In a landmark study published in the American Journal of Preventive Medicine, researchers have provided a sweeping analysis of the shifting landscape of immigration-related policies across the United States from 2000 through 2021. This comprehensive legal mapping uniquely traces both sanctuary and anti-sanctuary policies at the state and local levels, uncovering how legislation has evolved over two decades, frequently in reaction to federal immigration trends and sociopolitical currents. The study offers invaluable insights into the complexities of immigration enforcement and its profound implications on public health and social equity.
Immigration policy in the U.S. is constitutionally governed at the federal level, with exclusive jurisdiction over matters such as admission, status, and naturalization. However, state and local governments, while lacking direct authority to regulate immigration, influence enforcement through ordinances that dictate law enforcement cooperation with federal agencies, notably U.S. Immigration and Customs Enforcement (ICE). This jurisdictional interplay has resulted in a patchwork of disparate policies, reflecting diverse local political climates and attitudes toward immigrants.
Sanctuary policies have gained prominence as protective measures limiting local law enforcement’s cooperation with federal immigration authorities. These policies aim to reduce the fear and stigma attached to immigrant communities, fostering trust between residents and law enforcement. Evidence suggests that sanctuary jurisdictions experience lower crime rates, improved economic conditions, and healthier community relations. Consequently, sanctuary laws are often championed as mechanisms to enhance social cohesion, promote inclusion, and protect vulnerable populations.
In contrast, anti-sanctuary policies mandate or encourage collaboration between local law enforcement and federal immigration agencies, often intensifying enforcement activities. These policies can generate adverse health outcomes for immigrants by increasing deportation risks, exacerbating stress and anxiety, and prompting avoidance of healthcare and social services. The resultant social environment may worsen mental and physical health issues within immigrant populations, contributing to higher prevalence of depression, post-traumatic stress disorder, and chronic illnesses.
The motivations behind these policy enactments are deeply intertwined with national security concerns, especially following the September 11 attacks, which catalyzed a surge of local ordinances aimed at immigration enforcement beginning in the early 2000s. The study’s authors selected this period deliberately to capture the genesis and evolution of immigration-related policies in the wake of heightened security anxieties. These historical trends elucidate how localities and states have both emboldened and resisted federal immigration directives over time.
The research team employed rigorous policy surveillance methods, meticulously examining legislative databases and Department of Homeland Security records. They identified 27 state-level anti-sanctuary policies and 25 sanctuary policies between 2009 and 2021, alongside 24 city sanctuary ordinances enacted from 2000 onwards and a substantial number of 287(g) agreements—local-federal collaborations enabling delegated immigration enforcement—totaling 284 within the period studied. These data provide a granular, quantified view of dynamic policy landscapes.
A critical element highlighted in the study is the phenomenon of preemption, whereby higher levels of government invalidate or inhibit policies enacted by lower jurisdictions. Notably, anti-sanctuary states often pass preemptive laws forbidding sanctuary ordinances within their boundaries, while some sanctuary states restrict 287(g) agreements. This legal mechanism disrupts local policymaking autonomy and may stymie efforts to protect immigrant communities, raising vital questions about the balance of power within the federal system.
Of particular concern is the emergence of what the authors term “punitive preemption,” characterized by state governments not merely overriding local policies but leveraging punitive measures to dissuade municipalities from adopting sanctuary protections. This trend represents a novel and troubling legal tool aimed at curtailing local legislative independence through threats and financial penalties, chilling proactive policies that could promote immigrant health and safety at the community level.
The study also identifies a paradoxical partisan landscape: anti-sanctuary policies have been more frequently enacted under Democratic presidential administrations, whereas sanctuary policies tend to arise more during Republican administrations. This unexpected distribution underscores the complex interplay between federal leadership and state-local legislative dynamics, as well as the strategic use of immigration policy to signal ideological positions or resist federal mandates.
The chilling effect of punitive preemption on public health policymaking is particularly worrisome. Since healthcare access and related social services are often managed locally, constraints on municipal autonomy could hinder the development and deployment of policies that improve immigrant health outcomes. By suppressing legislative innovation, punitive preemption may exacerbate health disparities and impede the pursuit of health equity for immigrant populations.
This research constitutes the first known effort to systematically map both state and local sanctuary and anti-sanctuary policies over two decades, creating an essential foundation for future studies. While the analysis concludes in 2021 and does not depict the current legal environment, it equips policymakers, advocates, and researchers with a temporal framework to understand how immigration policies have been leveraged as tools of inclusion or exclusion.
Looking forward, the authors emphasize the need for quantitative studies that rigorously evaluate the causal health impacts of these policies. As immigration enforcement continues to evolve amid shifting political contexts, understanding how legislative environments shape public health outcomes remains a critical priority for scholars and practitioners committed to fostering equitable health access.
Lead author Caroline Kravitz and senior investigator Alina Schnake-Mahl from Drexel University’s Dornsife School of Public Health underscore the import of comprehending the historical and ideological underpinnings of immigration-related policymaking. Their work illustrates that immigration enforcement is not merely a legal or political issue but also a determinant of population health and social justice in the United States.
This timely study offers a rare legal and epidemiological lens on immigration policy, illuminating how governments at multiple levels have adapted, resisted, and contested federal immigration enforcement over two crucial decades. By revealing the complexities of sanctuary, anti-sanctuary, and preemptive measures, the research provides a blueprint for analyzing the intersection of law, health, and human rights in an era of intensifying immigration debates.
Subject of Research: Not applicable
Article Title: Mapping the Legal Landscape from 2000 – 2021: State Sanctuary and Anti-Sanctuary Policies, Local Sanctuary Ordinances, and 287(g) Agreements
News Publication Date: 27-Apr-2026
Web References: http://dx.doi.org/10.1016/j.amepre.108311
References: American Journal of Preventive Medicine / Kravitz et al.
Image Credits: American Journal of Preventive Medicine / Kravitz et al.
Keywords: Immigration Policy, Sanctuary Cities, Anti-Sanctuary Laws, Preemption, Public Health, Legal Mapping, Policy Surveillance, Health Equity, 287(g) Agreements, Punitive Preemption, State and Local Legislation
