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Public Charge Proposal: Heartless and Harmful to Children


William B. Burrough, MD, MPH
October 26, 2018

“Can you show me where your heart is?”


The reaction to this question tells me a lot about my patient. She can hear and understand what I am saying. She looks to her older sister for reassurance, and she makes eye contact with me as she proudly slaps her hand on the spot where I place my stethoscope to listen to the rhythmic “lub dub” of her heartbeat.


I’m seeing her in clinic for the first time. In fact, I’m the first doctor she’s seeing since arriving in the United States. Her father explains how they recently immigrated to Oakland. They are here today for a well-child check so his daughters can enroll in school. He is trying to do the very best for his children, just as so many other parents we see in our clinic.

The new #PublicCharge proposal threatens to deprive immigrant families of vital access to health care, food & shelter, @billyburrough writes in #AAPvoices.

Our visit is typical for families establishing care with us. I continue with my questions. “Do they take any medicines?” “Are they up-to-date on immunizations?” “Any problems when they were born?” “Have you had worries about providing food or housing?”


This last one—a routine question we ask all families because of the well-established link between food and housing security and health outcomes—now gives me pause. That’s because earlier that morning I had heard some disturbing news while driving into work.


The U.S. Department of Homeland Security released a new proposal that could jeopardize the visa status of my patient’s parents if they were to seek out life-saving government resources such as food stamps or housing assistance. In fact, my patient’s parents may ultimately decide it is too risky to seek out care for fear of being seen as a “public charge”—a term applied to those seeking government assistance, which would be expanded under the proposal.


"I get a gut-wrenching feeling as I think about the decisions these parents would have to make if the proposed public charge policy is passed, not wanting to return to their war-torn home country yet afraid to ask for help in their new one for fear of being separated from their family. ”


I get a gut-wrenching feeling as I think about the decisions these parents would have to make if the proposed public charge policy is passed, not wanting to return to their war-torn home country yet afraid to ask for help in their new one for fear of being separated from their family.


Our nation is stronger when children can reach their potential, and for this to happen they need access to good nutrition, stable housing, and healthcare. Children also do better when they have parents who are present to read them books, brush their teeth, and keep them safe. By instilling fear in the hearts of these countless families trying to follow the rules, we are destroying the very foundation on which a stronger, healthier nation is built.


When I ask my patients where their heart is, they know exactly where to point. So, I turn this question to our national leaders and current administration: “Can you show me where your heart is?”


For the health and well-being of immigrant children and families and for the future of our country, I am urging the Department of Homeland Security to rescind this proposal. No parent should have to choose between accessing vital services or keeping their family together.

* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author


William B. Burrough, MD, MPH, is a pediatric resident physician at UCSF Benioff Children’s Hospital Oakland and a member of the American Academy of Pediatrics. You can follow him on Twitter @billyburrough.