Why Structural Vulnerability? Why Latino Migrants in the United States? – James Quesada
San Francisco State University
Why propose another concept that appears to be a variation on a well-established theme … social suffering, the social production of disease and distress, the effects of violence of all kinds upon people and communities throughout the world? And why select a particular population like Latino migrants to represent how insidious and gripping structural vulnerability can be to one’s health and livelihood?
In a special issue of the journal Medical Anthropology, “Structural Vulnerability: Latino Migrants in the United States,”  the social science concept of structural vulnerability is introduced and put to use by medical anthropologists familiar with the plight of Latino migrants in the United States. Structural vulnerability refers to one’s position in social hierarchies that imposes physical-emotional suffering on specific population groups and individuals in patterned ways. It is the product of class-based economic exploitation and cultural, gender/sexual, and racialized discrimination that are embodied and often result in the formation of subjectivities that are socially depreciated. The vulnerability of an individual is produced by his or her location in a hierarchical social order and its diverse networks of power relationships and effects. Latino migrants, regardless of their legal status, are scapegoated and denigrated as they are placed at the lowest rungs of U.S. society while being criminalized as ‘‘illegal aliens.’’ This racialized ordering and criminalized othering result in a routinized, lived experience shared by Latinos throughout the United States; the impact such positioning has on their social and health status is immense. However, structural vulnerability is not unique to Latino migrants in the United States, as it also applies to the poor, the sexually stigmatized, the medically uninsured, people of color, the disabled, the formerly incarcerated, the drug addicted, runaways, throwaways and castaways around the world.
The notion of structural vulnerability builds upon the seminal work of medical anthropologists – Scheper-Hughes, Kleinman, Farmer, Singer to name a few – who not only have documented the ravages of structural vulnerability, but also are committed to transforming the institutional practices of medicine and public health, to realizing their potential as not only curative but also healing practices. And toward that end, it is vitally important to transcend conventional notions of how pathology occurs and recognize there is much more that can be done to mitigate mortality and morbidity through human commitment, ingenuity, and action.
Each of the contributors to this special issue uses the concept of structural vulnerability to deepen understanding of health and well-being:
- Linda Green questions how genuinely U.S. immigration policy can be reformed when it is linked to neoliberal global economic forces that compel Latin Americans to leave their homelands in pursuit of work and viable livelihoods and, moreover, when it regards health care as a for-profit enterprise.
- Elizabeth Cartwright describes how regardless of whether Latino workers are citizens or non-citizens, legally documented or not, their access to health and health care in the United States reflects the broader inequities of the health care system. Her piece further discloses that there are no automatic rights or unimpeded access to health care even for Latinos well on their way to naturalization.
- Sandy Smith-Nonini argues that the levels of worker injuries Latino laborers endure are tied to the structural violence of the North American Free Trade Agreement (NAFTA) and the suppression of union and worker rights as well as immigration status and deregulation of labor markets and protections.
- Michael Duke asserts that Latino workers trying to make sense of their plight often internalize notions of race and ethnicity that compel workers to exercise modes of self-governance and self-regulation that reinforce the organization of labor that places them in this predicament in the first place.
- James Quesada describes Latino workers internalizing the negative depictions and popular stereotypes against them while striving to escape the stigma and sanctions thrust upon them.
- Finally, Seth Holmes portrays how everyone, from Latino workers to the American citizens that employ them, is implicated in power dynamics that are harmful –albeit to different degrees — to everyone.
By introducing structural vulnerability into our lexicon, in some small way, all the authors of this special issue are committed to contributing to the establishment and practice of a to-be realized, genuine practice of social medicine.
 Quesada, James, Laurie Hart, & Philippe Bourgois. 2011. Structural Vulnerability and Health: Latino Migrant Laborers in the United States. Medical Anthropology, 30(4): 339-362 at 340-341.
 Other contributors to this special issue are Philippe Bourgois (U Penn), Kate Goldade (University of Minnesota), Laurie Hart (Haverford), Peter H. Koehn (University of Montana), Alessandra Miklavcic (McGill University), Adrienne Pine (American University), and Marja Tiilikainen (University of Helsinki). I also wish to acknowledge Lenore Manderson and Victoria Team for all their help.
James Quesada, PhD is an Associate Professor in the Department of Anthropology at San Francisco State University. A medical anthropologist who works in Nicaragua and California, his interests primarily focuses on the nature and consequences of structural violence, with a particular interest on how it influences transnational migration.
Quesada, James. 2011. Why Structural Vulnerability? Why Latino Migrants in the United States? AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed (date) at