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Social scientists are increasingly interested in the detrimental health impacts of immigration enforcement, including surveillance, arrest, detention, and deportation. In most empirical research—as well as the legal process itself—the family or household serves as the social unit for understanding ripple effects of immigration enforcement beyond the individual. While the mixed-status family analytic framework foregrounds the experiences of millions of individuals and valuably extended immigration scholarship to move beyond its heavy focus on individual behavioral choices, we argue that a continued reliance on the family as an analytic framework reproduces normative conceptualizations of kinship and care, obscures how the process of illegality is mediated by empire, racism, and (hetero)sexism, and risks reproducing narratives about the "deserving" immigrant. We propose the mixed-status community as an analytic framework to better understand the detrimental health impacts of immigration enforcement by accounting for the synergistic influence of 1) a fuller range of social and intimate relationships; 2) spatial arrangements of risk; 3) presumptions of immigration status; and 4) racialization of immigration law and enforcement practices. We draw on a case study of an immigration raid as well as contemporary examples to illustrate the added value of this analytic framework. • The frame of "mixed-status community" may better explain how deportation harms health. • Immigration enforcement harms health across a range of relationships. • Community members avoid public spaces and places when they fear arrest. • Immigration enforcement is rooted in racial profiling. [ABSTRACT FROM AUTHOR]

Abstract: This article discusses health concerns of migrant street-based male sex workers (SMSW) in Germany, a population that remains underexplored by health and social scientists. It is based on five months of ethnographic research in 2011/2012, including 46 semi-structured interviews with physicians, social workers, health department staff, and SMSW from Romania and Bulgaria. This is supplemented with annual reports by organizations providing assistance to this population in eight cities. The article contributes, first, an analysis of the increase in migrant SMSW as a response to economic opportunities (freedom of movement across European Union borders) and constraints (transitional measures restricting access to the labor market). It seeks to move beyond the myopic association between sex work and HIV to contextualize health risks as resultant of macro-level processes associated with migration. Second, the article contributes a summary of primary health concerns for this population. Especially troubling is their lack of access to regular medical services, reflecting a socio-legal position that often resembles that of unauthorized migrants rather than European Union citizens. [Copyright &y& Elsevier]

Abstract: Persons of migrant background, a highly heterogeneous group, now comprise one-fifth of the total population in Germany. However, delayed and conflicted responses to social inclusion have resulted in clear deficits in the health care system, with few serious attempts to assess migrants’ profiles and needs. This article provides a critical review based on meta-analysis of literature indexed in MEDLINE, a qualitative review of German medical and nursing curricula, and original ethnographic data. It examines discourses and practices embedded within larger national debates on migrant integration and their specific manifestations in the health sector in order to explain the current situation of unauthorized migrants. The historical arc of the last fifty years can be viewed as a progression of key themes based on interrelated concepts of deservingness and selective investment. Relative deservingness is evident in differential social positioning and access to resources, resulting in selective investment and decades of continued social inequality. [ABSTRACT FROM AUTHOR]

Abstract: Persons of migrant background, a highly heterogeneous group, now comprise one-fifth of the total population in Germany. However, delayed and conflicted responses to social inclusion have resulted in clear deficits in the health care system, with few serious attempts to assess migrants’ profiles and needs. This article provides a critical review based on meta-analysis of literature indexed in MEDLINE, a qualitative review of German medical and nursing curricula, and original ethnographic data. It examines discourses and practices embedded within larger national debates on migrant integration and their specific manifestations in the health sector in order to explain the current situation of unauthorized migrants. The historical arc of the last fifty years can be viewed as a progression of key themes based on interrelated concepts of deservingness and selective investment. Relative deservingness is evident in differential social positioning and access to resources, resulting in selective investment and decades of continued social inequality. [Copyright &y& Elsevier]

Abstract: Few studies have engaged issues of social class and access related to dental health care policy from an ethnographic perspective. The state of Florida in the US has one of the poorest records in the nation for providing dental care for low-income children, falling especially short for Medicaid-enrolled children. In this paper, we discuss unmet dental health needs of children in migrant farmworker families. Although one of the most marginalized populations, most are eligible for Medicaid and are thus covered for dental services. However, serious disparities have been linked to the lack of access through the public insurance system. This study was informed by participant observation at dental clinics and a Migrant Head Start Center and interviews with dental health providers (n = 19) and migrant farmworker parents (n = 48) during 2009. Our results indicate that some typical factors associated with poor oral health outcomes, such as low dental health literacy, may not apply disproportionately to this population. Instead, we argue that structural features and ineffective policies contribute to oral health care disparities. Dental Medicaid programs are chronically underfunded, resulting in low reimbursement rates, low provider participation, and a severe distribution shortage of dentists within poor communities. We characterize the situation for families in Florida as one of “false hope” because of the promise of services with neither adequate resources nor the urgency to provide them. The resulting system of charity care, which leads dentists to provide pro bono care instead of accepting Medicaid, serves to only further persistent inequalities. We provide several recommendations, including migrant-specific efforts such as programs for sealants and new mothers; improvements to the current system by removing obstacles for dentists to treat low-income children; and innovative models to provide comprehensive care and increase the number of providers. [Copyright &y& Elsevier]

Abstract: Unauthorized migrants face health disadvantages in many receiving nations. However, few studies have explored precisely how the condition of “illegality” influences illness experiences, medical treatment, and convalescence. This article presents a case study from Germany (2004–2006 and 2008), where unauthorized migrants face limited access to health care and the threat of deportation results in avoidance of services and treatment delays. This is confounded by unique laws which essentially criminalize health care workers for aiding migrants. This article provides a snapshot of 183 patients who attended a Berlin clinic that functions as the single largest source of medical assistance for unauthorized persons in Germany. The demographic information sketches a picture of labor migrants with a mean age of approximately 29 years. More women than men presented at this clinic, a result of its ability to successfully arrange prenatal care and delivery as well as a reflection of local labor markets. The diversity of countries of origin (n =55) is surprising, underscoring the utility of using illegal status as a unifying variable to highlight migrants'' shared position in the global economy and the resulting barriers to basic medical services. Patients presented with a range of illnesses typical for their age group. However, the effects of illegal status resulted in four areas of disparities: 1) limits to the overall quality and quantity of care for mothers and infants; 2) delayed presentation and difficulties accessing a regular supply of medication for patients with chronic illnesses; 3) difficulties in accessing immediate medical attention for unpredictable injuries and other acute health concerns; and 4) a lack of mental health care options for generalized stress and anxiety affecting health. In Germany, an incoherent policy environment contributes to inadequate services and treatment delays. Solutions must address these legal ambiguities, which represent a primary barrier to equity in a nation with otherwise universal health coverage. [Copyright &y& Elsevier]

With the increasing technical sophistication of medicine, clinicians’ task of assuring patient informed consent is increasingly elusive. Taking the example of prenatal genetic testing, we examine efforts to communicate the complexities of genetic knowledge and risk calculation to patients. In this qualitative, descriptive study, we interviewed 50 clinicians and 40 patients, and observed 101 genetic counseling sessions. We found the clinicians and patients have different goals, purposes, and values regarding testing, which affect their clinical interactions. The information the clinicians provide patients reflects their clinical interest in identifying and controlling pathophysiology, while patients, in contrast, are most concerned with protecting and nurturing their pregnancy. We argue informed patient decision-making about prenatal testing options requires information that is responsive to patient interests. We recommend developing a shared decision-making approach, to facilitate the full participation of both clinicians and patients in the decision-making process. [Copyright &y& Elsevier]