Citation

Van Natta M. Soc. Sci. Med. (1982) 2019; 235: e112411.

Affiliation

University of California, Department of Social and Behavioral Sciences, 3333 California Street, Suite 455, San Francisco, CA, 94143-0612, USA.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.socscimed.2019.112411

PMID

31319233

Abstract

Contemporary U.S. health and immigration policies exclude millions of noncitizens from healthcare coverage. Growing scholarship emphasizes legal status as a technology of social exclusion and determinant of health, but few studies capture the effects of recent policy uncertainty on noncitizen health. By examining the case of Coral County (a pseudonym), I highlight the challenges facing safety-net clinics and their noncitizen patients making life and death decisions amidst uncertainty before and after the 2016 presidential election. Observational and interview data with patients, clinic workers, and community partners (n = 27) revealed that growing anxiety over federal immigration policies altered clinical risk calculations through a process I refer to as "medical legal violence" (MLV). Whereas previous risk negotiation strategies leveraged bureaucratic routines to elevate imminent threats of illness and/or injury in health decisions, heightened immigration enforcement under the Trump administration shifted the balance in clinical risk calculations toward social risks of detention, deportation, and family separation. This transformed clinical care in Coral County by turning trusted medical-legal bureaucracies into potential tools for federal biopolitical surveillance of immigrant patients, blocking healthcare pathways and increasing patients' fear and anxiety.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Biopolitics; Health inequalities; Immigration status; Legal violence; Medicaid; Safety-net clinics; Social determinants of health; United States