Dr. Heide Castañeda is a professor of anthropology at the University of South Florida and the author of the 2023 book, Migration and Health: Critical Perspectives, which examines how we think about migration, mobility, and borders, and how these phenomena produce health inequalities. On this episode of Policy Outsider, Dr. Castañeda is interviewed by Institute on Immigrant Integration Research and Policy Executive Director Dina Refki and Shiyue Cui, an immigrant integration fellow at the Institute. The conversation builds off the wide breadth of topics covered in the book to provide an incisive look into the complex and tangled relationship between migration and health.
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Joel Tirado 00:03
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Joel Tirado. Dr. Heide Castañeda is a professor of anthropology at the University of South Florida and the author of the 2023 book, Migration and Health: Critical Perspectives, which examines how we think about migration, mobility, and borders, and how these phenomena produce health inequalities. On this episode of Policy Outsider, Dr. Castañeda is interviewed by Institute on Immigrant Integration Research and Policy Executive Director Dina Refki and Shiyue Cui, an immigrant integration fellow at the Institute. The conversation builds off the wide breadth of topics covered in the book to provide an incisive look into the complex and tangled relationship between migration and health.
Dina Refki 01:19
You so much for being with us today. Heidi Dr Castaneda, in your recent, fairly recent book, in 2023 on migration and health, you call for a radical rethinking of migration and health, and you argue for the health care system, you argue that the health care system, rather, is inherently unequal use for some and and not necessarily for others, especially migrants and immigrants who are one of the most vulnerable populations. So So you call attention to the need to go beyond the notion of cultural competency, which has, in your words, led to harmful outcomes because of the inability to operationalize this term or translate the concept of culture. Can you elaborate on that?
Heide Casteñada 02:16
Yeah, sure. So, yeah, thanks for the invitation. I really appreciate, appreciate being able to talk about this a little bit. This book kind of came out of a moment of frustration. I was teaching migration and health for many years, and my training is dual as a as an anthropologist, as a socio cultural anthropologist and in public health. So, you know, I’ve always sort of spanned those two worlds. And especially as an anthropologist, people would often come to me to talk about the cultural piece, right? They wanted, they wanted to know more about this culture that the migrants have. And, you know, and I’ve done this for about 25 years, and I at one point realized that, you know, I didn’t want to make things easy for folks. I felt like there was some real reflection that needed to happen around the topic of migration and health. It’s not just about us as scholars being culture brokers for them, but rather sort of leading both researchers and practitioners policymakers through the process of thinking about what migration means, what it doesn’t mean, even what health is, what health isn’t, you know, but just sort of stepping back and saying what, fundamentally, what are we talking about here? And you know, in writing this book, I got to the point where, you know, I almost felt like I was writing myself out of this field of migration and health. Because, you know, by stepping back and being critical, you really realize you have so many assumptions built into this research and into this topic. And I think it’s, it’s it’s really on us as scholars to step back and help policymakers and practitioners reflect on what they mean when they use these words, immigration, migrant, migrant, health. And so that was really the idea behind the book, was to say, you know, what’s out there? What have what have social scientists done? What have public health and medical folks done? What are policymakers picking up on and using and at what point do we need to step back and really sort of like, debunk and decenter some of these ideas? So that’s really what this critical approach was really kind of referring to. So to your question, particularly, again, as the anthropologist, people would come to me and say, you know, we’ve got this project on, like, let’s just say, diabetes and Hispanic Latinx populations. Can you be on the project? And, you know, help us understand, like, what kind of questions to ask to get at the to the cultural piece of it? And you know, our role as anthropologists, as social scientists, as political scientists, as sociologists at that moment, is to say, wait a minute, who exactly are you talking to, and what are you trying to get? What is the information you’re you’re going for here? Because there’s a lot more behind it, besides just the cultural piece, right? It’s all about sort of the people’s structural position, not just in society in general, but in American society, often particularly right. And so having the ability to sort of walk people through ideas of racialization in the American US American case, but also structures of our health care system and how that impacts the experiences people are having thinking, helping them think through like, Why do certain populations show up? Why do we have to be careful to be very clear what we’re measuring right when we talk about things like, you know, particular ethnic group or language, or ideas like acculturation, assimilation or cultural competency, what are we exactly talking about and what in what ways can that actually do more harm than good, by lumping folks or by being uncritical about these terms as as scholars, as researchers, but again, as policymakers and practitioners, especially,
Dina Refki 05:52
I love the notion of paying calling attention to the fact that culture itself is not fixed and it’s dynamic and changing, and that by really focusing on what you say, I will know, as a physician what your health beliefs are, if I know where you come from, your national origin or your ethnicity. And by doing that, by focusing on culture, you really are. Are ignoring or masking the structural issues that the structural factors that keep people excluded from the healthcare system and and you call attention for a healthcare system, that is what you say, migration aware, structurally aware, and a whole of organization approach that moves the focus from the individual to the system. So in your perspective, if we were to design a healthcare system that is informed by immigrants everyday lives, that is structurally aware. That is migration aware? What would that healthcare system look like?
