Paranoia on the Border: Immigration and Public Health

Like others, I find the growing humanitarian crisis in Texas deeply troubling. The number of minors making this dangerous journey alone, in search of a better life away from violence and poverty, is overwhelming and heart-wrenching, not least because they’ve been met with more hostility than sympathy at the US end of their long trek. The vitriol with which anti-immigration protesters have met these children and adolescents is both disturbing and nationally embarrassing.

I don’t dispute anybody’s right to disagree over immigration policy, but I don’t believe that the privilege of having been born in the United States entitles anybody to aggressively refuse assistance to children so obviously in crisis. I don’t intend to discuss the merits of one solution over another here, though. Instead, I want to highlight the particularly worrisome — but sadly familiar — paranoia about these refugees bringing disease into US border communities.

Some commentators, in outlets like and Breitbart, warn us through suggestively titled stories like Manny Alvarez’s, “Is America on the Verge of a Major Health Crisis?,” that immigrants threaten public health because they’ll spread diseases like measles, tuberculosis, or scabies. Notably, other news agencies haven’t reported this “looming health crisis,” and a few have suggested that such reports are unfounded and “wildly overstated.” Yet fears that these young refugees threaten the general population persist, even among several members of Congress [Reps. Lou Barletta (R-PA), Randy Weber (R-TX), Louis Gohmert (R-TX), and Phil Gingrey (R-GA)], according to Steve Benen on MSNBC and Esther Yu-Hsi Lee on ThinkProgress.

This tendency to link foreigners to disease appears throughout our nation’s past and gives this sort of anxiety ample traction even today.

Historically, public agencies and anti-immigrant groups have targeted immigrants as sources of pathological and cultural contagion, rather than engaging with difficult questions about how the United States deals with issues of immigration, poverty, labor, and race. On the surface, efforts by agencies like the US Public Health Service (USPHS) to screen immigrants for disease helped safeguard the US from disease outbreaks. But in execution, these programs perpetuated class, race, gender, and economic hierarchies in immigration policy (and citizenship) that persist to this day.

"Examining Eyes on the Line at Ellis Island," 1913. Doctors checked for contagious diseases, and also watched immigrants for evidence of heart or lung trouble, "poor physique," or "feeblemindedness," all of which might keep them from finding work. Source: Alfred C. Reed, "Going Through Ellis Island," The Popular Science Monthly (January 1913).
“Examining Eyes on the Line at Ellis Island,” 1913. Doctors checked for contagious diseases, and also watched immigrants for evidence of heart or lung trouble, “poor physique,” or “feeblemindedness,” all of which might keep them from finding work. Source: Alfred C. Reed, “Going Through Ellis Island,” The Popular Science Monthly (January 1913).

There’s been a tendency in the United States, especially since the late 1800s and the rise of bacteriology, to see “undesirable” immigrants — a category that over time has included Catholics, Irish, Jews, Russians, Southern and Eastern Europeans, Asians, Mexicans, and others — as disease carriers and sources of contagion. This has added a medical dimension to preexisting nativism. Fear about disease mirrors concern about the economic or cultural effects of immigration, but medicalization creates a more visceral fear, suggesting that the US is literally “under attack” from foreign migrants, which stigmatizes immigrants and refugees as dangerous “others.”

“Give Me Your Tired,” But Keep Your “Feeble”

Between the late 1890s and the late 1920s, millions of immigrants passed through Ellis Island and Angel Island, and in the process underwent what were often invasive, assembly-line style medical examinations. Understaffed medical teams looked for evidence of a variety of conditions, including trachoma, tuberculosis, parasites, and venereal disease, as well as anything that might keep someone from finding work and thus becoming a “public charge.”

These efforts stemmed from a concern that immigrants might carry deadly contagious diseases into the United States, but their application reflected racial and class assumptions of the time. For example, despite bacteriologists’ warnings that germs didn’t discriminate between rich and poor, medical inspectors focused almost entirely on steerage class passengers, while first- and second-class passengers could skip the more rigorous (and unpleasant) procedures, receiving instead cursory ship-board exams.[1]

Detained Chinese immigrants shared their pain and isoloation on the walls of the Angel Island detention center. One poem (not this one) read: "I cannot bear to describe the harsh treatment by the doctors, Being stabbed for blood samples and examined for hookworms, was even more pitiful." (Quoted in Markel and Stern, "Which Face," 1322) Image by Flickr user Roger Wagner, used under a CC BY 2.0 license.
Detained Chinese immigrants shared their pain and isolation on the walls of the Angel Island detention center. One poem (not this one) read: “I cannot bear to describe the harsh treatment by the doctors, Being stabbed for blood samples and examined for hookworms, was even more pitiful.” (Quoted in Markel and Stern, “Which Face,” 1322) Image by Flickr user Roger Wagner, used under a CC BY 2.0 license.

