‘Muslim Ban’ decreased preventative care for children of Middle Eastern ancestry, study finds

LAWRENCE — While relations between the Trump administration and Iran have collapsed after a series of U.S. targeted military strikes, this ongoing hostility initially appeared during the president’s first week in office. On January 27, 2017, Trump signed an executive order that prohibited entry of travelers from Iran, Libya, Somalia, Sudan, Syria and Yemen.

The so-called “Muslim Ban.”

“We want to highlight one small aspect of the significant cost of anti-Muslim rhetoric on the communities which it targets. The Muslim Ban did not directly prevent individuals in the U.S. from traveling to and from the designated countries. However, its language created a sense of fear and mistrust among the community, reducing their engagement in health care,” said David Slusky, professor of economics at the University of Kansas.

In a new paper titled “The Muslim Ban and Preventive Care for Children of Middle Eastern Ancestry,” Slusky and his co-authors evaluate the impact of this policy on preventive care use among Middle Eastern and North African (MENA) ancestry children in the U.S., finding decreased well-visits and associated vaccinations. The article appears in the Forum for Health Economics and Policy.

Co-written by Shooshan Danagoulian and Owen Fleming of Wayne State University and Daniel Grossman of West Virginia University, the research uses a large, longitudinal medical records database to evaluate the effect of this policy.

It finds that prior to the policy, MENA children had higher rates of well-visits compared to non-Hispanic white children. The monthly frequency of these visits declined by 20% after January 2017, resulting in a 6% cumulative decrease in visits in the post-period. It also reveals a 12.5% decrease in total vaccinations for MENA children compared to non-Hispanic white children after the policy. 

“Health care is a unique setting where patients are required to trust the medical provider with intimate and private information. Mistrust undermines this environment, reducing the benefit of the interaction,” Slusky said.

He noted that medical mistrust can originate from many sources, including past negative group experience with health care. (This is prominent in the Black community stemming from, for example, the Tuskegee Study of Untreated Syphilis.) Among MENA communities, the increased government surveillance during the Bush and Obama administrations deepened the mistrust of civic authorities and medical providers.

The study offered some surprising revelations. For Slusky, he expected to see more comparable results for well-visits and vaccinations.

“If individuals were avoiding appointments altogether, these results would be similar,” he said. “Instead we found strong results for vaccination, suggesting that individuals were taking their children to a provider but more likely to opt out of vaccination. This was a more nuanced manifestation of the increased distrust in authority than we were expecting.”

Were this study to be run again in 2025, would the results show improvement or reduction in preventative care for MENA children?

“Preventive care, and vaccines specifically, appear to be called into question by the current administration. At the same time, the increased focus on immigration, even targeting authorized immigrants, is expected to trigger the same mechanisms estimated in our paper, as well as by other researchers with respect to Hispanic and Asian immigrants. Therefore, this compounded effect should result in reduced engagement in preventive care by children and adults of MENA ancestry,” he said.

It should also be noted that preventative care by MENA children doesn’t merely impact their community; it impacts the nation overall. 

“Vaccination remains a tremendously efficient public health tool. It protects those vaccinated from infection, reduces the severity of symptoms if infected, reduces the spread of diseases in the community and even protects those who can’t be vaccinated for health or religious reasons,” he said.

A KU faculty member since 2015, Slusky specializes in health economics and labor economics. He has conducted research on a wide variety of topics, including the Flint Water Crisis, COVID-19 restrictions, abortion care, physician birth outcomes and Medicaid. He is also a courtesy faculty member of population health in KU’s School of Medicine. In 2022, he was named executive director of the American Society of Health Economics.

Although Slusky’s team has identified and analyzed the problem of how the Muslim Ban affected preventative care for MENA children, fixing this fallout is even trickier.

“There are solutions, though none of them is easy,” he said. “One is to increase representation of health care providers who are from MENA backgrounds themselves. This would hopefully reduce the distrust patients feel toward those in authority.”

He said another would be to make health care a space where immigration and counterterrorism government action is prohibited, so that people can seek medical care without fear of harm. And a third would be to shift the national rhetoric toward embracing individuals of different backgrounds who are united by their common goal of building a life in the United States.

Slusky said, “None are easy, but all are possible.”