WEAPONIZING PUBLIC HEALTH FEARS TO RESTRICT IMMIGRATION
Emily K. Abel
The most searing event in the early life of Maria, the daughter of Mexican immigrants in Los Angeles, was the death of her brother Enrique. During the last years of the Great Depression, Enrique had joined a work relief program established by President Franklin D. Roosevelt, but he had returned home when he was diagnosed with tuberculosis and died in the state sanatorium. Although Maria had only fleeting memories of him, she vividly remembered the church funeral and the walk home with her mother. As the hearse passed, her mother stopped, turned pale, and said softly, “Adios hijo mio.”
In official accounts, Enrique appears as a statistic purporting to show that immigrants should be deported because they bring infectious diseases into the country and overload social and health services. We are hearing that argument again. In February 2024, Trump warned that immigration would cause the “collapse of Medicare and Social Security.” Seven months later he declared at a rally that “immigrants were just destroying our country” not only because many were “terrorists” but also because “they come from mental institutions and insane asylums.” In words reminiscent of eugenic rhetoric, he added, “It’s poisoning the blood of our country. It’s so bad and people are coming in with disease. People are coming in with every possible thing that you could have.”
Eleven days before Trump’s second inauguration, the New York Times reported that members of his administration had spent several months trying to find a disease that could offer grounds for invoking Title 42, which gives U.S. Customs and Border Protection agents the authority to prevent the entry of people who pose a potential public health risk. Trump explained that “people are coming in with very contagious disease. You know, like it’s all of a sudden you see there’s a run on tuberculosis. There’s a run on things that we haven’t talked about for years in this country.” In his diatribe against Haitian immigrants in Springfield, Ohio, JD Vance argued that not only had the city seen a “massive rise in communicable diseases,” including HIV and tuberculosis, but that immigrants were also “draining social services.”
The comments of Trump and Vance are unsurprising. Throughout American history, anti-immigrant groups have repeatedly charged that immigrants import dread diseases and impose unbearable burdens on government coffers. The references to tuberculosis today are reminiscent of the 1920s when nativists in Los Angeles weaponized fears of that disease to restrict the entry of Mexicans and then expel them in the 1930s. Tuberculosis was the most fearsome disease of that era. After Robert Koch’s discovery of the tubercle bacillus in 1882, Americans began to understand that the disease could be transmitted from one person to another. Before the advent of antibiotics in 1946, permanent cure was impossible.
Far more than any other disease, tuberculosis helped health officials portray Mexicans as an overwhelming problem. Because TB was an endemic condition, it became the focus of sustained rather than sporadic attention; virtually every public health report mentioned the purportedly high prevalence among Mexicans. TB was also a chronic condition, keeping people out of the labor force for months and often years. Health officials frequently pointed out that because people with the disease needed economic support as well as medical care, they represented a high proportion of the recipients of “relief”—(the name then used for what is now called “welfare”). Employing eugenic arguments, those officials argued that TB prevalence among Mexicans demonstrated that their bodies were innately inferior to those of whites.
In the mid-1920s the California State Board of Health published two widely circulated reports, which helped to shape the anti-Mexican discourse during the subsequent decade and a half. The first, A Statistical Study of Sickness among the Mexicans in the Los Angeles County Hospital, from July 1, 1922 to June 30, 1924, appeared in 1925. It consisted largely of a series of statistical tables showing that in those two years Mexicans spent 122,033 days in the hospital at a cost to LA county of $328,075. The cost of care for Mexicans with tuberculosis was $75,141. The following year the State Board of Health published Summary of Mexican Cases Where Tuberculosis Is a Problem. The statistical tables in that study indicated that the 374 Mexican families in which at least one member had TB in Los Angeles received county relief or state aid. The annual expenditure for those families was $154,851.60; the total cost to date was $292,406.54.