The Angel Island facility in San Francisco, California, offers an even more telling example. During the Progressive Era, racial perceptions of cultural and biological difference meant that immigrants from places like China were effectively barred from coming to the United States. Lawmakers and others believed that they were too different to ever be assimilated into the United States and would be undesirable additions to the body politic. Chinese immigrants coming through Angel Island faced humiliating and intensive medical exams, and deportation rates at least five times greater than those at Ellis Island.[2] In these cases, the stigma of disease merged with the general atmosphere of Sinophobia that had generated the Chinese Exclusion Act of 1882.

At both facilities in the early 20th century, immigrants faced racial, ethnic, and social stereotypes that linked people from certain parts of the world — Eastern and Southern Europe and Asia in particular — with disease. This stigma gave nativists and eugenicists concerned with keeping “undesirable” individuals out of the United States a powerful rationale for restricting immigration. It helped determine the number of immigrants per country allowed under the quota system of the 1924 National Origins Act, which put strict limits on immigration and banned all Asian immigrants.

Selective Policing On the US-mexico Border

At the same time that immigration restriction advocates worked to reduce “undesirable” immigration in the early 1900s, growers and industrialists successfully lobbied President Wilson to exempt Mexicans from the literacy test, head tax, and contract labor ban of the 1917 Immigration Act. This provision no doubt helped many Mexican individuals and families continue their livelihoods, but it was by no means humanitarian. These businesses valued Mexicans as workers willing to take strenuous (often dangerous) jobs that many in the United States refused to do, and the US government subjected those crossing the border to aggressive medical screening.

"Bracero housing," 1956. Photograph by Leonard Nadel. Nadel's caption read: "This is housing provided by a Texan farmer for 200 braceros in this long building, with the beds made out of stretched canvas, upper and lower. Such close living conditions make for high incidences of respiratory illnesses among the braceros." Source: NMAH, History of Technology Collections.
“Bracero housing,” 1956. Photograph by Leonard Nadel. Nadel’s caption read: “This is housing provided by a Texan farmer for 200 braceros in this long building, with the beds made out of stretched canvas, upper and lower. Such close living conditions make for high incidences of respiratory illnesses among the braceros.” Source: NMAH, History of Technology Collections.

Beginning with the Mexican Revolution in 1910, the USPHS worried about the porousness of the US-Mexico border. In response, they established, and later expanded, disinfection facilities along the border where, as historians Howard Markel and Alexandra M. Stern have described: “Under the constant gaze of attendants, immigrants,” even those who commuted between cross-border towns for work, “were stripped naked, showered with kerosene, examined for lice and nits, and vaccinated for smallpox if deemed necessary.”[3] The process of detaining, cleansing, and disinfecting Mexican laborers on the border, Stern and Markel argue, not only solidified a border that had previously been much more porous and fluid, but also came to link “Mexican” with “dirty” and “diseased.” These stereotypes proved useful to eugenicists and others eager to restrict Mexican immigration in the late 1920s.

Nativist restrictionists and eugenics supporters united to focus on race and disease, but neglected greater public health and humanitarian threats. While quarantine procedures in the 1910s, and later during World War II, painted Mexican laborers and their families as threats to public health, in need of education and close supervision, the same programs failed to address dire conditions in labor camps and housing, such as overcrowding and a shortage of adequate toilets and bathing facilities.[4]

In these historical examples, as in the current crisis, public health efforts that on face value appear humanitarian and rational, neglect more pressing areas of concern such as overcrowding, poor sanitation, malnourishment, and poverty. These characteristics plagued immigrant tenement housing and migrant labor camps for Mexican laborers, and recent reports from the Los Angeles Times and Public Radio International suggest that today’s immigrant detention centers suffer similarly.

Fertile Soil For Paranoia

We do need to make sure that refugees and immigrants at the border are free of disease and cared for as best as possible — as we should for everyone in the United States. This includes making provisions for their adequate shelter and well-being while looking for a larger solution to the current situation. It does not include, however, vilifying them as disease-carrying, third-world “illegals” that threaten the well-being of the United States.

