Society and Environment, Medical Anthropology, and Public Health, University of California Berkeley, Berkeley, California, USA
Humanities and Social Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA.
BMJ Glob Health. 2021 Apr;6(Suppl 1). doi: 10.1136/bmjgh-2021-005107.
This article brings the social science concept of 'deservingness' to bear on clinical cases of transnational migrant patients. Based on the authors' medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.
本文将“应得”这一社会科学概念应用于跨国移民患者的临床病例。基于作者在非洲、欧洲和美洲多个地点的医学社会科学研究、医疗服务实践和临床工作，本文描述了三个临床案例，其中“应得”的假设对移民患者的发病率和死亡率有重大影响。“应得”这一概念使我们能够保持对以下假设的批判性认识：哪些类别的患者更值得获得医疗保健和高质量的医疗保健，而不论其正式的法律资格如何。许多法律地位模糊的跨国移民依靠公共医疗保健，但由于医疗诊所工作人员、临床医生和医疗系统规划者所持有的“应得”观念，他们可能会被排除在医疗保健之外，或受到较差的待遇。本文为临床医生、医疗专业教育、决策和宣传提出了几点启示。对“应得”的批判性认识可以帮助全球卫生专业人员、系统和政策制定者应对和改变移民患者获得医疗保健机会不平等和医疗质量差异的固有模式。通过这种方式，卫生专业人员可以更有效地为全球卫生公平而努力。
