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Deservingness: migration and health in social context
  1. Seth M Holmes1,2,3,
  2. Ernesto Castañeda4,
  3. Jeremy Geeraert5,
  4. Heide Castaneda6,
  5. Ursula Probst7,
  6. Nina Zeldes7,
  7. Sarah S Willen8,
  8. Yusupha Dibba9,
  9. Raphael Frankfurter10,11,
  10. Anne Kveim Lie12,
  11. John Fredrik Askjer12,
  12. Heidi Fjeld12
  13. On behalf of the Migration and Health in Social Context Working Group
  1. 1Society and Environment, Medical Anthropology, and Public Health, University of California Berkeley, Berkeley, California, USA
  2. 2Humanities and Social Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
  3. 3Paoli Calmettes Chair, IMéRA Mediterranean Institute for Advanced Study, Marseille, France
  4. 4Sociology, American University, Washington, DC, USA
  5. 5European Ethnology, Humboldt University of Berlin, Berlin, Germany
  6. 6Anthropology, University of South Florida, Tampa, Florida, USA
  7. 7Institute for Social and Cultural Anthropology, Free University of Berlin, Berlin, Germany
  8. 8Anthropology, University of Connecticut, Storrs, Connecticut, USA
  9. 9Partners in Health, Freetown, Sierra Leone
  10. 10School of Medicine, University of California San Francisco, San Francisco, California, USA
  11. 11Medical Anthropology, University of California Berkeley, Berkeley, California, USA
  12. 12Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Seth M Holmes; sethmholmes{at}berkeley.edu

Abstract

This article brings the social science concept of ‘deservingness’ to bear on clinical cases of transnational migrant patients. Based on the authors’ medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.

  • public health
  • health policies and all other topics
  • health systems
  • treatment
  • qualitative study

Data availability statement

All data relevant to the study are included in the article.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2021-005107

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    Data availability statement

    All data relevant to the study are included in the article.

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    Footnotes

    • Guest Chief Editor Emily Mendenhall and Seth M. Holmes.

    • Twitter @sarahwillen

    • Presented at This article is submitted as part of the BMJ Global Health “Migration and Health in Social Context” collection edited by Emily Mendenhall and Seth M. Holmes.

    • Collaborators The Migration and Health in Social Context Working Group, including the co-authors and: Lauren Carruth, American University; Shahanoor Akter Chowdhury, NextSkills Consulting, Dhaka, Bangladesh; Hansjörg Dilger, Freie Universität Berlin; Katharine M. Donato, Walsh School of Foreign Service, Georgetown University; Miriam Magaña Lopez, University of California Berkeley; Carlos Martinez, University of California Berkeley; Emily Mendenhall, Walsh School of Foreign Service, Georgetown University; Carlos Piñones-Rivera, Universidad Arturo Prat; James Quesada, San Francisco State University; Nasima Selim, Freie Universität Berlin; Lahra Smith, Walsh School of Foreign Service, Georgetown University; Sarah S. Willen, University of Connecticut.

    • Contributors All authors contributed to and approved the submission of this manuscript.

    • Funding The writing of this article was funded by the Deutscher Akademischer Austauschdienst (DAAD), the Global Futures Initiative (Georgetown University), the Berkeley Center for Social Medicine (UC Berkeley), the Peder Sather Center for Advanced Study, and the Paoli Calmettes Institute Chair IMéRA Mediterranean Institute for Advanced Study.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; internally peer reviewed.