Legitimate public health concerns all too easily turn to fear, then to anger, and then to violence. It’s easy to dismiss reports from news/commentary outlets like as cynical attempts to drive traffic to their websites, but I fear this would be overly optimistic. Judging by the comments on news reports covering the situation, which range from constructive to reactionary to vicious, and the traction gained by a spam news report about the CDC investigating a “mystery illness” on the border, it seems that the history of linking “unwanted” immigrants to disease has created fertile soil for just such “public health crisis” narratives.

We need to learn from past mistakes in places like Ellis Island and the Mexico-United States border in order to focus our attention where it needs to be rather than scapegoating, stereotyping, and attacking immigrants and refugees.

Further Reading

Abel, Emily K. “Only the Best Class of Immigration.” American Journal of Public Health 94 (June 2004): 932–39.

Canaday, Margot. The Straight State: Sexuality and Citizenship in Twentieth-Century America. Princeton, NJ: Princeton University Press, 2009.

Kraut, Alan M. Silent Travelers: Germs, Genes, and the “Immigrant Menace.” New York: Basic Books, 1994.

Markel, Howard. Quarantine!: East European Jewish Immigrants and the New York City Epidemics of 1892. Baltimore, MD: Johns Hopkins University Press, 1997.

Markel, Howard, and Alexandra Minna Stern. “The Foreignness of Germs: The Persistent Association of Immigrants and Disease in American Society.” The Milbank Quarterly 80 (January 1, 2002): 757–88.

Molina, Natalia. Fit to Be Citizens?: Public Health and Race in Los Angeles, 1879-1939. University of California Press, 2006.

Ngai, Mae M. Impossible Subjects: Illegal Aliens and the Making of Modern America. Politics and Society in Twentieth-Century America. Princeton, NJ: Princeton University Press, 2004.

PBS. Forgotten Ellis Island. Documentary. Produced by Lorie Conway, Boston Film & Video Productions LLC. Aired September 5, 2011.

Shah, Nayan. Contagious Divides: Epidemics and Race in San Francisco’s Chinatown. Berkeley: University of California Press, 2001.

Stern, Alexandra. Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America. Berkeley: University of California Press, 2005.

Stern, Alexandra Minna. “Sterilized in the Name of Public Health.” American Journal of Public Health 95 (July 2005): 1128–38.

Tomes, Nancy. “The Making of a Germ Panic, Then and Now.” American Journal of Public Health 90 (February 2000): 191–98.


  1. Howard Markel and Alexandra Minna Stern, “Which Face? Whose Nation? Immigration, Public Health, and the Construction of Disease at America’s Ports and Borders, 1891-1928,” American Behavioral Scientist 42 (June 1, 1999): 1318. Return to text.
  2. Markel and Stern, “Which Face?,” 1322. Return to text.
  3. Markel and Stern, “Which Face?,” 1324. Return to text.
  4. Natalia Molina, “Borders, Laborers, and Racialized Medicalization: Mexican Immigration and US Public Health Practices in the 20th Century,” American Journal of Public Health 101 (June 2011): 1026, 1027-29. Return to text.

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Reblogged this on and commented:
Adam Turner at Nursing Clio connects the paranoia expressed by several media outlets (Fox News, Breitbart, etc.) about the public health danger posed to the influx of minors to American border to the long history of racial discrimination embedded in our immigration policies. American nativists have often described specific “undesirable” immigrant groups as public health dangers. In the late 19th century, nativists were quick to describe Jews, Russians, Chinese, Southern and Eastern Europeans, and Mexicans “as disease carriers and sources of contagion.” The members of media who crying wolf about this health crisis will undoubtably complain when they are accused of racism, but they obviously are intentionally exploiting the irrational historic fears routinely used demonize “undesirable” immigrants throughout American history. Turner does outstanding job putting these concerns in their proper historical context.


Habitat for humanity should help build a border town. A place where both “sides” could share employees and schools and immigration to citizenship can be learned here too… There is no reason we should not help these women and children. And we have the money and power and skill to do it. We could develop systems of solar, wind and water condensation wells that help all the desert states. We could actually embark on a learning curve that experiments with renewable energies and teach immigrants skills. It’s not that we wouldn’t be teaching “our own”. It’s that we’d be learning how to share which is inevitable… after global markets and population booms, and religious missions. What are we waiting for? Let’s do the work. It’ll even be fun.


Reblogged this on dreamstocks and commented:
an interesting insight. actually this article opens my mind about public health widely. The public health problems is not only about how to cure the patient complaint, decrease illness, the degree of sick, the number of mortality, prevent the illness, rehabilitate disability, and so on, but its also about how to regulate some government policy which has a influenced to public health direct-or-indirectly.

A Visit with Children at the Border - LEAD

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