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Sign-on letter: Public health implications of family separation at the border

June 21, 2018

June 21, 2018


The Honorable Kirstjen M. Nielsen
U.S. Department of Homeland Security
245 Murray Lane, SW, Building 410           
Washington, DC 20528


The Honorable Alex Azar
U.S. Department of Health and Human Services
200 Independence Ave., SW
Washington, DC 20201


Dear Secretary Nielsen and Secretary Azar:


As organizations committed to protecting the public’s health and championing the health of all people, we are deeply concerned by the treatment of the families seeking asylum at the United States-Mexico border. We are alarmed by the environment that has materialized as a result of the Trump administration’s “zero tolerance” policy and we worry that this has set the stage for a public health crisis.


The administration’s “zero tolerance” immigration policy has resulted in the separation of more than 2,000 children from their families. The practice of separating children from their loved ones and caregivers for an extended period of time is a threat to public health, inflicting serious trauma and threatening long-term, irreversible health effects. While we are hopeful that the administration’s recent decision to reverse its policy of separating families at the border will prevent any future instances of children being separated from their parents, it is extremely critical that you immediately direct significant resources to efforts to quickly reunite any children who have been separated from their families. Additionally, due to the intense trauma these children have already experienced, we strongly encourage you to immediately provide the necessary health and mental health services to mitigate any long-term effects of adverse childhood experiences.


There is a significant body of evidence-based research detailing the vast public health implications of adverse childhood experiences. According to the Centers for Disease Control and Prevention, children exposed to adverse childhood experiences suffer from disrupted neurodevelopment; social, emotional, and cognitive impairment; are more likely to adopt health-risk behaviors; are at greater risk of developing chronic diseases, disabilities and social problems; and are susceptible to early death. Family stability is a key social determinant of health, and it’s imperative that we not disrupt these children’s chance at a healthy life.


We are aware that the president issued an Executive Order which we understand is intended  to end the administration’s policy of separating families at the border. However, your leadership in ending this practice is critical to preventing further damage to the health of these already vulnerable families. For these reasons, we urge you to immediately work to reunite the families who have been separated and we implore you to permanently end this inhumane practice. Finally, we encourage the administration to focus on implementing alternatives that do not entail what could amount to the long-term detention of families, including children, in prison-like conditions.


Thank you in advance for your prompt attention to our concerns about this troubling and critical public health matter.



Georges C. Benjamin, MD
Executive Director
American Public Health Association

John Auerbach
President & CEO
Trust for America’s Health

Mary A. Pittman, DrPH
President & CEO
Public Health Institute


Donna J. Petersen, MHS, ScD, CPH
Chair, Board of Directors
Association of Schools and Programs
of Public Health

Lori Tremmel Freeman
National Association of County and City Health Officials

Larry Cohen
Executive Director
Prevention Institute







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