Deservingness: migration and health in social context

• Published in: BMJ global health Vol. 6; no. Suppl 1; p. e005107
• Main Authors: Holmes, Seth M, Castañeda, Ernesto, Geeraert, Jeremy, Castaneda, Heide, Probst, Ursula, Zeldes, Nina, Willen, Sarah S, Dibba, Yusupha, Frankfurter, Raphael, Lie, Anne Kveim, Askjer, John Fredrik, Fjeld, Heidi
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.04.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Analysis; COVID-19; Ebola virus; Fatalities; Global health; Health insurance; health policies and all other topics; health systems; Humanities and Social Sciences; Immigration policy; Medical personnel; Migration; Noncitizens; Patients; Primary care; Public health; Qualitative research; qualitative study; Social sciences; treatment; Norway; West Africa; Romania; health policies and all other topics; treatment; qualitative study; health systems; public health
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2021-005107

This article brings the social science concept of ‘deservingness’ to bear on clinical cases of transnational migrant patients. Based on the authors’ medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.