As debates over immigration policy continue across the United States, state and local governments have increasingly adopted laws that either limit or encourage cooperation with federal immigration enforcement. These policies shape more than immigration enforcement practices — they can also influence health outcomes, access to services, and health equity in immigrant communities. 

A recent study published in the American Journal of Preventive Medicine mapped more than two decades of sanctuary and antisanctuary policymaking across the country, creating one of the most comprehensive datasets on state and local immigration policies to date. The research also highlights the growing use of "punitive preemption," a trend in which states impose penalties on local governments that pursue policies the state opposes. 

Caroline Kravitz, MPH, is a PhD candidate at Drexel University's Dornsife School of Public Health. As lead author of Mapping the Legal Landscape From 2000 to 2021: State Sanctuary and Antisanctuary Policies, Local Sanctuary Ordinances, and 287(g) Agreements, Kravitz and her colleagues examined how immigration policymaking has evolved over time and what those changes may mean for public health. 

We spoke with Kravitz about punitive preemption, the challenges of conducting local policy surveillance, and how researchers can use these data better to understand the relationship between immigration policy and health equity. 

CPHLR: Your research discusses the growing use of "punitive preemption." Why was it important to highlight that trend in the context of public health? 

Caroline Kravitz: Punitive preemption is a term that has been coined by legal scholars in recent years but has grown in popularity among states that wish to control the actions of localities in their jurisdiction. It is important to understand where punitive preemption occurs because it can have spillover effects on public health policymaking. The financial penalties that cities face may coerce them into ending their sanctuary policies, which can impact the well-being and health of constituents (both immigrants and those who live near immigrants). Also, these penalties can take away limited resources from other local public health policies and projects. Finally, the chilling effect of these penalties can instill fear in local policymakers, causing them to shy away from enacting public health policies or programs that are important for population health but could bring negative attention from the state. 

As we mentioned in our paper, in the context of immigration policy specifically, this trend of punitive preemption is particularly common in traditionally conservative states directed against traditionally progressive urban cities. These large urban centers tend to be home to many of the state's minoritized racial/ethnic populations, people who already face disproportionate rates of adverse health outcomes. Punitive preemption can exacerbate these already existing health inequities. 

CPHLR: What gaps in existing immigration policy research were you hoping this dataset would help address? 

Caroline Kravitz: We hoped to fill three distinct gaps with our dataset. First, to our knowledge, there was no existing dataset containing both state and local immigration policies that had been systematically created using legal mapping methodology. 

Second, it is uncommon to use legal mapping methodology for local policies. We knew this going into our project, but felt that mapping the local policy landscape, in addition to the state landscape, was essential. Throughout the process, we learned the significant challenges associated with local policy surveillance – mainly, that municipal search engines are not designed for research, so it is very difficult to systematically search for policies. We wanted to share our protocol and lessons learned with other social epidemiologists researching immigration policy and health so they could apply them to their own work. 

Finally, we wanted to understand preemption in the context of immigration policy. That was really the impetus behind the grant that our PIs – Dr. Schnake-Mahl and Dr. Langellier – wrote which was funded by the Robert Wood Johnson Foundation and the National Institutes of Health's National Institute on Minority Health and Health Disparities. The goal was to understand where preemption is occurring, how it might be changing the immigration policy landscape, and how this might impact population health outcomes. 

CPHLR: How did your team determine which policies to include in the dataset? 

Caroline Kravitz: Our team spent a lot of time deciding on the inclusion definitions for our state and local policies. We specifically wanted to focus on sanctuary and anti-sanctuary policies, so we limited our definition to include only policies that dealt with the actions of law enforcement. 

There is not one definition for a sanctuary policy, but legal scholars and immigration activists have generally settled on the definition that sanctuary policies relate to actions of law enforcement while immigrant or welcoming policies relate to how immigrants are welcomed and able to integrate into society. Our analytic research questions focused on the impact of sanctuary and anti-sanctuary policies and how preempting such policies at the local level impacts health equity, which is why we had such a narrow inclusion definition. 

We also limited our search to policies enacted during certain time periods: 2009-2021 for state policies and 2000-2021 for local policies because of the availability of policies in legislative search engines, the years of available outcome data for our empirical analyses, and because we wanted to capture the increase in local immigration-related policymaking that occurred following the September 11, 2001 terrorist attacks. 

At least two members of our research team read each policy in depth to ensure that it met the inclusion criteria, and we discussed the policies as an entire team to make sure we all agreed that the inclusion criteria had been met before adding any policy to our dataset. 

CPHLR: What additional areas of immigration policy research do you think warrant further study? 

Caroline Kravitz: There is an extensive literature base analyzing immigration policies at single levels of government and how they are associated with population health outcomes. To build on these studies, public health researchers need to employ quasi-experimental studies to determine if these policies can be causally linked to health outcomes. 

Also, researchers need to build multi-level policy exposures into their studies, or find other ways to account for policies at multiple levels of government (e.g., including policies at other levels as confounders or moderators). In doing so, we can systematically disentangle the effects of policies at different governance levels. 

We can also understand if something like a sanctuary policy helps to drive health equity or if there are more steps that policymakers can take to improve population health in addition to creating an inclusive society for immigrants. This will allow for more accurate research and better policy recommendations. 

CPHLR: How do you hope policymakers, researchers, or public health practitioners use this work moving forward? 

Caroline Kravitz: We hope that researchers can use the information we compiled in our legal mapping study in a few different ways. First, for public health researchers who want to conduct a legal mapping study at the local level, we hope that they will build on our protocol and lessons learned to improve the systematic search and coding of local policies. 

Also, we hope that we have inspired public health researchers to collect policy data at multiple governance levels to improve the accuracy of our studies. For public health researchers specifically seeking to analyze the impact of immigration policy, we hope that by mapping the immigration policy landscape over the last 25 years we have helped them understand descriptive trends in policymaking that can inform their empirical research questions. 

Finally, for public health professionals, immigration activists, and policymakers, we hope that we have successfully made the case that immigration policymaking is changing in our country and that the use of new and punitive preemption can have lasting impacts on public health and local policymaking that can hinder health equity for many years to come. 

You can read the paper here.