ACE

Tag: Prevent

  • Understanding Title 42: The Intersection of Public Health and Immigration

    Understanding Title 42: The Intersection of Public Health and Immigration

    What is Title 42?

    Title 42, established under the Public Health Service Act of 1944, grants the U.S. government authority to expel individuals recently present in a country with a communicable disease. Section 362 of the act allows the Surgeon General to halt the “introduction of persons or property” to prevent the spread of disease. While rarely used in modern history, Title 42 became a key immigration enforcement tool during the first Trump administration.

    The first recorded use of Title 42 occurred in 1929 to restrict entry from China and the Philippines during a meningitis outbreak. Decades later, on March 20, 2020, the Centers for Disease Control and Prevention (CDC) invoked the policy to limit the spread of COVID-19 across state and national borders.

    Implementation and Impact

    During the first two years of its enforcement, Title 42 was used around 2.5 million times to deport migrants entering the U.S. It gave border control agents the authority to expel migrants without offering the opportunity for them to seek asylum, although families and children traveling alone were exempt from this provision. Beginning in January 2023, migrants coming from Mexico could request a Title 42 exemption through the CBP One app if they met vulnerability criteria.  

    In April 2022, the CDC announced that Title 42 was no longer necessary and would be terminated in May 2022, citing increased vaccination rates and improved treatments for COVID-19. However, several Republican-led states challenged this decision, and the case went to the Supreme Court. While the Court allowed continued enforcement of Title 42 before it heard arguments, it dismissed the case the following year. Title 42 expired in May 2023.

    Arguments in Favor of Title 42

    Supporters of Title 42, including the Trump administration, argued that the policy was necessary to limit the spread of COVID-19 in detention centers and, by extension, within the United States. In a 2020 briefing, President Trump stated that his actions to secure the northern and southern border under Title 42 would “save countless lives.” The Trump administration’s declaration of a COVID-19 national emergency on March 18th, 2020, framed stricter immigration policy as a matter of public health.

    Some states also supported Title 42 to prevent a surge in migration that could overwhelm their border facilities. Texas, for example, argued that lifting the policy would place an undue burden on the state, leading it to implement Operation Lone Star, which allocated state resources to border security.

    The policy also received occasional bipartisan support, and was willfully enforced by the Biden administration until the CDC attempted to terminate Title 42 in April 2022. In early 2022, at least nine Democrats argued that Title 42 should be extended. President Biden also debated whether or not the policy should end. In January 2023, he expanded the scope of Title 42 to include migrants originating from Cuba, Nicaragua, Haiti, and Venezuela. 

    Arguments Against Title 42

    Critics of Title 42 argue that it violates international norms, particularly Article 14 of the Universal Declaration of Human Rights, which recognizes the right to seek asylum. While the U.S. did not ratify the declaration, it played a key role in its creation and remains a signatory. Additionally, since 1980, U.S. law has recognized the right to seek asylum, rendering Title 42’s restrictions controversial in the context of global and domestic asylum norms.

    Public health experts also questioned the policy’s effectiveness in controlling COVID-19. There is no statistical evidence linking Title 42 expulsions to a reduction in COVID-19 cases. Instead, critics suggest that overcrowding in detention centers may have worsened public health conditions. One migrant described being held in “crowded conditions” for days without COVID-19 testing before being transported in similarly congested vehicles. Additionally, a senior advisor to the Trump administration pushed for the use of Title 42 before COVID-19, raising concerns about whether the policy was implemented for genuine public health reasons. 

    Opponents also contend that Title 42 subjected migrants to precarious conditions. Doctors Without Borders emphasized that mass expulsions left individuals without access to shelter, food, medical care, or legal representation. A fire in a migrant detention center, which killed 39 people, underscored these risks; surveillance footage showed detainees trapped in locked cells while guards failed to intervene. Critics also argue that the policy’s implementation often resulted in asylum seekers being detained in poor conditions and returned to the dangers they had fled.

