Abstract
Meredith Van Natta's book titled “Medical Legal Violence: Health Care and Immigration Enforcement against Latinx Noncitizens” uses a combination of multi-sited ethnography and interviews in three states. The book documents noncitizen Latinx immigrants’ health and health care experiences in three different state contexts. It beautifully combines immigrant voices with the perspectives of health care service providers. These dual sources of data are one of the many characteristics that make this book a unique, engaging portrayal of contemporary Latinx immigrant life. The book argues that anti-immigrant policies put forth by the federal government, especially but not exclusively during the Trump administration, manifest in medical legal violence embedded within the health care system, which leads to immigrant suffering through institutional barriers to health care, increased mistrust in health care institutions, increased immigrant criminality in health care, and labor exploitation.
Van Natta's book is organized into five main chapters. Three of the five chapters are state-specific. Selection of the states in the study was intentional: one blue, one red, and one purple state cover the important typologies of the anti- or pro-immigrant political landscape in the United States.
Chapter One, “States of Injury: Exception, Emergency, and Exclusion” outlines the ebb and flow of inclusion and exclusion that shape immigrant suffering, injury, and the slow depreciation of the immigrant body through exploitative labor. Van Natta expertly ties in immigrants’ lived experiences in precarious economic positions, their relationship with health, and the pernicious ties between immigrants’ position in the socioeconomic and political hierarchy with the state of exception in the United States in which immigrants are continuously villainized, criminalized, and seen as scapegoats. The historical and contemporary anti-immigrant political waves have cemented more exclusionary policies over time that paved the way for immigrant suffering captured in the book.
Chapter Two, “Hostile Terrain: Shifting Ground and Anti-Immigrant Assemblages,” focuses on medical legal violence in a red state where the fear of deportation was palpable. Fear barricaded willingness to seek health care and other services among Latinx noncitizens. The red state's political context also did not allow undocumented immigrants to get a driver's license, which meant that any time someone was driving there was a threat of being criminalized.
Chapter Three is titled “Immigration Federalism and Health Care Surveillances in a Progressive Jurisdiction,” and it showcases the case of a blue state under a changing political context—Trump’s looming election win and inauguration. Van Natta traces the on-the-ground perceptions of health care workers at small clinics as they prepare to find creative ways to attempt to provide safe spaces and processes for noncitizen patients. Clinic workers created plans and protocols in case the worst were to happen. These strategies included creating safe rooms or zones within clinics.
Chapter Four, “‘No Safe Zones’: Criminalizing Patients and Providers in the Nuevo South,” focuses on a purple state's context. This chapter paints a candid portrait of the changing demographics in new immigrant destinations that have come about due to the agricultural and poultry industries. By highlighting the waning trust of rightly hesitant immigrant communities during the Trump administration, Van Natta captures the dance between health care community clinic workers’ efforts to provide care to immigrants whose lives have competing interests such as making more money by working more days of the week as well as avoiding attention from institutions whose ability to protect immigrants was tested and shaken by anti-immigrant policies.
In Chapter Five, “Medical Legal Consciousness in the ‘Crimmigration’ Age,” Van Natta introduces the concept of medical legal consciousness to showcase how non-medical clinic workers navigate a changing political terrain. The ability of community health care professionals to meet immigrant communities where they are takes more than knowing health care eligibility criteria. Community clinic workers sought extra knowledge about immigration law and legal rights of immigrants, and they did the labor of correcting misconceptions of eligibility among both immigrants and county officials as well as county eligibility workers. Immigrants’ internalized sense of criminality combined with potential and actual public charge changes during the Trump administration dissuaded immigrants from applying for aid for which they were eligible. Community workers were tasked with working against the anti-immigrant wave at the federal and state levels, but this feat did not come easily. They were preoccupied with the safety of immigrant clients and how trust in safety net programs can be maintained or repaired.
Medical Legal Violence is a timely and timeless contribution to sociology and other related disciplines such as public health and gerontology. The commonalities as well as differences in the three state contexts in the book remind readers the importance of nuance in the study of sociology. Living in a blue state, a policy-wise friendlier context, does not guarantee immigrant well-being. This book also showcases immigrant suffering. While some people, scholars, and politicians may wish to look away from the damage the status quo does to the Latinx low-income immigrant workforce that is treated as disposable, this book reminds us of the immigrant suffering that noncitizen Latinxs embody due to life-course-long economic exploitation, poverty, and neglect from social institutions.
The book invites researchers to think about other questions that were likely beyond the scope of this study. For instance, as I read the book, the question of family came to mind and what immigrants’ families could or could not do to support the noncitizen Latinxs with chronic conditions featured in the book. In addition, health care workers’ perspectives were rightly highlighted, but readers may remain curious about the specific occupation, position, and responsibilities of these health care workers. Community health workers and health promoters have gained more visibility in health care, and I wondered to what extent the health care workers highlighted in this book were a part of this new health care model. Finally, it would be interesting to examine what other institutions also rallied to protect immigrants’ well-being during the Trump administration (e.g., immigrant organizations, Latinx local nonprofits, churches, labor centers, etc.). Availability of these likely varied by state context, as well.
In conclusion, this book is a chilling reminder of immigrant suffering, the health care workers who are working to mitigate some of the state harms, and the structural constraints at the federal level that impinge upon and threaten immigrant well-being as well as the community clinic forces invested in immigrant health. This book has much to offer scholars and students of immigration, medicine, public health, and public policy.