The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social ...determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.
Immigration as a Social Determinant of Health Castañeda, Heide; Holmes, Seth M; Madrigal, Daniel S ...
Annual review of public health,
03/2015, Volume:
36, Issue:
1
Journal Article
Peer reviewed
Open access
Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this ...area. Global patterns of morbidity and mortality follow inequities rooted in societal, political, and economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena-social determinants of health and immigration-has resulted in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
Latino immigrants in the United States constitute a paradigmatic case of a population group subject to structural violence. Their subordinated location in the global economy and their culturally ...depreciated status in the United States are exacerbated by legal persecution. Medical Anthropology, Volume 30, Numbers 4 and 5, include a series of ethnographic analyses of the processes that render undocumented Latino immigrants structurally vulnerable to ill health. We hope to extend the social science concept of "structural vulnerability" to make it a useful concept for health care. Defined as a positionality that imposes physical/emotional suffering on specific population groups and individuals in patterned ways, structural vulnerability is a product of class-based economic exploitation and cultural, gender/sexual, and racialized discrimination, as well as complementary processes of depreciated subjectivity formation. A good-enough medicalized recognition of the condition of structural vulnerability offers a tool for developing practical therapeutic resources. It also facilitates political alternatives to the punitive neoliberal policies and discourses of individual unworthiness that have become increasingly dominant in the United States since the 1980s.
Based on the authors’ work in Latin America and Africa, this article describes and applies the concept ‘structural vulnerability’ to the challenges of clinical care and healthcare advocacy for ...migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA–Mexico border and another in Djibouti. Migrants’ and providers’ various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.
Desde hace una década, varios autores anglófonos, centrados principalmente en el análisis e intervención de los procesos de determinación social de la salud de los migrantes, forjaron el concepto de ...vulnerabilidad estructural, como una forma de combatir el individualismo, el biologismo, la invisibilización de los procesos de determinación estructural y la culpabilización de las víctimas. Siendo parte de las contribuciones históricas de la medicina social, los actuales desarrollos de la aproximación sobre la vulnerabilidad estructural han quedado desconectadas de las discusiones del movimiento de la salud colectiva y la medicina social latinoamericana en general, entre otras razones, por las barreras lingüísticas asociadas a la escasez de sus publicaciones en español. La presente entrevista, realizada a dos de sus principales representantes, indaga los orígenes históricos de dicha aproximación y busca explorar las contribuciones específicas que hoy está realizando, como una forma de acercarlas a los lectores de habla hispana, favoreciendo el diálogo con las propuestas de medicina social latinoamericanas.
California urban and agricultural centers rely heavily on Latino migrant laborers, regardless of their legal documented status. In the delivery of social services, and in the mass media, popular ...consciousness, and formal legal understandings and arrangements, Latino laborers are viewed as either legitimate voluntary low-wage workers or illegitimate undocumented workers not entitled to the same civil rights as US citizens. Their de facto second-class status becomes a central component of their social identity, with the structural conditions of their lives internalized, resulting in limited agency and poor social and health outcomes. The lived experience of structural vulnerability prefigures the actions and efforts of undocumented Latino contingent workers. In this article, the capacity for Latino laborers to maneuver and negotiate the travails of everyday life is explored.
...the article developing the social science concept of flourishing emphasises how clinical settings can move beyond the biological confines of disease to facilitate healing for unauthorised ...migrants. Collaborators The Migration and Health in Social Context Working Group: John Fredrik Askjer (University of Oslo), Lauren Carruth (American University), Ernesto Castañeda (American University), Heide Castañeda (University of South Florida), Shahanoor Akter Chowdhury (NextSkills Consulting, Dhaka, Bangladesh), Yusupha Dibba (Partners in Health Sierra Leone), Katharine M. Donato (Georgetown University), Raphael Frankfurter (University of California Berkeley and San Francisco), Jérémy Geeraert (Humboldt University Berlin and Centre Marc Bloch), Anne Kveim Lie (University of Oslo), Miriam Magaña Lopez (University of California Berkeley), Carlos Martinez (University of California Berkeley and San Francisco), Carlos Piñones-Rivera (Universidad Arturo Prat), Ursula Probst (Freie Universität Berlin), James Quesada (San Francisco State University), Nasima Selim (Freie Universität Berlin), Lahra Smith (Georgetown University), Sarah S. Willen (University of Connecticut), Nina Zeldes (Freie Universität Berlin), Hansjörg Dilger (Freie Universität Berlin). World Health organization and international bank for reconstruction and development / the world bank. tracking universal health coverage: 2017 global monitoring report, 2017.
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