    Future Prospects

    While Title 42 was invoked as a measure to protect public health, its effectiveness in achieving those goals remains debated. Proponents argue it was an effective solution that addressed co-occurring public health and immigration crises, while opponents argue it invited human rights violations and had a counterproductive impact on public health. Internal documents collected from the Trump administration in February 2025 suggest that President Trump aims to reinstate Title 42 policies, labeling unauthorized migrants as “public health risks” that “could spread communicable diseases like tuberculosis.” The Trump administration previously shut down the CBP One app, which assisted migrants in requesting Title 42 exemptions. The policy continues to evoke mixed reactions, and if reintroduced, past experiences may provide insights into its potential impact.

  • Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Introduction

    The United States faces a maternal mortality crisis, with maternal death rates significantly higher than other high-income nations. According to the CDC, maternal mortality disproportionately affects Black, Indigenous, and rural communities, with Black women experiencing maternal deaths at 2.6 times the rate of White women. The factors contributing to these disparities are complex and include unequal access to quality healthcare, socioeconomic barriers, and more. Despite advancements in healthcare, 80% of maternal deaths are preventable through timely medical intervention and comprehensive data collection. 

    What are MMRCs?

    State-based Maternal Mortality Review Committees (MMRCs) have been shown to play a pivotal role in analyzing maternal deaths to recommend evidence-based interventions. MMRCs are multidisciplinary teams that examine maternal deaths occurring during pregnancy or within one year postpartum. They utilize comprehensive data sources, including medical records, autopsy reports, and social service information. MMRCs assess preventability and contributing factors, allowing them to identify patterns and propose targeted policy solutions. Their review process centers on critical questions related to medical factors, social determinants, delays in care, and provider bias. By systematically addressing these factors, MMRCs generate insights that inform strategies to reduce preventable maternal deaths, which comprise 20% to 50% of all maternal deaths in the U.S.

    However, MMRCs face inconsistent funding and regulatory barriers, limiting their ability to track and analyze maternal deaths across states. Disparities in data collection methods and access to comprehensive patient records further hinder efforts to address maternal health inequities. Some states lack the authority to access certain medical records, while others experience delays in data sharing, reducing the timeliness and effectiveness of recommendations. Without consistent federal funding, many MMRCs struggle to maintain operations, particularly in rural and underserved areas, where maternal health disparities are often most pronounced. 

    Introduction to the Preventing Maternal Deaths Reauthorization Act

    The Preventing Maternal Deaths Reauthorization Act of 2023 (PMDR) was introduced to the House Committee on Energy and Commerce by Congresswoman Robin Kelly (D-IL) on May 18, 2023. The bill passed out of the Senate Health, Education, Labor, and Pensions (HELP) Committee in Fall 2023 and passed the House with bipartisan support in March 2024. However, the bill failed to pass the Senate before the end of the legislative calendar, rendering the bill “dead”. The reauthorization built upon the original Preventing Maternal Deaths Act of 2018, which helped establish and fund state-based Maternal Mortality Review Committees (MMRCs) to investigate maternal deaths and identify preventable causes. It sought to extend funding for MMRCs, enhance data collection, and address racial disparities in maternal health outcomes through the following provisions:

    1. Extending funding for state-level MMRCs to continue investigating maternal deaths
    2. Authorizing $58 million annually for the CDC to support state-level efforts
    3. Enhancing data collection on factors related to maternal health outcomes, particularly for minority populations
    4. Strengthening community-based interventions to reduce racial and ethnic disparities 
    5. Enhancing coordination among agencies to implement evidence-based solutions
    6. Expanding research on social determinants of maternal health 

    Arguments in Support

    Proponents of the PMDR Act of 2023 argue that the bill provides critical support for tried and true interventions to prevent maternal deaths. They emphasize that scientific literature identifies state-based MMRCs as the “gold standard” for preventing maternal deaths due to their multidisciplinary analysis. However, inconsistent funding threatens the effectiveness of MMRCs, particularly in states with high maternal mortality rates. In a letter to Congress, 125 public health and social services associations urged legislators to treat the PMDR as a top-priority bill, stressing the nation’s consistently high maternal mortality rate. Several national associations, including the American Medical Association, argue that continued federal funding is crucial to preventing maternal deaths. They highlight that past funding gaps resulted in reduced MMRC operations, hospital closures, and increased barriers to care. Supporters contend that the only way to ensure MMRCs can continue their vital work without funding disruptions is to pass the PMDR.

