Carolyn Sargent

Special Issue Part I: ‘Deservingness’ and the politics of health care

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The Construction of “Cultural Difference” and Its Therapeutic Significance in Immigrant Mental Health Services in France

e see front matter 2011 Elsevier Ltd. doi:10.1016/j.socscimed.2011.10.044 The articles in Part I of this Special Issue “Debating HealthRelated Deservingness and Mapping Embodied Vulnerability” bring a particular focus to a broader set of critical issues that are fundamental to ongoing debates concerning global health care models andaccess to care. Thefivearticles in this section address the concept of “deservingness,” drawing on centuries-old representations of the “deserving”poor,worthyof public support, in contrast to those less meritorious, who are marginalized from the body politic and denigrated for presumed moral laxity. Although this special issue takes as its theme “illegal” immigration and its implications for the health of immigrant populations, the articles in Part I, taken as a whole, draw our attention to core questions central to the politics of health care, key among them, that of health care as a human right, versus health care as a commodity (Castro & Singer, 2004; Jacobs & Skocpol, 2010). Paralleling this contested issue is the dichotomous representation of health care construed as within the domain of social justice, or contrastingly, as a component of amarket economy, and hence subject tomarket forces. Accordingly, the issues raised in these articles are relevant not only to our understanding of the inextricable connections between immigration status and health, but also to a more nuanced analysis of the very assumptions that underlie the provision of health care worldwide. As many scholarly works have documented, immigrant health is a product of policies of entitlement and exclusion, which ultimately shape health risks and access to care (Fassin, 2005; Sargent & Larchanché, 2011). The attention to “deservingness” of immigrant populations in this special issue moves this body of research

Disease, Risk, and Contagion: French Colonial and Postcolonial Constructions of “African” Bodies

Since the early 1970s, the French public health system has been accorded considerable responsibility for immigrants identified by the educational, judicial or social service authorities as psychologically distressed or socially disruptive. In this paper we discuss three models of healing embedded in constructs of “cultural difference” and addressed at specialized mental health-care centers catering to immigrants in Paris: “cultural mediation,” transcultural psychiatry/ethnopsychiatry and clinical medical anthropology. Based on observations and interviews at three specialized mental health centers in Paris, we explore how these clinical approaches address migrant wellbeing and seek to resolve crises in migrant families, especially those of West African origin. We suggest that the prevalent approaches to therapy creatively blend concepts and practices of anthropology, psychiatry and psychology but, at the same time, confront challenges inherent in the use of a generic “African” healing modality. Cases studies demonstrate that in order for such interventions to be perceived as effective by patients, “cultural difference” must be acknowledged but also situated in broader social, political and economic contexts.

Austerity and its implications for immigrant health in France.

In this article, we explore how sub-Saharan African immigrant populations in France have been constructed as risk groups by media sources, in political rhetoric, and among medical professionals, drawing on constructs dating to the colonial period. We also examine how political and economic issues have been mirrored and advanced in media visibility and ask why particular populations and the diseases associated with them in the popular imagination have received more attention at certain historical moments. In the contemporary period we analyze how the bodies of West African women and men have become powerful metaphors in the politics of discrimination prevalent in France, in spite of Republican precepts that theoretically disavow cultural and social difference.

Transnational Migration and Global Health: The Production and Management of Risk, Illness, and Access to Care*

The ongoing economic crisis in France increasingly has affected immigrant rights, including access to health care. Consistent with a 2014 League Against Cancer survey, we identify the ways in which sickness produces a double penalty for immigrants with serious illness. Immigrants with chronic illnesses such as cancer, diabetes, and other debilitating conditions divert vital funds from daily needs to deal with sickness and loss of work while at the same time national austerity measures shred the states traditional safety net of social services and support. We examine how immigrants strategize to manage financial exigencies, therapeutic itineraries and social relations in the face of these converging pressures. We base our findings on two studies related by this theme: an investigation of health inequalities in the Médoc region, in which 88 women, 44 of North African and Eastern European origin, were interviewed over a three-year period (2010-2013); and a three-year study (2014-2017) of West African immigrant women with breast cancer seeking treatment in the greater Paris region, 70 members of immigrant associations, and clinical personnel in three hospitals.