American Arrivals: Anthropology Engages the New Immigration

7. Immigration and Medical Anthropology

Immigrants trying to negotiate the US medical system give testimony to the truth in Virchow’s famous declaration, “All medicine is politics.” Viewing immigrants as outsiders who are simultaneously insiders, the larger society often questions their use of medical and other social services. The issue of medical services for immigrants and citizens alike, at least in the United States, is open to such debate because there is no guaranteed “right” to medical care. Even though citizens may feel an entitlement to medical care, many are unwilling to grant this to immigrants. As a consequence, immigrants seeking medical care face restrictive policies, financial tests, and citizenship requirements . Moreover, immigrants often enter the labor force at the bottom, where low incomes, lack of medical insurance, and little available time present obstacles to their use of medical services. In short, immigrants are disadvantageously embedded in a political economy of health care characterized by pervasive structural inequalities (Farmer 1999; Morsey 1996; Whiteford 1996). It is a challenge for anthropologists, particularly those taking a critical approach (Lock and Scheper-Hughes 1996), to explore the influence of culture on immigrants’ use of US medical 197 7 Immigration and Medical Anthropology Leo R. Chavez 197 services without minimizing the tremendous role these structural factors play in the lives of immigrants. This chapter highlights several important problems that occur when immigrants interact with the US medical system (also see Hirsch, Chapter 8). I will draw on my own research and that of others for examples of issues that arise from the confrontation of immigrants’ cultural beliefs with the receiving society ’s medical beliefs and practices, the stigma of disease when associated with particular immigrant groups, structural obstacles faced by immigrants seeking medical care, and the limitations of interventions at the individual instead of societal level. Anthropological interest in immigration is both old and new. Franz Boas, the totemic ancestor of American anthropology, provided a classic example of anthropological research countering public representations of and taken-for-granted assumptions about immigrant characteristics. His research on Southern and Eastern European immigrants in the early twentieth century directly challenged existing scienti fic and commonsense assertions about the link between immigrants’ physical/bodily structures and shapes and their moral and intellectual potential. Using the methods popular at the time, Boas measured the heads of immigrants’ children (an example of the “second generation” study so in vogue in immigration research today) and compared them with the immigrants’ measurements. He found that the second generation did not resemble the immigrant generation in head shape. As Kraut has noted, “Boas concluded that nutrition and other aspects of living conditions determined these ‘racial characteristics’ more than heredity” (Boas 1911a; Kraut 1994). A few years later, in the 1920s, the Mexican anthropologist Manuel Gamio carried out investigations into the life and working conditions of Mexicans in the United States (Gamio 1930, 1931). The poignant narratives he collected from Mexican workers provide compelling evidence for the harsh, unhealthy working conditions they endured and the social and political barriers to integration they encountered. (See Chavez [1992] for a discussion of contemporary living and working conditions for farm workers in Southern California. See also Goldsmith [1989]). Despite these early examples of interest in immigration, anthropological research on immigration waned, perhaps because of the massive reduction in immigration during the Great Depression and World War Leo R. Chavez 198 II (Pedraza 1996). Just as influential was anthropology’s professional identification as the science of the Other (read “primitive,” “less technologically advanced,” “less complex political organization”), of nonWestern cultures and societies that had to be “salvaged” before they passed away as a result of the putative, homogenizing march of modernity . An anthropological interest in immigrants returned in the latter decades of the twentieth century, corresponding to worldwide increases in the transnational movements of refugees and people seeking economic opportunities (Brettell and Hollifield, eds. 2000). In the United States, immigration flows have increased steadily since the mid-1960s, reaching about one million legal and undocumented immigrants a year by the end of the twentieth century and into the early twenty-first century (Pedraza 1996). The movement of people has not affected only the United States; it has had global repercussions (Castles and Miller 1998). Immigration has given anthropologists a window into the ramifications of people’s crossing national borders. As the world experiences what has become glossed under the concepts of globalization and transnationalism, anthropologists, and...