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- Convenors:
-
Laura Ferrero
(University of Turin)
Chiara Quagliariello (Ecole des Hautes Etudes en Sciences Sociales)
Ana Cristina Vargas (University of Turin (Italy) - LDF (Fundamental Rights Laboratory))
- Location:
- JUB-115
- Start time:
- 10 September, 2015 at
Time zone: Europe/London
- Session slots:
- 3
Short Abstract:
How can a human rights-based approach be used in anthropological studies on migrants' right to health? Our panel propose fundamental rights as an instrument to analyse healthcare policies offering a common ground for an interdisciplinary and comparative approach.
Long Abstract:
A human rights-based approach on migrants’ right to health
Fundamental rights, and in particular the right to the best attainable standard of physical and mental health, should be understood not only as a theoretical framework. It can also be an instrument to analyse healthcare policies, to evaluate the right to health of vulnerable groups, such as migrants, and to promote viable and adequate solutions.
The United Nations Committee on Economic, Social and Cultural Rights stated that there are four criteria that National health services must comply with in order to ensure the right to health: availability, accessibility, acceptability, and quality. These categories, even if not often used in Medical Anthropology, can offer a common ground for the development of an interdisciplinary and comparative approach.
At the same time, concepts developed in Medical Anthropology such as structural vulnerability (Quesada, Hart, Bourgois), social suffering (Kleinman, Das, Lock) and structural violence (Farmer) can offer an essential contribution to the construction of a human rights-based approach to health issues thanks to their focus on inequities and social determinants of health.
Moreover, ethnographical methodology can give voice to migrants’ experiences providing a critical understanding of the social reality in which the four criteria mentioned before are grounded and offering the opportunity to show that right to health does not correspond uniquely with access to healthcare.
On these basis, we invite researchers working on the field of migrant’s right to health to submit proposals in one of the following areas:
1. How can a human rights-based approach be used in anthropological studies on migrants’ right to health?
2. What are the more relevant consequences of inequities, marginalization and other social determinants of health?
3. How the privatisation of healthcare, the shrinking of public resources and normative restriction affects migrant’s right to health?
4. What are the local/national answers of institutions, such as national health services, healthcare operators, migrants’ communities, associations and NGOs to provide and promote the right to health?
Accepted papers:
Session 1Nolan Kline (Purdue)
Paper short abstract:
Based off fieldwork in Atlanta, GA, this paper underscores how immigrant policing efforts constrain undocumented immigrants’ health-related rights in the United States. Informed by theories of citizenship, this paper further highlights how immigrant policing upholds rights-based power hierarchies.
Paper long abstract:
In the United States, immigration policies created at a state level join federal statutes to produce a multilayered immigration enforcement regime targeting undocumented immigrants. When combined with local police practices, increasingly harsh immigration regimes form a type of localized enforcement that moves the social and health-related precariousness of national borders into everyday spaces. Immigrant policing objectives in the US demand research attention as they are efforts to restrict undocumented immigrants' already constrained rights, and further contribute to notions of some immigrant groups as being undeserving of social services.
Drawing from theories of citizenship to examine power relationships and sets of rights and entitlements among specific populations, this paper explores how immigrant policing efforts in Atlanta, GA constrain some immigrants' rights and how those efforts are resisted.
Using data collected from interviews with undocumented immigrants, activists, health providers, and policy makers, I describe how immigrant policing shapes undocumented immigrants' ability to seek and access healthcare and activists' responses to increasingly localized immigration regimes. Data presented in this paper demonstrate how theories of citizenship allow for examining power relationships that shape and determine rights and can further shed light on the lived experiences of populations most impacted by legislative efforts to constrain sets of rights. Furthermore, findings from this paper highlight how policy efforts may be used to maintain social hierarchies based on categories such as race and immigration status. Lastly, this paper emphasizes how rights-based methodologies allow for greater access to hidden, vulnerable, populations.
Anahi Viladrich (Queens College & The Graduate Center, CUNY)
Paper short abstract:
Passage of the 2010 US Health Reform Act excluded unauthorized immigrants from receiving all types of federal aid for health coverage. This paper uses a human rights framework to examine media constructions of immigrants’ deservingness on the basis of economic and public health grounds.
Paper long abstract:
Passage of the 2010 US Health Reform Act excluded unauthorized immigrants from receiving all types of federal aid for health coverage. This paper relies on a human rights framework to critically discuss mainstream media constructions of deservingness, which rationalizes undocumented immigrants' access to health coverage on the basis of economic and public health grounds. A human rights critique allows us to understand that the overall US media's positive views of unauthorized immigrants are in tune with long neoliberal assertions that view them as "worthy" — as both responsible students and productive workers who are not going to become "public charges".