Heide Castañeda 07:06
Yeah. So, you know, I think there’s, there’s already some models out there in the health field. We talk about patient centered care, for example. And I think it both basically comes down to that it’s understanding the individual, person where they’re at, rather than making large assumptions about them based on things like their age or their gender or their immigration status, but rather having the space to get to know the person who you know as a as an individual with all of their complicated and intersectional ways of being, I think that’s really something that people have called for for a very long time in many healthcare systems. And so it’s not sort of a mystery. I think it’s just, you know, a matter of we, necessarily, often in the healthcare services, have to take shortcuts and have to be efficient, and that creates bigger problems around understanding where the patient’s coming from, and that that’s no different for any other population, really, than it is for immigrants. So it’s really, in some ways, a critique also of the system that we have where we don’t take the time to get to know the social and environmental circumstances stances of a particular illness that a person might come in with, because we are, we’re so busy trying to, you know, make, make it to the next patient. So that’s one thing that I think, as far as systems change go, that’s one thing. But I think the bigger philosophical issue here is that I think people tend to exceptionalize migration. And to me, that’s the bigger issue. And I think I and that’s kind of page one of the book here is that, you know, at some point we were all migrants, and at some point migration is not something unique, it’s not exceptional, it’s not pathological, but rather, it’s, it’s who we are as human beings. And so by delineate, delineating out a migration particular experience, it’s really doing a big disservice, in general, to to the whole population. Because I think just philosophically, we we have to, you know, when I say migration aware, migration centered, we have to recognize that it’s not a unique circumstance. It’s, it’s part and parcel of our of our populations globally, migration is here to stay, and it has always been here, and it’s here to stay. So, you know, finding ways to take it away from being an exceptional occurrence in the way that people interact with each other in health settings and and even in research settings, right?
Dina Refki 09:39
So, the notion that physicians knowing about the background of the patient at the individual level is one thing, but also, what are their responsibilities to address the social determinants of health is another thing. So do you argue for institutional obligation and responsibility to address some of these social determinants of health in how can that be done? What interventions or models are available to have that done?
Heide Castañeda 10:15
Yeah, I mean, absolutely, if you’re serious about improving population health, you have to be serious about engaging with all the different social determinants of health that go along with that easy task, absolutely not. And that’s why we rarely do it, and that’s why there is no one answer for all situations, but But certainly, having a commitment to that is really important, and I think there are ways in which different institutions are pushing in that direction. Again, it’s not always feasible. It’s often financially expensive, and it’s often time consuming, but I think ultimately it comes down to whether or not we’re serious. If there’s an actual commitment to improving health that just like is there truly a political will to improve the situation for immigrants in this country. So it comes down to, you know, having to take a stance and and move in that direction. So, yeah,
Dina Refki 11:12
right, you want to take it over.
Shiyue Cui 11:16
Yeah. Thank you. Uh. Heidi, I want to, I’m very curious about the gender and family perspective that shows up in this book. And I want to, I want to invite you to talk a little bit more about migrant women and their family and gender roles, because in your book, you mentioned debate about reproduction and how that shapes migrant families well being. So I wonder, what do you think about gender narratives around fertility, parenting, childcare obligations, causes? How do they influence migrant women and migrant families health?
