Elsevier

Social Science & Medicine

Volume 75, Issue 12, December 2012, Pages 2099-2106
Social Science & Medicine

Review
More than culture: Structural racism, intersectionality theory, and immigrant health

https://doi.org/10.1016/j.socscimed.2011.12.037Get rights and content

Abstract

Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics’ main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants’ experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health.

Highlights

► Cultural explanations for immigrant health outcomes obscure the impact of structural factors on immigrant health. ► A stronger emphasis on how place, racialization processes, and immigration policies impact immigrant health is necessary. ► We recommend an intersectional approach to the study of immigrant health. ► We suggest specific lines of inquiry regarding immigrants' experiences with racism and anti-immigrant policies, and their health impact. ► Interpreting available immigration-related measures requires fuller theorizing as to their context-specific meaning.

Introduction

Beyond selectivity and methodological explanations for immigrant health patterns in the United States, scholars often invoke culture to explain these patterns. We contend that cultural explanations mask the effects of social inequalities on immigrant health outcomes, and argue for a shift from individual culture-based frameworks to perspectives that consider the role of structural factors in producing health inequalities among immigrants. In particular, we propose that a richer understanding of the social determinants of immigrant health requires an intersectional approach—one that considers the simultaneous and mutually constitutive effects of the multiple social categories “of identity, difference, and disadvantage” that individuals inhabit (Cole, 2009, p. 171; Crenshaw, 1991). To these ends, we first highlight key shortcomings of cultural explanations as currently employed in much of the immigrant health literature. We then discuss intersectionality theory and review research that examines two intersecting social categories: race and immigrant status. We build on our review of this literature to suggest specific lines of inquiry regarding immigrants’ experiences with day-to-day discrimination, as well as the roles that place and immigration policies play in shaping immigrant health outcomes. We conclude with suggestions for how to better integrate intersectionality theory in future research on immigrant health.

Section snippets

The limits of cultural explanations for immigrant health outcomes

Cultural explanations for immigrant health outcomes in the United States typically propose that culture influences social norms and individual health behaviors—such as, smoking, drinking, and dietary patterns—to impact health outcomes (Lara, Gamboa, Kahramanian, Morales, & Hayes Bautista, 2005). At the core of these explanations lies the assumption that, as immigrants shed cultural characteristics presumably associated with their country of origin and adopt those of the receiving society, their

Intersectionality, immigration, and health

Intersectionality theory has its roots in the writings of U.S. Black feminists who challenged the notion of a universal gendered experience and argued that Black women’s experiences were also shaped by race and class (Collins, 1990, Davis, 1981). Contrary to articulating gender, race, and class as distinct social categories, intersectionality postulates that these systems of oppression are mutually constituted and work together to produce inequality (Cole, 2009, Collins, 1990, Crenshaw, 1991,

Racism, immigration, and health

Scholars examining the social determinants of health have long stressed racism’s central role in the production of health inequalities (Williams & Collins, 1995). Racism reliably produces and reproduces social and economic inequities along racial and ethnic lines, and, as such, it is a fundamental cause of disease (Link & Phelan, 1995), which intersects with other forms of oppression and marginalization to influence the health of immigrants. Scholarship in this area has highlighted multiple

Residential segregation, immigration, and health

Abundant evidence has revealed that residential segregation, through its attendant concentration of poverty, lack of resources, and exposure to environmental risk factors, affects physical and mental health, as well as access to care (Acevedo-García, 2000, Acevedo-García et al., 2003, Echeverría et al., 2008, Gaskin et al., 2009, Gresenz et al., 2009, Kirby and Kaneda, 2005, Mair et al., 2008, Pickett and Pearl, 2001, Prentice, 2006, Williams and Collins, 2001, Williams and Sternthal, 2010).

Immigration policy as health policy

From a social determinants of health perspective, it is generally acknowledged that social and economic policies are synonymous with health policy (House, Schoeni, Kaplan, & Pollack, 2008). However, with the exception of their effect on immigrant access to health care, the health implications of immigration policies have received considerably less attention (Gee & Ford, 2011; Hester, personal communication).

Historically, immigration policies have served to reproduce ideologies that define

Conclusion

In this paper, we have argued that a richer understanding of immigrant health patterns requires a shift in focus from individual-level cultural explanations to research that provides a broader, more in-depth analysis of racism as a structural factor that intersects with other dimensions of inequality, such as gender and class, to impact immigrant health outcomes. This shift is necessary because explanations that “place the onus of culture on the individual… are likely to lead to

Acknowledgments

This research was supported by the Research Board at the University of Illinois at Urbana-Champaign (to E. Viruell-Fuentes). The authors are members of Place, Migration, and Health: A Cross-National Research Network (PMH); PMH has been supported by the David Rockefeller Center for Latin American Studies at Harvard University, the Robert Wood Johnson Foundation, and the Center for the Advancement of Health. We thank the journal’s anonymous reviewers for their feedback and suggestions, as well as

References (113)

  • T.L. Osypuk et al.

    Are immigrant enclaves healthy places to live? The Multi-Ethnic Study of Atherosclerosis

    Social Science & Medicine

    (2009)
  • Y. Park et al.