Three media frames will be particularly examined. A "cost-effective" frame (i.e., benefits surpass costs) works in tandem with a "cost-saving" one (i.e., preventive care reduces costs), making DREAMers ideal candidates for government-sponsored coverage. Portrayed as young and healthy patients, their insurance premiums would help reduce health care costs for everyone in the United States. Preventive measures, including vaccinations and screening tests, are seen as rational means for curbing both the spread of infectious disease and costly long-term care. A third frame — the "effortful immigrant" — features DREAMers' industriousness and their blamelessness concerning the conditions by which they came to be unauthorized immigrants. Ultimately, denying unauthorized youth access to government-sponsored programs would lead to preventable losses in productivity and higher costs in emergency services, thus negatively impacting the US economy.
Pietro Cingolani (University of Bologna)
Paper short abstract:
The Roma are one of the groups that has the worst health conditions and whit which medical professionals have the biggest relational difficulties. Is the concept of culture an adequate source of explanation? The answer is rather an integrated approach that address the roots of structural vulnerability.
Paper long abstract:
The concept of structural vulnerability is particularly useful to explain the health conditions of Roma migrants. The situation of the Roma is an example of "extreme" fundamental rights at risk and it shows that health is unevenly distributed across the population. In the Roma case the four criteria of availability, accessibility, acceptability, and quality are rarely met by the National health Service. Evidence from a research in the city of Turin, Italy, confirms that barriers to access are closely linked to social exclusion factors, specifically:
1) A lack of knowledge of available health care systems also due to language and literacy barriers; 2)Physical barriers, mobility and distance; 3) A lack of trust in health professionals; 4) Discrimination by health care professionals. Health professionals may not realise that the Roma's apparent disregard for their health is sometimes a response to the inadequacy of the healthcare they are offered. In some doctor-patient interactions, perceptions of cultural difference or otherness seem to overrule all other motivations, becoming the only source of understanding. Medical professionals interprets attitudes and behaviours as 'cultural' when, instead, they are simply engendered by poverty. In this paper I show how a full right to health could be reach only taking in consideration all the variables that are the basis of Roma structural vulnerability.
Anna Beesley (Glasgow University)
Paper short abstract:
The Scottish Government states that an individual at any stage of the asylum process is entitled to the same medical treatment as a UK national. This paper argues that the culture, discourse and uncertainty which surround the asylum process affect perceptions of entitlement, and thus applicants’ access to wellbeing.
Paper long abstract:
According to guidance offered by the Scottish Government, ‘anyone who has made a formal application for asylum, whether pending or unsuccessful, is entitled to [NHS] treatment on the same basis as a UK national who is ordinarily resident in Scotland while they remain in the country.’1 Yet, this is not always acted upon by NHS staff due to a lack of knowledge around eligibility.2
Based on ethnographic research conducted in Glasgow, with actors involved in the asylum system in various ways (from asylum applicants to Home Office caseworkers and the service providers, campaigners, medics and lawyers in between), this paper explores the gap between policy and perceptions of entitlement.
Over the last few decades there has been a growing de-legitimisation and suspicion, a ‘culture of disbelief’, towards asylum seekers throughout Europe. This culture causes politically-loaded acts of classification and moral distinctions around the deservingness of asylum applicants. By juxtaposing this with the uncertainty involved in the asylum process as a whole, in this paper I will argue that applicants' perceptions of entitlement, their access to health-related support services, as well as their overall wellbeing, are negatively affected by these issues.
Chiara Dallavalle (Fondazione ISMU)
Paper short abstract:
The paper explores the issue of migrants’ access to health focussing on the specific case of refugees within the Italian scene. The analysis will take into account the limits of the Italian Health System in taking in charge refugees’ psychological vulnerabilities.
Paper long abstract:
As the word itself suggests, the refugee is someone looking for a shelter, for protection from experienced violence and abuses. Usually refugees escape wars, ethnic conflicts, political oppression, and any other kind of personal discrimination. The violence and tortures experienced produce physical and psychological frailties, affecting refugees' abilities to undertake even the simpliest daily activity. The Italian Reception System for asylum seekers and refugees (SPRAR), promoted by the Ministry of Interior, recognizes such a condition of vulnerability, and disposes that those with serious psychological fragilities are hosted in specific reception centres offering adequate healthy services. However there are two main critical aspects of such a model:
1.The early diagnosis of possible mental disorders in a refugee is very hard to fullfil, mostly because before entering into the SPRAR centres, migrants transit into huge governative camps, where a very shallow health screening is carried out. Therefore often migrants are allocated to "ordinary" SPRAR reception centres, and their vulnerabilities emerge once people are already entered into an unsuitable place;
2.Refugees are hosted into the SPRAR centres only for six month, exstensible only to other six months. After this period, people should be able to take care of themselves, and live autonomously as any other Italian citizen. However the access to public services for pshycological and psychiatric support is harduous, and often the staff is not prepared to work with this kind of patients.