Heide Castañeda 11:58
Yeah, that’s a fantastic question. I mean, I think, yes, I’m fascinated by these issues. I think that’s really, you know, sort of, in many ways, theoretically and on a, on a, on a practical policy level, a very interesting question, right? How do the experiences of migrant women sort of differ? And particularly, how do we frame migrant women, especially those who are racialized in particular ways. I think there’s a lot of overlap there. And you know, it clearly is a topic that speaks to people sort of basic fears around immigration in some ways too. You may see discussions around current threats to birthright citizenship, for example. And that’s, that’s absolutely, you know, centered in this debate around children of immigrants and their place in a society, and women’s role, women’s roles, in particular, in in reproduction of of migrant populations. And, you know, for a long time, I think social scientists have looked at this issue and how, you know, the children of immigrants have been treated as suspect citizens, as a racial threat to the nation. Many of them talk about, you know, feeling, you know, even if they’re born here in the United States, I’m jumping to the second generation here, but many children of immigrants feel like they’re citizens, but not necessarily Americans, because of the exclusions they feel on sort of a daily basis, whether that’s spatial segregation, microaggressions, anti, you know, Instagram immigrant or anti ethnic rhetoric of various types, and that’s something that I’ve been intensely interested in my book borders of belonging looks at this a little bit more about how folks who are in mixed status families, you know, in in a space where the migrant family is reproduced in different ways, with with various gradations of legal status, how people sort of respond to, you know, feeling, feelings of belonging in the United States, for example. So, yeah, I think, I think there’s, there’s something very fundamental about migrant reproduction and the way it connects to ideas about citizenship in different places around the world. I’ve also done quite a lot of work in Germany, where the rhetoric is is quite different. But still, there’s this anxiety about migrant reproduction that that sort of emerges in very different ways. And so I think it’s a very fruitful way to think about the place of immigrant women in society, and how it’s how they are quite different. Their experiences are different than than that of of others, for example. And just again, looking at how it plays out intergenerationally too. I think is really key at understanding some very fundamental issues around American citizenship and notions of belonging.
Shiyue Cui 14:49
That’s a great perspective. I really, I agree. I think it is really important to think about how citizenship reproduction and how, how that influence individuals well being and in terms of health care and their overall health condition. Can you give us more information or an example about how legal status or mixed family status could influence first gen and second gene family members, I don’t know, maybe access to health care, or their reproduction decisions, or their overall health condition. What do you think about that? Yeah,
Heide Castañeda 15:31
it’s, I mean, it’s a fascinating issue, simply because you can have within a household, you can have siblings with different opportunities. And to me, that’s just as a researcher, a very interesting way to parse out what is happening. You know how the how policy can influence what’s happening in the intimate space of the household, and the different opportunities and the stratification of opportunities and barriers within the household, right? So you often hear in the United States. It’s very common, and mixed status. Families for the oldest child, perhaps to have been born outside the country, maybe they have DACA status, a deferred action for childhood arrival status, or something similar. And then younger siblings are born in the US and have citizenship status in the US. And so you do see within these families a stratified forms. Of of access to health care and different types of opportunities. And you know, for the parents, often, and especially the mothers, it’s very it’s very difficult to to recognize that your children have different opportunities, because that’s not something that you never wish and so, you know, you there’s, there’s a there’s a lot that can be explored around there. But I think that the key here is that that’s a great example of where you see the policy environment penetrating into the household intimate spaces and sort of disrupting family relationships and dynamics in a certain way. It’s
Dina Refki 16:55
sort of like the same stratification that happens in the larger society and the power dynamics, the unequal power dynamics, is reproducing itself within the intimate spaces of the household, right? Fascinating,
Shiyue Cui 17:09
yeah, and from a life course perspective, these legal status have long reaching effects on individuals across their life course. So, yeah,
Heide Castañeda 17:18
absolutely, absolutely see that. You see that people, when you compare folks, you know, who grew up, you know, undocumented or with DACA status, and compare them with the the trajectories of their siblings, you can see that very clearly marked on their bodies. And I think, to me, that’s what’s so fascinating about migrant health, is that, you know, you can really trace the policies being inscripted on people’s bodies, and you can measure it often too. There’s a lot of great work out there right now where people are measuring, you know, different types of stress markers, and are, you know, really showing that, for example, fear of deportation carries over from an individual onto their family members and even onto their community, their neighborhood, their neighbor, their neighbors, right? So there have been studies where people look at things like systolic blood pressure and being BMI and things like this, and they see that it’s not just the individual who’s maybe is undocumented and fearing deportation themselves, but rather, you know, their neighbor down the street feels that effect too, because it’s a spillover insecurity for the entire social fabric of that community.
