ELEVATING PUBLIC HEALTH AND OTHER LONG-TERM INTERESTS IN GOVERNMENT POLICYMAKING

In Interagency Dynamics in Matters of Health and Immigration, Medha D. Makhlouf uses three case studies involving shared authority of the Department of Health and Human Services and the Department of Homeland Security to illustrate how practical, legal, and political dynamics operate to give immigration enforcement precedence over public health concerns.· 1 Makhlouf demonstrates that the examined agency interactions resulted in a failure to ensure that unaccompanied immigrant children received safe and appropriate placements;2 singled-out certain asylum seekers for exclusion at the border during the pandemic;3 and excluded Deferred Action for Childhood Arrivals ("DACA") beneficiaries from publicly funded health insurance, including benefits under the Affordable Care Act.4 The article then applies theories of agency coordination in shared regulatory space from the administrative law literature to explain that while overlapping, shared, and competing agency authority may identify important policy goals, this aspiration for coordination often falls short or is not honored at times of perceived urgency or crisis.5 Makhlouf then argues that the potential for interagency coordination to value public health goals, and possibly to improve policy outcomes, should cause policymakers to value public health at the center of decision-making in the immigration context.6 Giving greater priority to public health goals will require political leaders and agency policymakers to gain a deeper understanding of the consequences of disregarding public health in immigration enforcement and in other policy arenas. Despite the recent backsliding,12 life expectancy in the United States increased by thirty years between 1900 and 2000.13 Health care for individuals accounts for some of that increase, but more than eighty percent of the gain is due to public health interventions.14 According to the Centers for Disease Control and Prevention, the ten great public health achievements of the 20th century were vaccination, motor-vehicle safety, safer workplaces, control of infectious diseases, decline in deaths from coronary heart disease and stroke, safer and healthier foods, healthier mothers and babies, family planning, fluoridation of drinking water, and recognition of tobacco use as a health hazard.15 Obviously, some items on the list-such as maternal and infant health, control of infectious diseases, and reduction in fatalities due to heart disease and stroke-involve a combination of