New Special Issue of Social Science & Medicine – “Migration, ‘illegality,’ and health: Mapping embodied vulnerability and debating health-related deservingness”
University of Connecticut
Earlier this month, the journal Social Science & Medicine published a Special Issue — “Migration, ‘illegality,’ and health: Mapping embodied vulnerability and debating health-related deservingness” — that showcases the ongoing work of both the Initiative on Unauthorized Immigration and Health within the Society for Medical Anthropology’s Critical Anthropology of Global Health Special Interest Group and the AccessDenied community.
We are delighted to recap that volume here, and we encourage interested readers to access the individual articles via the journal’s website.[1,2]
In this new collection, we propose the time is ripe for rigorous interdisciplinary conversation about two urgent matters: first, the complicated but largely under-investigated matter of health-related deservingness, and second, the ways in which “illegality,” like other forms of marginalization and exclusion, can become literally embodied.
Bringing together an interdisciplinary group of anthropologists, sociologists, clinicians, and public health researchers, the collection probes these issues using both qualitative and quantitative methods in a wide array of geographic settings: North America, Central America, Western Europe, the Middle East, and Central Asia. The volume’s central aims are outlined below.
Part I: Debating deservingness
Part I explores how divergent ideological environments, framing narratives, and moral commitments shape the content, contours, and implications of contemporary ethical debates about what unauthorized migrants do or do not deserve, especially in the health domain.
Sarah Willen (2012b) opens the discussion by calling upon social scientists of health to investigate how health-related deservingness is reckoned, and to what end, both by those with power, influence, and political voice and, as importantly, by those portrayed as “undeserving,” including unauthorized migrants and immigrants themselves.
Anahí Viladrich (2012) employs “framing” theory (Goffman, 1986) to analyze debates about unauthorized immigrants’ health-related deservingness in the United States. In particular, she shows how counter-framing strategies can help problematize widely circulating assumptions about both the root cause of “social problems” (like unauthorized immigration) and the nature and characteristics of marginalized social groups (like unauthorized immigrants).
Turning to Europe, Heide Castañeda (2012) examines how changing notions of inclusion and exclusion, and changing conceptions of health-related deservingness, influence clinical education. She analyzes German medical and nursing curricula, as well as her own ethnographic findings, to show how stereotypes and ideologically motivated constructions of migrants shape how clinicians are taught to see and think about their patients, sometimes in ways that recapitulate damaging forms of stereotyping and victim blaming.
Nora Gottlieb, Dani Filc, and Nadav Davidovitch (2012) analyze a polarizing internal debate at an Israeli NGO that operates a volunteer-run Open Clinic for unauthorized migrants, refugees, and asylum seekers. Not only do these authors show how vulnerable groups fare in a state with exclusionary citizenship and migration regimes and an imperiled national health care system, but they also helpfully assess the strengths and limitations of human rights, humanitarianism, and other “idioms of social justice mobilization” (Willen, 2011) for efforts to improve unauthorized migrants’ health.
Helen Marrow (2012) explores the attitudes and actions of safety net health care providers in San Francisco, California, a declared “sanctuary city” that is among a handful of American communities to have divorced deservingness to basic health care services from legal status.
Part I concludes with a set of analytical reflections from Carolyn Sargent (2012), whose research has laid important groundwork for contemporary scholarship on immigration, health, and deservingness. An important next step, she contends, is to pay greater attention to how entitlement and moral worth are reckoned – not only in relation to unauthorized migrants and immigrants, but also in wider debates about health inequities and social justice.
Part II – “Illegalization” and embodied vulnerability
Part II, “’Illegalization’ and embodied vulnerability,” examines how “illegalization” and criminalization interact with other forms of marginalization to aggravate unauthorized migrants’ vulnerability to illness, injury, and violence and impede their access to health care. Specifically, these papers explore how vulnerabilities associated with “illegality” can become embodied.