Dina Refki 18:27
Yeah, and that brings us to the point of resiliency, which you talk about in your book as well. And you say that there should be greater focus on resiliency, not from an individual perspective, but from a structural level, and focus on population or community resilience by looking at things like social capital, informal care networks, community resistance to policies and practices that are detrimental to health. Can you tell us a little bit more about that, what kinds of policies and practices that need to replace what exists right now in terms of the really the harmful, unsettling approaches and what you call the pathogenic structures and processes that impact well being, yeah,
Heide Castañeda 19:19
yeah. So, I mean, yeah, absolutely. I think that resiliency needs to be at this more broader community or structural level, rather than at the individual level. Because at the individual level, it implies that people maybe have more power than they actually do. It’s really about sort of the power of the of the group and of community ways of networking and building new practices. And I guess the way I would answer that is, you know, increasingly we have people who experienced, for example, people experienced illegalization themselves, people who grew up who are undocumented but who now are professors and researchers, right? So I think, and not just that, not just professors and researchers, but many of them are activists. Many of them are politicians, yeah, yeah. Many of them are doctors. And so I think that is probably one of the first places I would sort of point is that this resiliency is increasing over time, continually through the through the through the successes of these folks. And I think letting them speak and listening to them and having them share their experiences is probably the best way to understand community resilience.
Shiyue Cui 20:33
Thinking about resilience, I also want to talk a little I also want to discuss a little bit about the humanitarian population in your book, you also mentioned the refugee and asylum seeker population. And we know that in academia, there’s some debates over, do we group humanitarian population with economic migrants? Do we put them under the same category, or they should be separated as we study them. So in terms of migration and health, I wonder, what do you think about economic immigrants versus the humanitarian population, and should we think about them as different groups? What are particular about their community group needs?
Heide Castañeda 21:18
Yeah. That’s, that’s great, yeah. So, I mean, I don’t have a, I don’t have my own particular answer here, but I will say that it’s just important to to sort of explain what we’re talking about when we talk about a refugee population, right? I think there’s many different definitions, and some people have this, you know, sort of generic 1951 convention on the Status of Refugees definition, and they just assume that applies in Very Black or White ways, which it really doesn’t. And so, as you already hinted, one of the one of the big issues is that there are many different forms of violence that can be happening. Various types of economic violence also pushes people to migrate, not just a particular political violences. And the I think what’s really telling is the particular political violences that are referenced when we talk about refugee or asylee populations can change over time, right? So I think it was, it was quite recently that we saw an influx of white South African refugees coming to this country, right? So that that was a shift in how people define refugee status. And so I think recognizing that there is no there is no clear black or white legal definition for these things, there are constructions that shift over time, and many of them rely on particular ideas of what it means to be politically persecuted, for example. So I think, though your question is a good one, because it points to the fact that there’s really this, there’s really sort of a spectrum of ways of thinking about people being pushed from, you know, push, pushed violently, from their homelands. And that that can look many different ways. It can be economic economic desperation, it can be political forms of violence. It can be climate change, displacement, right? I think all of those things in different ways play out for different populations, and sometimes it’s a combination of those, right? Sometimes, you know, economic desperation may seem to be the the first, the first, you know, factor, but, but climate change might be an underlying issue, or new types of underlying political changes. So it’s never, it’s never that so clear, and it’s also a highly politicized topic. So I think, I think what it comes down to is when that term is utilized, when you say refugee or asylum seeker, or particularly refugee, I think what’s, what the My, my, my call would be to simply be clear and in defining what you mean in that particular instance, right? So certainly, a lot of activists have extended the term refugee to include broader populations, and some politicians have narrowed the term to to mean other things, right? So it’s just a matter of defining and not taking for granted. I think that term because it can encompass so many different things,
Dina Refki 24:17
and I think we are really constantly socially constructing the terms and shifting and and broadening and constricting, for sure, but it seems to me, your book also argues against that same kind of, what you call deservingness or legitimacy. Who is deserving of access to healthcare, and who is a legitimate person to access care and access services, and you say that we need to to really push against that system and create a system that is more based on entitlements, and it’s in the best interest of everybody, you said, native and foreign born. And can you explain that point of how it is the in the best interest of everybody? Because this seems to be a really important point to make. You argued for a community that ripple effect that can be felt in the community in terms of security and insecurity and safety. But how do you argue for a system that is based on entitlement, on safety and security for our Access for All and and get aware again, get rid of that system of deservingness and system of who is a legitimate person to access and who is not