The timing of the two reports helps us understand their import. Both appeared shortly after the passage of the Immigration Act of 1924, which instituted quotas for European immigrants. In the introduction to the Statistical Study, Edythe Tate-Thompson, the director of the California State Bureau of Tuberculosis, noted that the act “does not help California” because it failed to impose a quota for Mexicans. Tate-Thompson was one of the many health officials who urged that quotas be extended to Mexicans. Sixty-one public health nurses and social workers in Los Angeles signed a petition in 1928 stating that they “have extensive and intimate knowledge of our foreign born population” and “believe in immigration restriction, as necessary to maintain the unity and safety of our country.” Tate-Thompson’s introduction to the Statistical Study also highlighted the danger of unrestricted immigration:
Last year an aged Mexican in the last stages of tuberculosis came across the border unattended and of course unexamined, and a few years later he was sent to the already overcrowded ward of the tuberculosis hospital. He was put to bed and on the second day decided he would not stay in bed in spite of a fever of 104 degrees, so he left the hospital and later was picked up on the street again and returned…While the patient was waiting to be readmitted, he died. The incident was most unfortunate, the hospital was blamed, yet the episode of dying people entering this country is not unusual.
Soon after the Great Depression struck, Los Angeles became the center of the nation-wide drive euphemistically called “repatriation,” which reduced the size of the Mexican community in the metropolis by a third. In 1932, the State Board of Health wrote, “The exodus of Mexicans from this State has reduced both our clinic and hospital population with reference to this group.” Because the campaign targeted relief recipients, it is likely that families visited by tuberculosis constituted a high proportion of those pressured to depart. On at least one occasion, officials removed sick patients from both the county hospital and the state tuberculosis sanitorium and sent them to Mexico. Although the Department of Charities stated that it would transport people with tuberculosis only if there were guarantees of medical assistance in Mexico, the country had just one TB hospital with 180 beds. In 1934 Tate-Thompson referred to “the great numbers of tuberculous repatriates that were being left in various Mexican states without provision of care.”
A virulent animus toward one group often extends to others. After the expulsion of Mexicans, health officials turned their attention to Filipinos, again urging those with tuberculosis to depart and providing transportation. A far more extensive campaign targeted the thousands of people who poured into Los Angeles from other parts of the nation. Inspiring both Woody Guthrie’s protest songs and John Steinbeck’s 1939 Grapes of Wrath, those dust bowl refugees reported serious health problems, including tuberculosis. State and local health authorities thus participated enthusiastically in efforts to seal California’s borders, even participating in the notorious “Bum Brigade,” a vigilante patrol organized by Los Angeles Police Chief James Edgar Davis to keep migrants out of the state and deport those who entered. Migrants with TB who sought medical care in Los Angeles were offered only train fare home.
In one way, the situation has changed dramatically. Today, public health leaders and advocates are at the forefront of efforts to promote social equality. Public health researchers have demonstrated that racism not only contributes to health disparities but also undermines the health of the entire population. The current administration, however, has recycled century-old arguments, charging that immigrants are a grave threat because they bring fearsome, communicable diseases with them and overburden health and social services.
Sources:
Emily K. Abel, Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles (Rutgers University Press, 2008).
Richard L. Abel, How Autocrats Are Held Accountable (Routledge, 2025).
Alan M. Kraut, Silent Travelers: Germs, Genes, and the “Immigrant Menace (Basic Books, 1994).
Francisco E. Balderrama and Raymond Rodríguez, Decade of Betrayal: Mexican Repatriation in the 1930s (University of New Mexico Press, 2006).
Zolan Kanno-Youngs and Hamed Aleaziz, “Inside Trump’s Search for a Health Threat to Justify His Immigration Crackdown,” New York Times, January 9, 2021.
Emily K. Abel is professor emerita at the UCLA-Fielding School of Public Health. Her most recent book is Gluten Free for Life: Celiac Disease, Medical Recognition, and the Food Industry (NYU Press, 2025).