Assistant Professor of Anthropology University of Washington-Seattle, Seattle, WA, USA.
Assistant Clinical Professor of Emergency Medicine Harbor-UCLA Medical Center Torrance, CA, USA.
Soc Sci Med. 2021 Jun;279:113967. doi: 10.1016/j.socscimed.2021.113967. Epub 2021 Apr 28.
Most existing approaches to border health focus on identifying the social determinants that produce ill health and health disparities among migrants, including language barriers, documentation status, and trauma associated with migration. Attention to these kinds of problems can lead to policy and clinical changes that indeed help improve quantitatively measurable outcomes for patients. However, these approaches usually ignore the larger historical and political framework that determines the determinants - the underlying infrastructure of ill health, or what we term the infrastructural determinants of health. In this paper, we outline specific infrastructures involving race, political economy, history, and most importantly, borders themselves, that lay the foundations for border illness. We examine the plans, histories, policies, and peoples involved in building the conditions for migration, particularly out of the Northern Triangle, including forces of colonialism, US imperialism, neoliberalism, and border militarization. In place of a tacit acceptance of the modern system of borders, we argue for border abolition as a vital but underused treatment in the repertoire of medical intervention. Outlining the rights of people to stay and to move, and drawing on lessons from the prison abolition movement, we offer policies and practices towards a 'no borders' system that privileges liberatory solidarity with migrants by explicitly challenging global infrastructures that drive displacement. In doing so, we offer an emergent framework for a medical border abolition that treats both the causes and symptoms of a widespread global sickness.
大多数现有的边境健康方法都侧重于确定导致移民健康状况不佳和健康差异的社会决定因素，包括语言障碍、文件状况和与移民相关的创伤。关注这些问题可以导致政策和临床的改变，从而确实有助于改善患者可量化的结果。然而，这些方法通常忽略了决定这些决定因素的更大的历史和政治框架——即健康的潜在基础设施，或者我们称之为健康的基础设施决定因素。在本文中，我们概述了涉及种族、政治经济、历史，最重要的是边境本身的具体基础设施，这些基础设施为边境疾病奠定了基础。我们研究了为移民创造条件，特别是从“北方三角”（中美洲北部的三个国家：危地马拉、洪都拉斯、萨尔瓦多）移民创造条件所涉及的计划、历史、政策和人民，包括殖民主义、美国帝国主义、新自由主义和边境军事化的力量。我们反对默许接受现代边界体系，而是主张废除边界，将其作为医学干预手段中一个重要但未被充分利用的治疗方法。我们概述了人们停留和迁移的权利，并借鉴了监狱废除运动的经验教训，提出了一种“无边界”系统的政策和实践，通过明确挑战推动流离失所的全球基础设施，优先考虑与移民的解放性团结。通过这样做，我们为医学边界废除提供了一个新兴框架，既治疗了广泛的全球疾病的病因，也治疗了其症状。