Heide Castañeda 25:47
right. Well, so couple thoughts here. First of all, you know, in the United States, well, let me step back. Let me first say that you know healthcare access is, is it’s just one lens that we can look at, sort of the migrant condition and healthcare access is particularly interesting because we can actually see, you know, the very real health effects on populations around them. If they, if they’re not taken care of, then if, you know, if one subgroup in our population is not taken care of, then we’re, we’re all in trouble, especially when. Comes to certain kinds of illnesses, or, like you said earlier, the issue of stress and immigration enforcement, there’s a lot of spillover effects. But I think what’s fascinating first of all is that in the United States, because we have such a high level of uninsured folks, even following the Affordable Care Act, I mean, it’s been well over a decade, and immigrants were excluded from the get go for the most part, and even today, we have incredibly high levels of uninsured populations in the United States. So the idea of health for all in the United States is is very much a pipe dream, I think, in many ways. And it’s just it’s a political question that has, you know, had different moments, but certainly has not solved the situation. But what I think is really interesting is that if you turn your attention to countries that do have universal health care systems, you can look there to see, how are migrants faring there, whether they don’t have to be undocumented, undocumented or documented. You know, how are different migrant groups faring under universal health care systems? But even there, you see that they tend to be systematically excluded for a lot of reasons. Usually there’s, you know, even if they are, you know, included by law, they are disentitled through the bureaucratic process, through difficult processes and requirements, so that they are often unable to be part of that system. So there’s always a there’s what we see is there’s often a really big disconnect between the obligations that that states have and that international rights conventions have suggested, and the way that that’s translated into daily practice, even in countries that have universal care systems. And so I think that’s what’s really important to think about, too, is that there’s something going on, not about our healthcare systems, per se, but also about this migrant status. There’s something about the way in which migrants are discouraged from being, from being part of the system that is fairly universal that we see happening in many places. And of course, this has spillover effects on others around them, entire communities, you know, their well being is also threatened by some kind of, some combination of a lack of healthcare access and also the pathogenic conditions that exist. Or, you know, for migrant populations, one thing that I’ve really been quite interested in is, is focusing on how, for many migrants, because of the the sort of bureaucratic disentitlement and the disconnect with policy that often they get pushed into irregular channels of care. And I don’t necessarily mean, you know, alternative sources, but definitely things like charity clinics or NGOs or nonprofits that tend to pick up the slack, and I find that’s a really fruitful way for us to think about sort of the politics of the current moment and state responsibility, because you see these very short term, improvisational solutions for migrants, even though They may actually have rights under particular laws and policies. So I think that’s another interesting sort of, again, health care just being one lens that to look at the migrant condition you could you can really investigate a lot around the role of the state and the way it plays out with with NGOs, nonprofits picking up the care for these populations.
Shiyue Cui 29:40
Also, I remember, I’m not sure if I remember, probably some migraines may get access to health care services through public hospitals. They have some, some called financial aid. Some call them maturity bills, and it’s like the hospital could waive or could pay for some of the medical expenses if the visitor, If the patient cannot afford it, and immigrants can get access to those resources sometimes, and that is mostly state, funded by state government. I’m not sure so that do. What do you think about that channel, if it is coming from states, state funding?
Heide Castañeda 30:23
Yeah, I think it’s, it’s fascinating, because I’ve always said, look, as long as migrants aren’t like dying in the streets, people aren’t going to be outraged. And this is one of this is one of the ways in which this happens. There are these back doors that people would rather use to provide pro bono care, right for free, write it off as an institution, whether it’s a hospital or a nonprofit, they’re able to shoulder these resources and in in exchange, we don’t have a larger conversation about populations that are are being left out of the system, right? And I, by no means was, was trying to imply that people should be dying in the streets. But I’m saying is that it distracts us from the fact that there, there are legal obligations that people are not able to take advantage of, because this sort of is a smoke screen in many ways. And I think that’s something that we see, not just in the United States, but we do see it here in the US as well. And I think that’s a great example you gave that, you know, hospitals can just write off care for the. Uninsured. And, you know, similarly, we did a study of farm worker children here in Florida, and a lot of dentists, you know, were actually able to file dental Medicaid for these children, but they didn’t bother because it just wasn’t worth it. For them, the remuneration rates were so low. So for them, they they just would rather give it out for free. They just wrote it off as charity work. And I think that just says a lot about the way we you know, if, if people can’t be treated equally, it’s undermining the entire system. It that undermines the quality of the system. When you you can’t, you can’t absorb those folks into the regular system and have to instead set up parallel types of care.
