Week 10-2 Social

Determinants of
Health

Undocumented
migrants’ health
deservingness

INTD 200
Kazue Takamura
 Visibility of
migrant ”illegality”
vs.
invisibility of
migrant health
deprivation
Central issue: Undocumented migrants’ health deservingness

Social Undocumented A dual frame of

determinants of migrants’ health health
health theory access deservingness
Theory and practice

Rights
Privileges
(universal,
(exclusive
inalienable
access)
provision)
 Article 28
Theory Migrant workers and members of their families shall
have the right to receive any medical care that is
International urgently required for the preservation of their life or
the avoidance of irreparable harm to their health on
human rights the basis of equality of treatment with nationals of
the State concerned. Such emergency medical care
law’s shall not be refused them by reason of any
irregularity with regard to stay or employment.
guarantee Convention on the Protection of the Rights of All
Migrant Workers and Members of Their Families
(CMW)
Paul Farmer
Social
determinants
of health
 Big picture - Competing priorities

Market-centric State-centric Human-

centric
Global health regimes
Public health policies

States The pharma patent system

- Protection of intellectual property rights
- Drug price control
- Prevention of generic drugs
Theory: inclusivity
International
Markets
law
Human rights
Practice: exclusivity
Privatization of health
- Care deficits in the public health sector
Health - Increased health costs
sector

-Care providers
Health and social justice

Social justice
Health Existing structural
violence
Social determinants
Gender

Legal Racial/ethnic
status/nationality minorities

Class - income
In what ways does Paul Farmer’s
social determinants of health theory
explain undocumented migrants’
unique health experiences?
Social determinants
Migrant illegality

Hyper Denial of
Migrant illegality
criminalization undocumented
determined by
migrants’ health
immigration law Racializaztion access
What is ”illegality”?
Who constructs ”illegality”?
Social determinants of health -

Legal status – “illegality”

Gender
Income insecurity
Race
Law’s construction of illegality – moral
deservingness

Illegality
Legality
Outside the
Inside the
territoriality
territoriality
Morally
Morally
“undeserving
“deserving”
”
 “illegal aliens”

Discourse - Intensified “deportable”

Hypercriminalization

“criminals”
To what extent, does the
“illegality” discourse
normalize the health risks of
undocumented migrants?
Historicize illegality – perceived
”naturalness”
“Illegality is a result of states’
monopolization of the legitimate
means of movement” (John
Torpey 2000 Invention of the
Passport)
“Deportation and detention are
both perceived as ”the proper and
natural responses of the sovereign
state to those who have violated
its territorial sovereignty.” (Galina
Cornelisse 2010 Immigration
detention and human rights)
Law enforcement – serious consequences
of “illegality”
 Categorization
“Coverage for lawfully present
immigrants”
“qualified non-citizens” (Vermont Health
Access)
Why is undocumented migrants’
health access viewed as a “threat”
to public health? Who constructs
such view?
A “threat” & a “burden”
Undocumented migrants’ health access – a “threat”
and a “burden”
”the media gradually switched to images of migrants as
trespassers, criminals, and welfare thieves who illegally,
and routinely, enter the United States to take
advantage of its health and welfare program.” (Viladrich
2019:1448)
What is a “dual frame” of health
deservingness? (Voaldrich)
The role of media – a dual frame of
deservingness

A key mediator in the Tangible and

production and A dual frame of intangible impacts on
transmission of deservingeness individuals' health
images and narratives access
A dual frame of deservingness #1 –
“morality”

“Deserv
ing” Moral paradox “Undes
innocen erving”
t aliens
victims
-Racialized stereotypes
-Constructed ”Otherness”
-”abnormal” “dangerous”
A dual frame of deservingness #2 – “costs”

Undeserving
Deserving High
economic
Cost-saving
burden on
Cost- public
effective welfare
Undocumented women’s pregnancy

https://www.youtube.com/watch?v=SzHHgjAigq4

“Anchor babies”

Why is undocumented migrant pregnancy viewed as a “threat” to

national security?
Consequences of medical deportation

Deportation of Luiz Jiménez to Guatemala in 2003

https://www.youtube.com/watch?v=rXvmoigtk2o

Jiménez’s severe brain damage

High cost of hospitalization (no public health coverage)
Migrant health deservingeness
“Selective inclusion” (specific forms of vulnerability)

Pregnant The
Children
women elderly
Legal protection of “DREAMers”

DREAM Act (proposed by

Obama)
Development, Relief, and
Education for Alien Minors Act

DACA
Deferred Action for Childhood
Arrivals
DREAMers’ unique deservingness

“These are young people who study in our schools,

they play in our neighborhoods, they’re friends with
our kids, they pledge allegiance to our flag. They are
Americans in their heart, in their minds, in every single
way but one: on paper.” (Barack Obama 2012)
What (deserving) images of “Dreamers” are presented
by Obama?
What are potential bottom-up
responses to the health
deprivation of undocumented
migrants?
Montreal’s declaration of “Sanctuary City”
(2017)
 A sanctuary city shall “ensure
protection and accessibility to
persons without legal status living
What is a within its borders”

sanctuary Provision of sanctuary spaces

city? where non-status migrants have
rights to access to public services
without the risk of being deported
Is Montreal really a
city of “sanctuary”?
Civil society – Médecins du Monde
Paul Farmer
Social
determinants
of health
Displaced women’s health risks
“Women in
Pakistan’s Flood-
Hit Areas • https://www.voanews.com/a/women-in-pakistan-s
Delivering -flood-hit-areas-delivering-babies-in-unsafe-condi
tions/6796711.html
Babies in Unsafe • The United Nations Population Fund last week
said at least 650,000 pregnant women and girls,
Conditions” 73,000 of whom are expected to deliver in the next
(Voice of month, are among the flood victims, with many of
them lacking access to health care facilities and
America, support they need to deliver their babies safely
(Voice of America, September 4, 2022)
October 19,
2022)