When deservingness policies converge: US immigration enforcement, health reform and patient dumping

Extra/ordinary medicine: Toward an anthropology of primary care

Primary care is at the forefront of healthcare delivery. It is the site of disease prevention and health management and serves as the bridge between communities and the health care system As ethnographers of primary care, in this article we discuss what is gained by situating anthropological inquiry within primary care. We articulate how anthropologists can contribute to a better understanding of the issues that emerge in primary care. We provide a review of anthropological work in primary care and offer empirical data from two ethnographic case studies based in the United States, one focused on social risk screening in primary care and the other examining the diagnosis and care of people with dementia in primary care. Through these cases, we demonstrate how research of and within primary care can open important avenues for the study of the multidimensionality of primary care. This multidimensionality is apparent in the ways the medical field addresses the social and structural experiences of patients, scope of practice and disciplinary boundaries, and the intersection of ordinary and extraordinary medicine that emerge in the care of patients in primary care.

Communicating effectively with inclusion health populations: 2022 ICCH symposium

OBJECTIVE

To describe communication strategies for clinical practice that allow practitioners to work more effectively with marginalised population groups and to discuss how to incorporate these into medical practice.

METHODS

Active practitioners working in inclusion health and people with lived experience of homelessness and the asylum-seeking process shared their perspectives in the symposium at the 2022 International Conference on Communication in Healthcare (ICCH) and a subsequent conference on empathy in healthcare. The views of attendees were sought.

SYMPOSIUM DISCUSSION

We describe the perspectives shared at the symposia under two main themes: communication needs in people experiencing homelessness and migrant populations, and trauma-informed practice.

CONCLUSIONS

People experiencing homelessness have more communication challenges compared to the general adult population. Migrant, refugee, and asylum-seeking populations also face the complexity of negotiating unfamiliar healthcare, legal and social systems with the added burden of language barriers. Trauma-informed practice provides a useful framework that can improve communication with these groups.

The work of reform: a critical examination of health policy

Anthropologists have critically examined a range of reforms from education and land to finance and health. Yet the predominant way of looking at reforms has been through a lens focused on neoliberal governance. For example, prior studies of health reforms focus on insurance, financing, and access to care. Yet, seeing reform in this way fails to attend to other types of cultural work at play when calling a policy or law a reform. In this paper, we draw on ethnographic research on health policy reforms in Israel and Bolivia to examine the concept of reform and the work it does within national movements. We argue that while the language of reform often signals change or novelty, reforms also carry forward historical continuities and reifications of the past. By delving into the past and its relationship with ongoing health reforms, we attend to how reforms can reinforce and maintain health inequities in some cases, while creating a national language for new possibilities in others. Reform, as we will discuss in this paper, is not only about political ideology, neoliberal governance, or on-the-ground policy implementation, but centrally it is about representations of aspirations, and about crafting relationships between past, present, and future.

Responding to "Don't Say Gay" Laws in the US: Research Priorities and Considerations for Health Equity

INTRODUCTION

Despite increased legal rights for lesbian, gay, bisexual, transgender, and queer-identifying (LGBTQ +) people in the USA over the past 30 years, there has been an increasing number of anti-LGBTQ + laws proposed and passed at the state level. One of the most notorious laws, Florida's HB 1557, also known as the "Don't Say Gay" law, garnered substantial national attention for prohibiting discussions of sexual orientation or gender identity in public school classrooms. Other states quickly proposed similar laws, but little scholarship exists on the potential impacts of these laws.

METHODS

We explore the potential health equity ramifications of laws like Florida's HB 1557, focusing on the individual, interpersonal, and broader policy and practice implications. Examining these policies through the lens of political determinants of health, we identify theoretical and methodological approaches needed to address recent "Don't Say Gay" policies.

RESULTS

Theoretical approaches emphasizing power, intersectionality, and the role of politics in health should guide research examining the impacts of recent anti-LGBTQ + policies. Laws like Florida's HB 1557 emphasize the need for methodological approaches that emphasize collaborative engagement between researchers and community members, and future research may be needed to understand how stressors created by law and policy can have individual and interpersonal consequences.

CONCLUSIONS

Public health researchers have a role to play in reversing policies that negatively affect LGBTQ + individuals and undermine health equity. Research combating harmful policies may require theoretical approaches attentive to power differences and methodological approaches that squarely focus on disrupting power imbalances.

Health and immigration systems as an ethnographic field: Methodological lessons from examining immigration enforcement and health in the US

The complexity of health systems and their social, political, and economic contexts has resulted in a call for multidisciplinary research that can appropriately examine the relationships and interactions surrounding health systems. Anthropologists, who have a disciplinary training that emphasizes social structures and human relationships, are well-suited to conduct health systems research. However, there remains a gap in anthropologically-ground methodological approaches for conducting in-depth, qualitative research that simultaneously conceptualizes and maps out a health system and examines connections between health systems and other social structures, such as immigration enforcement systems. Without such methodological approaches, limitations in examining a health system and its constituent elements will persist, and health and social scientists will miss opportunities to identify links between different factors in a health system and outside the system itself. In this article, I use ethnographic research examining the health-related consequences of immigration enforcement laws and police practices in the United States to show how to examine relationships between multiple social systems. In doing so, I provide an example for how to conduct in-depth, qualitative health systems research by merging theoretical frameworks in health sciences and anthropology to demonstrate how medical anthropologists can conceptualize a health system as a social field for ethnographic inquiry. Overall, I argue that such an approach permits anthropologists a way to conduct rigorous health systems research that emphasizes relationships and reveals potentially hidden interactions.

Laws and Policies Related to the Health of US Immigrants: A Policy Scan

Objectives

We conducted a policy scan of state and local laws and policies across the United States related to social determinants of health among immigrants.

Methods

We collected all state and municipal laws and policies in 10 domains that had potential to affect immigrant health from all 50 U.S. states and the 30 most populous U.S. metropolitan statistical areas. We coded these laws and policies and created an index of restrictiveness and supportiveness of immigrants.

Results

We identified 539 state and 322 municipal laws and policies. The most common restrictive state laws and policies were in the domains of identification requirements and driver's license access. The most common supportive state laws and policies were in the domains of health services and higher education access. The most common restrictive municipal laws and policies were in the domains of identification requirements and immigration policy enforcement. The most common supportive municipal laws and policies were in the domains of immigration policy enforcement and health services access.

Conclusions

Most states had index scores reflecting policy environments that were primarily restrictive of immigrants, indicating potential negative impacts on social determinants of health. Further research examining the impact of these on health behaviors is warranted.