Dina Refki 32:06
And speaking of the policy perspectives and the role of the state and the obligation of the state, we can’t help but bring up the culturally and linguistically appropriate standards that were created by developed by the federal government in 2000 late 2007 and nine, and then updated again 11, 2011 which really was supposed to create that what you talk about the the whole of organization approach, the structural approach to to access by changing the organization and how the system responds. But what we see on the ground is that the enforcement is lacking, you know, and is not taken seriously at the organization at the facility level. And so what needs to happen at the policy level to make sure that this is really institutionalized, that it seems to me that it’s it’s the ideology need to change, that health needs to become a right, not a not a product that you purchase if you have the money or not. And it looks like we’re really moving away from that vision, at least at the this, this juncture in time. But what do you think needs to happen in order for policies, universal healthcare, policies to be applied?
Heide Castañeda 33:37
Right? I think, I think you’re spot on to say it’s an ideological issue, ultimately, and I think a lot of politicians don’t want to put their necks out for these particular causes. I think, you know, another issue when it comes to, for example, linguistically appropriate services, or, you know, language concordance with the patient population, one of the issues there is that it gets, it devolves to the state level, and so different states have different policies, right? And, and that’s, you know, that’s fine. We this is a if we’re, I’m, I’m now referencing the United States specifically, and that’s just how things work in the United States as a federal system. But absolutely, it needs to be an ideological commitment at the larger level that you know that this is something that we all value as a collective and want to see, you know, insured as a collective. Otherwise you get these piecemeal policies, or you get local policies that are quite different from the federal policies, which are, which are, which are, you know, interesting in and of themselves, that you can, that you can move 20 miles down the road and have better services and better conditions, right? But it certainly is. It’s a matter of political will and collective commitment to wanting to have a right to health. I don’t think in the United States currently, health is seen as something that is a right. It’s something that can be as you, as you kind of, you know, hinted at, something that can be purchased if you if you can, or maybe you get, maybe you get lucky and someone offers it to you for free or for low cost. But it’s really a matter of political will. I will say also, though, and I earlier referenced the study we did with the with the dental Medicaid here in Florida. You know, we, we took this, we took our findings back policy makers at the state level. And we said, look, you you have this great Medicaid system, actually very poor medical Medicaid system in Florida, they ranked F when it came to dental Medicaid, which is precisely why we went in to talk to the families. That was, that was our intent. But we took the findings back to the policymakers and said, you know, you pass this law that gives access to these, to these. You know, us, born farm worker children of migrant parents, supposed to give them, you know, full dental access, but, yeah, nobody wants to see them. And we explained to them that, you know, the it was a reimbursement rate issue, primarily. And long, long story short, many of them had no idea they had pat themselves on the back that they had passed this wonderful bill, but they had never followed the bill from from when it was passed to when it was implemented, and how actual real life families dealt with the repercussions of that bill, or maybe the lack of repercussions. So they they were petting themselves. On the back saying, you know, we did the great thing, and we were saying, well, it actually kind of made things worse. And here’s why. So I think our role in as a researchers is to sort of interpret and kind of follow the the effects of bills and policies, to find out, you know, how they end up being implemented on the ground, and giving that information back. I mean, that’s sort of fundamental, fundamentally what we do as researchers who are interested in influencing public policy, right? But you have to go and talk to the people that are being affected by it, and then find a way to to tell that story back to the policymakers. So my point here is simply that the policymakers, they really did, generally think that they had done a good thing, but they just weren’t kind of aware of how it played out on the ground,
Dina Refki 37:03
right? Right? Absolutely, the unintended and intended consequence of a policy, and whether it’s enforced at all or not, right? Yeah, shall we
Shiyue Cui 37:13
Yeah, yeah, in Yeah, when thinking about how policies are implemented, in the case you just talk about the dentist, as a dentist here in Florida, I was just thinking about what would be a better way, what would be a more efficient way, ideally, to to put things work as they are intended to be like, from your perspective, in from your field research. Do you think it will be regulation or state level regulation, policymaker leading this change, or it should be community based organizations to push for a change. Or there should be more support from, I don’t know, dentists or hospital from from their side, which agency do you think has a best capability to make a change?
