Department of Sociology & Anthropology, Rochester Institute of Technology, College of Liberal Arts, 18 Lomb Memorial Drive, Rochester, NY, 14623-5604, USA.
Soc Sci Med. 2021 Feb;270:113676. doi: 10.1016/j.socscimed.2021.113676. Epub 2021 Jan 2.
Medical sociologists widely conceptualize illegality as a social determinant of health, implicating immigration law but not health care law in immigrant health disparities. Contributing to an emerging literature on legal violence in the context of health care, I explore how the Harris Health System in Houston, Texas legally affects low-income undocumented migrants' lives as they seek care. Drawing on eleven months of ethnographic and interview research with migrants and volunteers at a community-based organization, I argue that the health care system legally exacerbates migrant vulnerability in particular ways. Clerical staff follow medical protocol to deny migrants care on the basis of legibility (i.e., a photo ID), not legality (i.e., legal status), resulting in two classifications of illegality - what I term legible and illegible illegality. The former keeps migrants visible to the state but offers potential care, and the latter legally relegates migrants to the exploitative conditions of informal home care and/or a protracted state of suffering where, for many, death is the only recourse. This research shows that without substantive health reform, health practitioners - physicians, social workers, clerical staff, and home care workers - play an (in)direct role in shaping and normalizing immigrant health disparities.
医学社会学家广泛地将非法性视为健康的社会决定因素，将移民法而不是医疗保健法纳入移民健康差异的范畴。在医疗保健背景下，我探讨了德克萨斯州休斯顿哈里斯卫生系统如何以合法的方式影响寻求医疗服务的低收入无证移民的生活，以此为新兴的医疗保健法律暴力文献做出贡献。我利用与一个社区组织的移民和志愿者进行的为期十一个月的民族志和访谈研究，认为医疗保健系统以特定的方式加剧了移民的脆弱性。文书人员根据可识别性（即照片身份证）而不是合法性（即合法身份）遵循医疗协议拒绝为移民提供医疗服务，导致出现两种非法性分类——我称之为可识别和不可识别的非法性。前者使移民对国家可见并提供潜在的医疗服务，而后者则使移民在法律上被置于非正规家庭护理和/或长期痛苦的剥削性条件下，对许多人来说，死亡是唯一的出路。这项研究表明，在没有实质性的医疗改革的情况下，医疗从业者——医生、社会工作者、文书人员和家庭护理人员——在塑造和规范移民健康差异方面发挥着（间接）作用。
