Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies

Health and legal literacy for migrants: twinned strands woven in the cloth of social justice and the human right to health care

“…In realising these ideals, the domain of human rights becomes multifaceted, as the practical out-workings of an individual’s right to health care are negotiated within the contexts of national public health agendas, spheres of economic trade rights, and particularly the individual’s right to privacy, freedom of religion and self-determination [6, 20–22]. Despite this multiplicity of expression, the premise in the field of public health is that health care should be available to all [4, 7]. Furthermore, governments that are signatories to international agreements such as “The Universal Declaration of Human Rights”, “The International Covenant on Civil and Political Rights” and “The International Covenant on Economic, Social, and Cultural Rights” [21] have moral and legal obligations to reduce social injustices, including mitigating barriers to accessing medical care, particularly for those most vulnerable groups within their population [19, 20].…”

“…However, as law is a socio-political construct built on categories derived from and within social life, premises of law shift in response to social change, and rights manifest differently between national contexts [48, 49]. As a result, the specific health care related legal rights and particular responsibilities constituted in the adoptive nation are, at least initially, outside the experience of the migrant [7]. Furthermore, the interrelationship between law and state as instruments of a specific culture empowered to define the application of justice, imparts the law with the breadth of responsibility, power and imprimatur which can elevate its views above consideration of the particular social circumstances in which sex, gender and migration are intersecting determinants of need [7, 23, 50].…”

“…As a result, the specific health care related legal rights and particular responsibilities constituted in the adoptive nation are, at least initially, outside the experience of the migrant [7]. Furthermore, the interrelationship between law and state as instruments of a specific culture empowered to define the application of justice, imparts the law with the breadth of responsibility, power and imprimatur which can elevate its views above consideration of the particular social circumstances in which sex, gender and migration are intersecting determinants of need [7, 23, 50]. Rocher [51] stated that: “to understand the level of effectiveness of a law involves tracing the diversity of its effects and impacts, intended or unintended, planned or accidental, direct or indirect, foreseen or unexpected, social, political, economic, or cultural” (p. 133).…”

“…This is an additional learning and adaptive process that is often beyond the resources of women and men going through a diversity of integration experiences and facing medical encounters in their adoptive society [11]. Furthermore, the power and bureaucratic formality of the law can create an additional risk as migrants who are the living human subjects of their legal rights may be reduced by the “system” to the static and inhuman position of being considered “objective facts” or impersonal objects of care [7, 33, 55]. Such an objectification completely overlooks the gendered identities and socio-political life courses of real women and men seeking redress, and taken to extreme has similarities to the objectification of refugees described in Malkki‘s seminal work “ Speechless Emissaries: Refugees, Humanitarianism and Dehistoricization ” [60].…”

“…While universal health care systems recognise patient and migrant diversity, and aim to respond equitably to the range of circumstances experienced by all groups of women, men, girls and boys [5–7], it is the position of these authors that any host country medical system will be, to at least some extent, “foreign” for all migrants. The level of assistance an individual migrant or migrant population requires in order to equitably access health care, will be variously influenced for example by the size and resources of their migrant community or family cohort, their category of entry and migration status, and integration trajectories [2, 8–11].…”