Heide Castañeda 38:08
That’s a good question. So you know, in this particular case, we this is one of the, one of the nice times where your research actually does have some some impact, where there were migrant families that actually got together and sued the state of Florida in this particular case. So there is legal recourse of that kind. But I guess what I’m what I don’t want to suggest, is that people should be forced to do things, because that’s not the answer. I don’t think you’re having forcing people to do things that’s not going to make things a lot better. There needs to be some other type of incentive. One thing we also found in that case, and this might apply to other situations too, is that the dental profession has a strong hold over the availability of services, right? And so there are, there are alternative models out there. If you look sort of at a global health level, how are people dealing with issues like dental pain? We, you know, we found that there are these, all these innovative models to have sort of mid level providers that can provide certain kind of care. And that’s something that the dental profession has prevented here in the United States for, you know, as a as a powerful lobby, and, you know, that’s, that’s the dentist, but you could say the same for many other groups as well, right? So there are powerful interests at play here that are kind of, you know, sort of, you know, putting a wedge in between some of the innovative solutions that we could possibly come up with. And I guess that’s sort of my big, sort of reflection on that particular case, was that, you know, there’s powerful interests out there that aren’t necessarily desiring to have better access for everyone and to limit their own power. So it would be nice to all be on the same page. Would be nice to pass laws that do certain things, but I think there’s, there’s a lot of competing interests, and every situation, every state’s a little bit different. So yeah, it’s a complex situation, for sure.
Dina Refki 39:56
Yeah, that’s then brings into brings our attention to the role of civil society, really in keeping government accountable in check, and the example you said about suing, using the courts for litigation or really simply advocating with administrative branch and The executive branch on how policies are implemented as well.
Shiyue Cui 40:23
I actually I have a question about social integration in general. A lot of what we discussed today, access to healthcare and the migrants experience. It remind me about the idea about everyday citizenship, or like, lived experience about being a migrant or having or not having citizenship. So I wonder, what do you think about healthcare access and experiences with this service health service providers? How does that influence individuals feelings about social integration now, not only for individuals, for family, but also for migrant communities. What does that mean for for them? Yeah,
Heide Castañeda 41:10
well, I mean, I do like the term belonging, right? I think belonging has a has a spatial and an emotional component to it that is a really important one. So. That shows us, you know, really shows people’s sort of emplacement in a particular place. A lot of the migrants I talked to, even those who are undocumented, have been in the US for decades right there. They’re certainly parts, part of our and, and so I think so, yeah, so I guess I just, I just kind of wanted to, kind of, you know, one of the, one of the issues around the sort of discourse on integration is it sort of makes suggest that migrants need to be somehow translatable, renewable, to be part of society. And in fact, there, as as we all know, they’re, they’re already here, they’re part of our communities as it is, right? So I think, I think there’s, you know, lots of different ways to kind of think through that. I think people find their find their forms of belonging in the communities that they’re in, certainly in the you know that I’ve worked in many migrant communities, for example, on the US Mexico border, where you know 10% of the population or more is is undocumented, and those folks have have all sorts of strategies And and forms of of resilience that they have sort of come together as a community to sort of build and, and, and, you know, take care of each other’s health in lots of ways as well. So I think, I guess my point here is that, you know, it’s not only what we see and what is knowable to us. People have other ways in which they have created sense of belonging community, sense of health and wellness in their own communities. And, you know, I think it’s, it’s really about local, smaller places and people, how people sort of are in place in those communities. And so it’s, it’s easy for us to think of these big picture policy solutions. But as you’re as you’re saying, you know people’s everyday lives are lived in a way and within social networks that uphold, you know both, both in some ways, you know the the negative racialization and other effects of immigration, but also uphold their wellness and healthy well being too. So I think that’s going on simultaneously, and I think it needs to be a little bit more nuanced. I
Dina Refki 43:29
love how you challenge the popular notion of or what used to be a popular notion of assimilation into a one, conformity to a one standard of social integration, to a dominant culture in the way that you are saying we are a multicultural cited versus society, and there are many ways of belonging and being in the world and feeling a sense of well being. And this is what you know what it looks like in migrant population. You don’t have to assimilate as much as the forces right now is really pushing us into this direction of conformity to one dominant standard of integration. You’re challenging that, and I love how you frame it as a more of a of multicultural, diverse and and different ways of being.