The paper will develop the analysys of the issue, presenting an ethnography carried out within the SPRAR reception centres.
Milena Greco (University of Study Federico II - Naples)
Paper short abstract:
This intervention intends to consider the right to health for foreign women and its barriers and issues focusing on two Italian regional case studies within considerably different contexts because of their management, policies and the organization of health services.
Paper long abstract:
Foreign presence in Italy, diverse and featuring a significant incidence of women, poses new political, social and cultural challenges, amongst which the issues connected with using health-related rights have a sizable importance. My intervention is born of a research in progress, considering the "actual" access and use of health services by foreign women in Italy, within considerably different regional contexts because of their management, policies and the organization of health services (Campania and Tuscany). Such an action does also focus on the role the network of social and health services, as well as the entities of the so-called Third Sector (NGOs and the like) has had and still has within the network policies connected with the effective use of health-related rights by immigrant women. Considering an universalistic national health system and an inclusive law system concerning health and immigration, several barriers still exists in Italy against foreigners (these obstacles may concern administration and management, economy, law, communication and culture), and they are intertwined with prejudices, stereotypes and significant inequalities between the different contexts considered. Taking the current crisis into account as well, the recent welfare cuts risk putting the extent of the acquired rights in jeopardy.
This research will consider the aforementioned issues starting with a methodological and interpretive approach, itself typical of medical anthropology, integrated with an exam of relevant statistics and network analysis. Participative observation has been carried out within some health facilities; health professionals, officers of the aforementioned Third Sector and foreign immigrant women have been interviewed
Anna Isaacs (City, University of London) Nicola Burns Sara Macdonald Kate O'Donnell (Harvard University)
Paper short abstract:
A focused ethnography to explore perceptions of chronic disease risk and engagement with preventive health care by migrants from Sub Saharan Africa in Glasgow, Scotland. Critical theory will help to draw links between broader structural forces and health outcomes at the individual level.
Paper long abstract:
Preventive healthcare interventions are a central focus of public health efforts to reduce the prevalence of chronic diseases such as type II diabetes and cardiovascular disease. However, such programmes often focus excessively on individual-level behavioural determinants of health, which can increase health inequity since those with greater social, economic and cultural capital can utilise such programmes more effectively. For migrants, obstacles to engagement with such interventions may present at several levels (social, political, cultural and economic) and relate not only to healthcare access but also to the ways that chronic disease risk is perceived.
I am conducting a focused ethnography with migrants from Sub Saharan Africa living in Glasgow, Scotland, to explore perceptions around chronic disease risk and engagement with preventive healthcare. This involves a combination of participatory focus groups, 'go-along' and 'sit-down' semi-structured interviews, and photo elicitation, together with interviews with health care professionals.
My approach draws on theories of 'structural vulnerability' (Bourgois et al 2011) and 'risk environments' (Rhodes 2002) in the design and analysis of the fieldwork. This will allow for an exploration of how individual and cultural factors interact with wider political, social and economic contexts to shape migrants' health in Scotland and the power dynamics inherent in these interactions. A reconceptualisation of risk and risk perception should shift the focus from individual risk factors onto the broader determinants of illness risk, contributing to the development of preventive interventions that more comprehensively address how health behaviours are influenced and thus aid in reducing health inequity.
Laura Ferrero (University of Turin)
Paper short abstract:
A case study of 5 ethnic associations actively involved on health will be presented to discuss a form of community welfare in which associations can be described as health provider for their communities and migrants became more than service users, but also providers and defenders of the right to health
Paper long abstract:
Within the last two years a group of anthropologists, sociologists and jurists has been working on migrant's access to health services in the city of Turin, Italy. The research stressed the role that associations, ngos, third sector and charities play in the city as subjects active in the health sector for the most marginalized groups of citizens (e.g. alternative health services for undocumented migrants, information campaigns and mediation between migrants and the national health services).
A new subject of the civil society appeared in the Italian cities in the past few decades: migrants' associations. The role of migrants' associations in promoting health has not been studied in literature as still few of them worked directly and exclusively on health. Starting from the emerge of this new actor, my paper discusses the role that associations of foreigners can play in terms of health and welfare.
The role of five associations has been analysed to point out a form of community welfare in which associations can be described as health providers for their communities and migrants became more than services users, but also services providers. In order to describe migrants' associations commitment and to make the observations comparable with other contexts, the five associations' work was analysed from the stand point of human rights, with reference to the fundamental criteria identified by the Committee on Economic, Social and Cultural Rights through which migrants' associations were identified as means to access and accept services, as well as promoting health literacy.