Lyman Briggs College, Michigan State University, USA.
Soc Sci Med. 2024 May;348:116822. doi: 10.1016/j.socscimed.2024.116822. Epub 2024 Mar 27.
A growing body of scholarship examines the varying impact of legal status and race on accessing healthcare. However, a notable gap persists in comprehending the supplementary mechanisms that hinder immigrants' pathway to seek care. Drawing on ethnographic observations in various clinical settings and in-depth interviews with 28 healthcare professionals and 12 documented Haitian immigrants in a city in Upstate New York, between 2019 and 2021, I demonstrate the tension between the conceptualization and implementation of inclusive care practices by healthcare providers. I argue that the mere expansion and adoption of inclusive discourse among providers do not inherently ensure equity and the removal of barriers to healthcare access. This work contributes to the social study of medicine and race and ethnic studies by introducing the innovative concept of "immigrant-blind." Through this concept, the research sheds light on how providers' conceptualization of inclusivity proclaims medical encounters to be devoid of stratifications and rationalizes their practices which mask the profound impact of immigration status and immigration on immigrant health. Furthermore, these practices reinforce existing divisions within care settings and medical encounters, where immigration laws and enforcement practices operate and further exacerbate stratifications. By examining providers' uninformed implementation of culturally competent care practices, the findings reveal that providers stigmatize and essentialize immigrants during medical encounters. This highlights the imperative for a more nuanced and informed approach to healthcare provision, where genuine inclusivity is upheld, and barriers to access are dismantled to foster equitable and dignified healthcare experiences for all.
越来越多的学术研究考察了法律地位和种族对获得医疗保健的不同影响。然而,对于理解阻碍移民寻求医疗保健的补充机制,仍然存在明显的差距。本研究通过在纽约州北部一个城市的各种临床环境中的民族志观察和对 28 名医疗保健专业人员和 12 名有记录的海地移民的深入访谈,从 2019 年到 2021 年,我展示了医疗保健提供者在实施包容性护理实践方面的概念化和实施之间的紧张关系。我认为,提供者之间包容性话语的扩展和采用本身并不能确保公平性,也不能消除获得医疗保健的障碍。这项工作通过引入“移民盲目”这一创新概念,为医学和种族与民族研究的社会研究做出了贡献。通过这个概念,研究揭示了提供者对包容性的概念化如何宣称医疗接触没有分层,并为他们的实践提供了合理化,这些实践掩盖了移民身份和移民对移民健康的深远影响。此外,这些实践在医疗保健环境中强化了现有的分层,在这些环境中,移民法和执法实践在起作用,并进一步加剧了分层。通过检查提供者在实施文化上胜任的护理实践方面的不知情实施,研究结果表明,提供者在医疗接触中对移民进行污名化和本质化。这凸显了在医疗保健提供方面采取更细致入微和知情的方法的必要性,坚持真正的包容性,并消除获得医疗保健的障碍,以促进所有人获得公平和有尊严的医疗保健体验。