Heide Castañeda 44:26
And I think also, you know, we we’re here talking about migration and migrants, and I always have to remind myself, as a researcher and as a person, to just, you know, not, that’s not necessarily people’s primary identity, right? So people don’t walk through life saying, I am an immigrant, right? They walk through life, they say, I’m a sister. I am a Catholic. You know, I was school teacher. They have many, many complex I’m attending, very complex identities. And we, as researchers and as policy makers tend to reduce them to one thing, and I think that’s really important too, is that, you know, we’re so focused on this one piece of their lives, but their their identities are so much more complex, and that may not be the way they see themselves.
Shiyue Cui 45:06
Absolutely, absolutely wonderful and and what would you what would you say in terms of future research directions? Because you just mentioned that migrant scholars tend to focus one status, migrant citizenship status, and we definitely need to look beyond that, to think about the complex identities that individuals, individuals have. So I wonder, what would you say for future research directions? What do you think should be, should we see more in migration research?
Heide Castañeda 45:40
Yeah. I mean, I think, I think we all sort of have a we migration scholars tend to have a certain way of thinking about migration, and I and I think it’s also often implicit, but I think we need to talk more about precisely what are we talking about. I think, you know, there’s a lot of frameworks and models that persist ideas of, you know, departure, transit and arrival that are very uni linear, and they don’t make sense for the way people live their lives. There’s lots of ways in which we delineate citizens and migrants that don’t make sense. There’s lots of ways in which we, you know, think of migration as a singular activity. It happens one time, and there. So much diversity and different kinds of forms of entry, legal status, different intentions of settlement, different temporal mobility, patterns that people are experiencing different structural reasons behind their decisions. And so I think, I think we need to be a little bit more forceful in critiquing ourselves actually, and you know, not taking for granted when we say certain terms, as far as sort of area of the migration, you’ve probably been able to sort of sense that one of the things I’m quite interested in is thinking about measuring and elaborating on the issue of these spillover effects. I think it’s a very powerful way to talk about the lack of a distinction between a migrant and a something else, a citizen or a resident or whatever. Maybe one powerful way to push back against that is by being able to show that there are these effects on others around them, and not just individuals, but rather entire communities. And so I think that’s an area that I would like to push and see more work happening. And it also that way, my migrants themselves are not like isolated as some variable in a project, but rather they’re viewed as part of the fabric of larger society. To me, that’s a really big one. And then, you know, quite frankly, when I wrote this book and when I’ve been teaching, I haven’t seen a lot of work that is directly concerned with the effects of climate change. We know that that is a major push factor for a number of reasons, but we usually it gets translated into things like, I don’t know, loss of land, desertification, or political unrest. And we’re not looking at, we’re not stepping back and looking at that bigger picture around climate shifts, and that’s something that I think is again, very implicit in a lot of migration and refugee research, but I think we should be addressing more explicitly.
Dina Refki 48:10
Thank you very much. So Dr costanda, we really enjoyed talking with you. You know, in in your book is fascinating. It’s a pleasure to discuss these issues with you. Thank you again for your time, and we look forward to continuing to read interesting pieces from you in the future. Thank you again.
Heidi Castañeda 48:33
Thank you. Thanks so much for inviting me.
Joel Tirado 48:37
Thanks again to Heide Castañeda, Dina Refki, and Shiyue Cui for this illuminating conversation on the complex and tangled relationships between migration and health. Thanks also to Institute on Immigrant Integration Research and Policy Deputy Director & Intergovernmental Liaison Guillermo Martinez for his contributions to this episode.
If you liked this episode, please rate, subscribe, and share. It will help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts and transcripts are available on our website. I’m Joel Tirado; until next time.
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