ReviewMore than culture: Structural racism, intersectionality theory, and 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
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