    Place of birth, duration of residence, neighborhood immigrant composition and body mass index in New York City

    The International Journal of Behavioral Nutrition and Physical Activity

    (2008)
  • J.C. Prentice

    Neighborhood effects on primary care access in Los Angeles

    Social Science & Medicine

    (2006)
  • L. Rosenthal et al.

    Explaining racial disparities in adverse birth outcomes: unique sources of stress for Black American women

    Social Science & Medicine

    (2011)
  • E.A. Viruell-Fuentes

    Beyond acculturation: immigration, discrimination, and health research among Mexicans in the United States

    Social Science & Medicine

    (2007)
  • D. Acevedo-García et al.

    Latino health paradoxes: empirical evidence, explanations, future research, and implications

  • D. Acevedo-García et al.

    Future directions in residential segregation and health research: a multilevel approach

    American Journal of Public Health

    (2003)
  • F.C.D. Andrade et al.

    Latinos and the changing demographic landscape: key dimensions for infrastructure building

  • P. Andreas

    Border games: Policing the U.S.-Mexico divide

    (2011)
  • K.S. Bernstein et al.

    Acculturation, discrimination and depressive symptoms among Korean immigrants in New York City

    Community Mental Health Journal

    (2011)
  • C. Caldwell et al.

    Identity development, discrimination and psychological well-being among African American and Caribbean Black adolescents

  • A. Carter et al.

    2011 immigration-related laws, bills and resolutions in the states: January 1–March 31, 2011

    (2011)
  • E.T. Chang et al.

    Disparities in liver cancer incidence by nativity, acculturation, and socioeconomic status in California Hispanics and Asians

    Cancer Epidemiology Biomarkers & Prevention

    (2010)
  • L. Chavez

    Shadowed lives: Undocumented immigrants in American society

    (1998)
  • L.R. Chavez

    The Latino threat: Constructing immigrants, citizens, and the nation

    (2008)
  • E.R. Cole

    Intersectionality and research in psychology

    American Psychologist

    (2009)
  • P.H. Collins

    Black feminist thought: Knowledge, consciousness, and the politics of empowerment

    (1990)
  • P.H. Collins

    It’s all in the family: intersections of gender, race, and nation

    Hypatia

    (1998)
  • B. Cook et al.

    Pathways and correlates connecting Latinos’ mental health with exposure to the United States

    American Journal of Public Health

    (2009)
  • K.W. Crenshaw

    Mapping the margins: intersectionality, identity politics, and violence against women of color

    Stanford Law Review

    (1991)
  • J. Daniels et al.

    Constructing Whiteness in health disparities research

  • A.Y. Davis

    Women, race, & class

    (1981)
  • J.J. Escarce et al.

    The health status and health behaviors of Hispanics

  • J. Escobar et al.

    Mental health and immigration’s AAAs: where are we and where do we go from here?

    The Journal of Nervous and Mental Disease

    (2000)
  • B.K. Finch et al.

    The role of discrimination and acculturative stress in the physical health of Mexican-origin adults

    Hispanic Journal of Behavioral Sciences

    (2001)
  • B.K. Finch et al.

    Perceived discrimination and depression among Mexican-origin adults in California

    Journal of Health and Social Behavior

    (2000)
  • R. Frank et al.

    Barrios and burbs: residential context and health-risk behaviors among Angeleno adolescents

    Journal of Health and Social Behavior

    (2007)
  • D.J. Gaskin et al.

    Segregation and disparities in health services use

    Medical Care Research and Review

    (2009)
  • G.C. Gee et al.

    Structural racism and health inequalities

    Du Bois Review: Social Science Research on Race

    (2011)
  • G.C. Gee et al.

    Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans

    American Journal of Public Health

    (2008)
  • G.C. Gee et al.

    Racial discrimination and health among Asian Americans: evidence, assessment, and directions for future research

    Epidemiologic Reviews

    (2009)
  • G.C. Gee et al.

    Self-reported discrimination and mental health status among African descendants, Mexican Americans, and other Latinos in the New Hampshire REACH 2010 Iinitiative: the added dimension of immigration

    American Journal of Public Health

    (2006)
  • A.T. Geronimus

    To mitigate, resist, or undo: addressing structural influences on the health of urban populations

    American Journal of Public Health

    (2000)
  • A.T. Geronimus et al.

    To denigrate, ignore, or disrupt: racial inequality in health and the impact of a policy-induced breakdown of African American communities

    Du Bois Review: Social Science Research on Race

    (2004)
  • G. Gonzalez-Lopez

    Erotic journeys: Mexican immigrants and their sex lives

    (2005)
  • C.R. Gresenz et al.

    Community demographics and access to health care among U.S. Hispanics

    Health Services Research

    (2009)
  • S.M.A. Gualtieri

    Between Arab and White: Race and ethnicity in the early Syrian American diaspora

    (2009)
  • E.C. Hagopian

    Civil rights in peril: The targeting of Arabs and Muslims

    (2004)
  • U. Hannerz

    Soulside: Inquiries into ghetto culture and community

    (2004)
  • Hester, R. (2009). Embodied politics: Health promotion in indigenous Mexican migrant communities in California....
  • Cited by (814)

    • The Impacts of Inclusionary State Immigrant Policies on Psychosocial Outcomes Among Latinx Adolescents

      2024, Journal of the American Academy of Child and Adolescent Psychiatry
    View all citing articles on Scopus
    View full text