directly targeted by the raids; it spread through the community, affecting people of Hispanic identity in particular. The data showed that Hispanic residents were more than three times as likely to avoid medical care in 2025 compared to non-Hispanic residents. This avoidance was not just about skipping a single doctor's visit; it was a broader withdrawal from public life, with many people staying away from public places and transit systems as well.
Crucially, the study provided strong evidence that this change was driven by the enforcement itself, rather than by pre-existing problems. By looking at the people who had no trouble getting medical care before the enforcement surge began, the researchers found that a large number of them started avoiding care afterward. Among Hispanic residents who had previously been able to see a doctor without issue, more than 30 percent began avoiding medical care in 2025, compared to less than 10 percent of non-Hispanic residents. This gap appeared only after the enforcement intensified, indicating that the raids created new barriers where none had existed before. While the findings suggest that pre-existing vulnerabilities like poverty or poor health are not the primary explanation, the researchers noted that it remains possible the groups differed on other characteristics the panel did not measure, which could have influenced why some individuals delayed care while others did not.
The researchers also noted that this fear came with a heavy psychological cost. People who witnessed the enforcement operations reported higher levels of distress and anxiety than those who did not. However, when the researchers looked closely at the data, they found that the distress was not the only thing driving people away from the doctor; the fear of the enforcement itself was the primary force. The study suggests that immigration enforcement acts as a structural barrier, effectively shutting down access to health services for entire communities. This happens even when the people avoiding care are citizens or have legal status, because the atmosphere of fear makes everyone feel unsafe. The findings indicate that the solution requires more than just individual medical care; it demands policies that protect the safety of communities so that people feel secure enough to seek help when they need it.
The implications of these findings are significant for how public health is managed in areas with high immigration enforcement. The study argues that health protections, such as sanctuary policies that prevent hospitals from sharing patient information with immigration authorities, should not depend on a person's legal status. Instead, these protections should be universal to ensure that the fear of deportation does not become a barrier to survival. The researchers emphasize that the current approach, which relies on the threat of raids to enforce immigration laws, is actively harming public health by driving people away from the very systems designed to keep them safe. As the study concludes, the most effective way to protect health in these communities is to end the collaboration between local law enforcement and immigration agencies and to invest in trusted community organizations that can bridge the gap between need and care.
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