Legal status as a life course determinant of health: parent status, adjudication stages, and HIV knowledge among highlanders in Thailand

Abstract

Background Rising nativism and political volatility worldwide threaten to undermine hard-won achievements in human rights and public health. Risks are particularly acute for hundreds of millions of migrants, minorities, and Indigenous peoples, who face disproportionately high health burdens, including HIV/AIDS, and precarious legal status (LS). While LS is receiving increasing attention as a social determinant of health and HIV, understandings are still limited to select immigrant communities. Its effects on health among stateless communities, particularly in the Global South, remain largely unknown. Moreover, widespread limitations in census measures of LS reduce its complexity to a simplistic citizen/non-citizen binary or insufficient proxies. Thailand’s ethnolinguistically diverse highlander population experiences disproportionately high HIV prevalence and comprises one of the world’s largest and most protracted cases of statelessness, an acute condition of precarious LS. As such, analysis of LS and health outcomes among highlanders is both critically warranted, and useful as a case study outside of the migration paradigm. Methods Drawing on the UNESCO Highland Peoples Survey II (2010), an unprecedented and unique cross-sectional census of highlanders in Thailand, we mobilize complex measures of LS in adjusted ordinal logistic regression models to assess how parent citizenship and LS adjudication over the early life course condition adult HIV knowledge—a key protective factor against transmission (n = 8079). Results Adjusted ordinal logistic regression on knowledge scores reveal that parent citizenship predicts odds of greater knowledge by 1.4- to 2.2-fold, depending on ethnic group. This is partially explained by divergent stages of LS adjudication between birth and adulthood, including successful birth registration and adult citizenship acquisition, along with secondary school completion. Precisely how these factors contribute to HIV knowledge varies by ethnic group. Conclusions This study advances knowledge of LS outside of the migration paradigm, reveals heretofore unexamined connections between LS and access to public health information, and elucidates how instabilities in LS adjudication stages underlie health inequalities over the life course. Findings indicate that securing success in public health and human rights agendas requires attention to how states adjudicate and deploy LS in multiple stages across the life course to structure access and exclusion among migrant and non-migrant communities alike.

Health Care Experiences of Stateless People in Canada

“…This study broadens our understanding of statelessness and health in Canada by exploring the nexus between status and health as SPs age, consider life goals, and interact with immigration processes. Our participants’ experiences also illustrate that the legal statuses of stateless persons in Canada are not fixed but can change throughout life in both in situ and migratory contexts (Koning et al 2021). Our findings thus add statelessness to the corpus on non-citizen vulnerability in Canada and confirm that lack of nationality has egregious effects on health and well-being, in ways that mostly align with other non-citizen groups.…”

“…Furthermore, statelessness negatively impacts a number of social determinants of health, including access to quality housing, sanitation, employment, and food security (Sköld 2023, 10–11). Koning et al (2021) find that precarious legal status is a dynamic determinant that affects health differently at various stages of nationality recognition. The COVID-19 pandemic also exposes links between legal status and health outcomes.…”

Legal identity at the margins: the impact of violent conflict on birth registration in India

“…Comparative research shows that individuals without official identity documents often come from marginalised communities (e.g. Cheva-Isarakul and Sperfeldt 2023 ; Liew 2021 ; Pearson 2021 ; Sardelić 2021 ; Sperfeldt 2020 ) or live in zones without effective state institutions (Koning et al 2021 ; Lee and Zhang 2017 ; Adamczyk and Doumit 2024 ; Harbers 2020 ). This creates a vicious cycle as vulnerable individuals are rendered even more vulnerable by their lack of state-recognised documents.…”

‘We are inferior, we have no rights’: Statelessness and mental health among ethnic minorities in Northern Thailand

“…Their possession, therefore, demarcates the scope of geographic and social mobility ( Cheva-Isarakul, 2019 ). Studies using data from Thailand, for example, demonstrated that legal status (as indicated by the possession of identification cards) affects education and health risk ( Koning, Flaim, Baldiga, & Feingold, 2021 ), access to healthcare ( Flaim et al, 2021 ; Herberholz, 2020 ), as well as access to land and credit ( Flaim, Williams, & Ahlquist, 2019 ), that is, more generally, the key factors that matter for social ascent. Experiences of in situ stateless populations in Southeast Asia further showed that protracted statelessness results in an intergenerational transmission of immobilization ( McAuliffe, 2017 ).…”

“…Experiences of in situ stateless populations in Southeast Asia further showed that protracted statelessness results in an intergenerational transmission of immobilization ( McAuliffe, 2017 ). Koning et al (2021) , for example, found that parent citizenship increases the odds of greater adult HIV knowledge, which is partially explained by birth registration, adult citizenship and secondary school completion.…”