The concept of embodiment evokes two distinct scholarly conversations that ought to be in dialogue with one another. From an epidemiological standpoint, embodiment refers to complex, multilevel processes through which human bodies literally incorporate aspects of our environments – social, political, and biological – in ways that can be “read” on our biology, much like skeletal remains can tell stories of people who lived long ago. Yet the epidemiological approach to embodiment ignores what anthropologists regard as its defining feature: attention to subjectivity and lived experience. Moreover, embodied experiences of “illegality” – in both the epidemiological and the phenomenological sense – are profoundly shaped by local moral assessments of who is, or is not, deserving of society’s attention or investment.
Stéphanie Larchanché (2012) shows how France’s deeply rooted commitments to universal health care access and the right to health are imperiled in today’s increasingly hostile political climate, in which unauthorized immigrants are constructed as “socially illegitimate” (Fassin, 2004). Her study reveals how discourses of undeservingness can become embodied, especially when immigrants internalize negative assessments of themselves as undeserving of care.
Taking a more explicitly epidemiological approach, Samantha Huffman and colleagues (2012) examine the nature of tuberculosis risk among unauthorized seasonal Uzbek migrants in Kazakhstan. In this post-Soviet context, structural factors such as poverty, “illegalization,” and social marginalization interact to place Uzbek migrants at risk of contracting and transmitting TB or, among those with latent TB infection, of developing active disease.
What Castañeda’s study of medical curricula in Part I implies, Seth Holmes’ (2012) study of a migrant circuit linking Mexico and two U.S. sites demonstrates ethnographically; negative portrayals of unauthorized migrants can influence both the dispositions of biomedical practitioners toward their unauthorized migrant patients and practitioners’ clinical conduct.
Kate Goldade and Kolawole S. Okuyemi’s (2012) article on Costa Rican health care providers who treat undocumented Nicaraguan patients shows how in Costa Rica (as in France), a longstanding national commitment to health as a universally accessible public good can come under threat when unauthorized migrants constitute an increasingly visible segment of the national population.
Leo Chavez‘s (2012) findings from a random telephone survey in Orange County, California, challenge the popular assertion that unauthorized immigrants in the U.S. are abusers of taxpayer-funded health services. His contribution demonstrates the important role empirical research can play in evaluating, and at times debunking, unfounded discourses that nonetheless influence electoral politics, policymaking, pathways of health care access, and ultimately the embodied experience of immigrants and their families.
Part II concludes with reflections from James Quesada (2012), who considers these papers through the lenses of “structural vulnerability” and the embodiment of risk. He contends that negative constructions of unauthorized migrants and immigrants as “illegal” and undeserving have profound and far-reaching consequences not just for members of this group, but also for migrant advocates and care providers and, moreover, for the broader communities whose lowest social and political rungs migrants tend to inhabit.
Overall, this Special Issue provides strong scaffolding for broad-ranging, interdisciplinary inquiry into the core issues that concern the AccessDenied community: the complex challenges associated with migration and immigration, “illegalization,” and health.
Fassin, D. (2004). Social illegitimacy as a foundation of health inequality. In A. Castro & M. Singer (Eds.), Unhealthy health policy. Walnut Creek, CA: Altamira Press.
Goffman, E. (1986). Framing analysis: An essay on the organization of experience. Boston: Northeastern University.
Willen, S. (2011). Do “illegal” migrants have a “right to health”? Engaging ethical theory as social practice at a Tel Aviv open clinic. Medical Anthropology Quarterly, 45, 303–330.
 This overview draws extensively on the Introduction to the collection (Willen, 2012a).
 Please contact us at firstname.lastname@example.org if you are interested in reading a particular article but lack direct journal access.
Willen, Sarah. 2012. “New Special Issue of Social Science & Medicine – Migration, ‘illegality,’ and health: Mapping embodied vulnerability and debating health-related deservingness.” Accessed [date] at https://accessdeniedblog.wordpress.com/2012/03/30/new-special-issue-of-social-science-medicine-migration-illegality-and-health-mapping-embodied-vulnerability-and-debating-health-related-deservingness/.