Written by: Heide Castañeda
This book offers a radical rethinking of the field by unsettling conventional ideas of mobility and borders to highlight the ways in which they produce health inequalities. Covering a wide range of topics, the text provides insight through a critical lens, and proposes areas for intervention along with an added emphasis on the need for future research to address the health inequities that affect migrants. It illustrates how a critical perspective can deepen our understanding of the relationship between migration and health, which remains a defining global issue of our century.
The text employs a critical approach to examine the structural conditions of inequality and larger historical and political processes, recognizing that exclusionary bordering practices increasingly occur away from physical points of entry. It posits the concept of migration as complex, tangled and multi-directional and underscores how migrant vulnerability can shape the lives of people in wider communities. Furthermore, it acknowledges diverse and intersectional standpoints, as well as shifting spatial and temporal influences. Chapters include coverage of health in transit; healthcare access and utilization; clinical encounters; communicable disease; labor and occupational health; gender and sexuality; immigration enforcement, detention, deportation; and the effects of forced displacement on refugee and asylum-seeker health.
Reviewed by: Chrysovalantis Papathanasiou
Although migration is a common phenomenon during human history, we are currently witnessing the highest-ever recorded number of international migrants. According to the statistics of IOM and UNHCR, 281 million people were estimated to be international migrants at mid-year 2020 and 108.4 million forcibly displaced worldwide at the end of 2022. One of the most important dimensions of migration is health. The rapid growth of population mobility in a globalized context, the heterogeneity characterizing these populations, and the diversity of their health needs, pose a major challenge to public health policies and systems. The protection of migrants’ health must be a high priority of the public health agenda as it has benefits for all the population regardless of their status (natives and foreigners).
Heide Castañeda in her book Migration and Health: Critical Perspectives, calls for a revision of the notions “migration” and “mobility”, exploring the genesis of health disparities and inequalities. The book covers a wide range of issues related to migrants’ health. It provides insights on crucial topics, such as the construction of the discourse on migration and health, as well the ways that the institutions marginalize and exclude the mobile populations. Castañeda, from a critical point of view, rejects the binary oppositions (citizens/foreigners, insiders/outsiders, health/illness, biological/social), proposes a broader understanding of “borders”, takes in consideration influential social factors (i.e., gender, sexual orientation, race, and ethnicity), and re-examines spatialities and temporalities associated with migration. She explores the impact of dominant ideologies, institutional constraints, and social pathogenic phenomena (poverty, violence, etc.) on disparities, risk, access, treatment, and outcomes. The author invites us to rethink our views about migration (colonizing, hegemonic, and even racist assumptions) and to realize that globalization and colonialism process displaces people and shapes their lived experiences in host countries (e.g., unemployment or dangerous jobs, precarious living conditions, non-access to goods and services, etc.).
Castañeda brings up methodological issues for discussion in migration studies. According to her, the tendency to naturalize the global regime of nation-states (the so-called “methodological nationalism”) as the sole site of social processes is problematic, especially during times of nationalism, xenophobia, and racism. She argues that “in our current global system, there is no stabile epistemic partition between ‘here’ and ‘there’” (p. 6), and migrants are not persons who demonstrate a kind of “spatial disobedience”. She also emphasizes that our knowledge about “migration” is composed of summarizing merger data coming from multiple disciplines which use different methodologies. She proposes life-course and multinational approaches to understanding migrant health.
The book consists of eleven chapters, with each one of these covering a conceptual area. The first and the last chapters are the introduction and the conclusion respectively. Chapter 2 examines some important conceptual and terminological considerations. Chapter 3 attempts to understand health in transit and analyses the influential factors, such as violence of border controls, “stuckness” in refugee camps and detention centers, smuggling and trafficking, etc. In Chapter 4 and Chapter 5 the author explores migrants’ health issues in macro- (health systems and policies) and micro-level (patient-provider encounter) respectively. Three communicable diseases –tuberculosis, HIV, and covid-19– are used as means to illustrate in chapter 6 the social representations of migrants as diseased “others”, resulting in persistent stigma. Chapter 7 focuses on occupational health and specifically on the health hazards that are linked with the types of work (known as 3D-jobs: dirty, demanding, and dangerous) that migrants have access to in host countries. In Chapter 8, Heide Castañeda explores the issues of gender, sexuality, parenting, and family and how a hostile public discourse is constructed around the concept of “reproduction” (i.e., fear of loss of national identity). Health impacts of immigration enforcement, detention, and deportation is the subject of Chapter 9. Finally, Chapter 10 is dedicated to refugee health and examines the complex relationship between governments and health care institutions.
The main characteristic of the book is the adoption of a critical perspective. The author approaches migrant health within the historical, social, and cultural contexts. She highlights structural and systemic factors that influence migrants’ health status, beyond behavioral and intrapersonal elements. Although social determinants of health regarding migration have generated social scientists’ interest and have been adequately explored, Castañeda brings understudied factors such as the militarization of the boarders, enforcement, detention, and deportation as health risks to our attention.
The author attempts to approach most of the issues that are related to the core theme, in order to provide the reader with a broad picture of an extensive subject matter. Thus, she deals with terminological considerations (i.e., Who is migrant?) as well as with conceptual areas, such as occupational and reproductive health. The wide array of factors discussed, has led to a limited analysis of important issues such as mental health, that could have been presented as a separate chapter, is however presented in a few paragraphs. Nevertheless, the writing strategy Castañeda has adopted (vignette – question – critical perspective) facilitates understanding of the conceptual area presented in each chapter, despite the density of information.
Overall, the book seeks to fill a void in the literature concerning migrant health, offering crucial insights into the structural determinants as “root causes” of health inequities. It serves as an important resource for both experts and lay readers. Its broad range of topics can be of interest to social scientists, policy makers, and clinicians. It can also be useful for field workers in the humanitarian aid sector.
About the reviewer
Dr Chrysovalantis Papathanasiou holds a PhD in Social Psychology of Health from the Aix-Marseille University and a Master’s degree in Sociology of Health from the Ecole des Hautes Etudes en Sciences Sociales in Paris, France. He used to be Deputy Manager of the General University Hospital of Patras and President of the National Center for Social Solidarity (EKKA) in Greece. He represented Greece in the working groups for “AIDS & Mobility”, an EU programme for HIV prevention among mobile populations. Currently, he is the head of the largest programme of mental health care for refugees and asylum seekers in Greece, implemented by the Association for Regional Development and Mental Health (EPAPSY) in partnership with UNHCR, the UN Refugee Agency. His research interests focus, among others, on the health and mental health of refugees/asylum seekers, migrants, and other mobile populations. His research has been published in peer review journals and has been presented in several European and international conferences.
Panteion University of Social and Political Sciences, Athens, Greece