    Proponents of the PMDR Act also highlight its potential to promote health equity. Beyond identifying risk factors, MMRCs are critical in addressing racial, socioeconomic, and geographic disparities in maternal health by filling critical knowledge gaps on the drivers of maternal mortality in underserved populations. The PMDR Act directly supports these efforts by requiring MMRCs to report on disparities in maternal care and propose solutions. Federal support through this bill enables MMRCs to strengthen provider training, expand access to prenatal care, and address structural barriers contributing to maternal deaths. Without reauthorization, proponents argue, efforts to close maternal health gaps would be fragmented, leaving vulnerable populations without necessary protections.

    Arguments in Opposition

    The most prominent critique of the PMDR Act is that it focuses too heavily on MMRCs. Critics voiced concerns about MMRCs’ inconsistency, lack of accountability, and failure to acknowledge all social determinants of health. 

    Opponents highlight that legal and logistical challenges, such as data collection issues and lack of legal protections for participants, can create disparities in MMRC operations. Rural populations, who face higher maternal mortality rates and limited access to care, are often overlooked in MMRCs, further exacerbating disparities. Additionally, bureaucratic barriers and state laws limiting community involvement in MMRCs reduce their effectiveness in addressing maternal health challenges. 

    Others argue that MMRCs lack accountability, particularly regarding inclusivity and equitable decision-making. Advocates contend that MMRCs often exclude community representatives or organizations that challenge the status quo, prioritizing clinical expertise over individuals with lived experience. This exclusion can foster distrust, as community members may feel their knowledge and perspective are undervalued. The lack of compensation for community members to attend all-day MMRC meetings – unlike salaried clinicians – adds another barrier, further entrenching inequalities. Laws that impose burdensome requirements on MMRCs further complicate the process and reduce diversity in ideas. Opponents of the PMDR contend that these factors contribute to a lack of accountability from MMRCs, preventing them from fully creating lasting and inclusive solutions. 

    Finally, critics assert that MMRCs often fail to adequately address the underlying social determinants of health that contribute to maternal mortality. While MMRCs focus on clinical factors, such as healthcare quality and implicit bias, they can lack the frameworks to assess other social determinants like housing instability, food insecurity, or socioeconomic status. Often, these factors are deeply rooted in the broader healthcare system and community environments. Critics argue that the absence of these social factors in MMRC reviews limits the committees’ ability to develop holistic prevention solutions. Reports suggest MMRCs could benefit from incorporating a health equity framework and utilizing socio-spatial measures to address the full spectrum of challenges mothers face. Without this consideration, critics argue that MMRCs fall short of offering effective solutions to reduce maternal deaths and disparities. 

    Due to these critiques of MMRCs, critics of the PMDR argue that the bill should allocate more funding toward alternate interventions 

    Conclusion 

    The Preventing Maternal Deaths Reauthorization Act of 2023 represented an effort to extend investment in evidence-based maternal health interventions. While it received strong bipartisan support in the House, it died before a vote in the Senate, leaving MMRC funding uncertain in the years to come. While the bill was applauded for its potential to expand access to maternal care and fill critical knowledge gaps on maternal mortality factors, critics argued it placed too much emphasis on an intervention that lacked consistency and accountability to marginalized communities. 

    Future Outlook

    The Trump administration has implemented significant changes to the National Institutes of Health (NIH), including halting medical research funding and restructuring the agency, which has led to delays and uncertainties in grant approvals. These actions have raised concerns about the future of critical medical research, including studies on maternal health. Given these developments, the future of the PMDR may depend on an evolving public health funding environment. Advocacy groups and policymakers will need to collaborate to ensure that maternal health research and interventions receive the necessary support, despite the current challenges in the federal funding landscape.