Publications by authors named "James Quesada"

9 Publications

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Structural vulnerability and new perspectives in social medicine on the health of immigrants: Interview with James Quesada and Seth M. Holmes.

Salud Colect 2019 12 9;15:e2146. Epub 2019 Dec 9.

Médico, Doctor en Antropología Médica. Profesor Asociado UC Berkeley's Division of Society and Environment, UCSF-Berkeley's Joint Program in Medical Anthropology, University of California, California, EEUU.

A decade ago, a number of English-speaking authors focused mainly on the analysis and intervention of processes of social determination of health of migrants developed the concept of structural vulnerability as a way to combat individualism, biologism, the invisibilization of processes of structural determination and the blaming of victims. As part of the historical contributions of social medicine, the current developments of the structural vulnerability approach have been disconnected from the discussions of the collective health movement and Latin American social medicine in general, among other reasons due to linguistic barriers associated with the scarcity of publications in Spanish. The present interview, conducted with two of the primary representatives of the structural vulnerability approach, investigates its historical origins and seeks to explore the specific contributions that are being made today, as a way to bring them closer to Spanish-speaking readers and so enable dialogue with the proposals of Latin American social medicine.
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http://dx.doi.org/10.18294/sc.2019.2146DOI Listing
December 2019

Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.

Acad Med 2017 03;92(3):299-307

P. Bourgois is professor of anthropology and director, Center for Social Medicine and Humanities, Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, California. S.M. Holmes is associate professor of medical anthropology and public health, University of California, Berkeley, Berkeley, California, and attending physician, Department of Internal Medicine, Highland Hospital, Oakland, California. K. Sue is a first-year general internal medicine resident, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. J. Quesada is professor and chair, Department of Anthropology, San Francisco State University, San Francisco, California.

The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.
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http://dx.doi.org/10.1097/ACM.0000000000001294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5233668PMC
March 2017

Immigration as a social determinant of health.

Annu Rev Public Health 2015 Mar 10;36:375-92. Epub 2014 Dec 10.

Department of Anthropology, University of South Florida, Tampa, Florida 33620; email:

Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of morbidity and mortality follow inequities rooted in societal, political, and economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena-social determinants of health and immigration-has resulted in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
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http://dx.doi.org/10.1146/annurev-publhealth-032013-182419DOI Listing
March 2015

Structural vulnerability and problem drinking among Latino migrant day laborers in the San Francisco Bay Area.

J Health Care Poor Underserved 2014 Aug;25(3):1291-307

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels.
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http://dx.doi.org/10.1353/hpu.2014.0121DOI Listing
August 2014

"As Good As It Gets": Undocumented Latino Day Laborers Negotiating Discrimination in San Francisco and Berkeley, California, USA.

City Soc (Wash) 2014 Apr;26(1):29-50

San Francisco State University.

Undocumented Latino day laborers in the United States are vulnerable to being arrested and expelled at any time. This social fact shapes their everyday lives in terms of actions taken and strategies deployed to mitigate being confronted, profiled, and possibly incarcerated and deported. While perceptions of threat and bouts of discrimination are routine among undocumented Latino day laborers, their specific nature vary according to multiple social factors and structural forces that differ significantly from locale to locale. The experience of discrimination is often tacitly negotiated through perceptions, decisions, and actions toward avoiding or moderating its ill effects. This essay examines urban undocumented Latino day laborers over a variety of sites in the greater San Francisco Bay Area, which, compared to many metropolitan areas in the U.S. is "as good as it gets" in terms of being socially tolerated and relatively safe from persecution. Nonetheless, tacit negotiations are necessary to withstand or overcome challenges presented by idiosyncratic and ever changing global, national/state, and local dynamics of discrimination. [undocumented Latino laborers, social exclusion, discrimination, tacit negotiation].
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http://dx.doi.org/10.1111/ciso.12033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043379PMC
April 2014

Sexual health of Latino migrant day labourers under conditions of structural vulnerability.

Cult Health Sex 2013 9;15(1):58-72. Epub 2012 Nov 9.

School of Social Welfare, University of California, Berkeley, USA.

The purpose of this paper is to explore the context of the sexual health of Latino migrant day labourers in the USA, challenges to sexual health and ways of coping, with attention to conditions of structural vulnerability permeating the lives of this unique Latino population. Given the limited information about this topic and population, ethnographic research employing in-depth semi-structured interviews with 51 labourers, recruited through purposive sampling in the San Francisco Bay Area, was utilised. The sexual health aspirations of the men are deeply embedded in the core value and practice of Latino familismo or, in this case, the central goal of securing a family headed by men as providers and present husbands/fathers. However, such goals are frequently thwarted by the poverty engendering work and prolonged separations from home that characterise predominantly undocumented day labour in the USA. Resulting goal frustration, combined with pent up sexual urges, often lead to sexual risk in spite of efforts to cope with challenges to sexual health. Unless community-, state- and national-level interventions are developed to mitigate the pronounced structural vulnerability of migrant day labourers, individual level interventions to promote sexual health, and decrease risk and distress, are likely to have diminishing returns.
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http://dx.doi.org/10.1080/13691058.2012.740075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743724PMC
May 2013

Special issue part II: Illegalization and embodied vulnerability in health.

Authors:
James Quesada

Soc Sci Med 2012 Mar 17;74(6):894-6. Epub 2011 Dec 17.

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http://dx.doi.org/10.1016/j.socscimed.2011.10.043DOI Listing
March 2012

No soy welferero: undocumented Latino laborers in the crosshairs of legitimation maneuvers.

Authors:
James Quesada

Med Anthropol 2011 Jul;30(4):386-408

Department of Anthropology, San Francisco State University, 1600 Holloway Ave., San Francisco, CA 94132, USA.

California urban and agricultural centers rely heavily on Latino migrant laborers, regardless of their legal documented status. In the delivery of social services, and in the mass media, popular consciousness, and formal legal understandings and arrangements, Latino laborers are viewed as either legitimate voluntary low-wage workers or illegitimate undocumented workers not entitled to the same civil rights as US citizens. Their de facto second-class status becomes a central component of their social identity, with the structural conditions of their lives internalized, resulting in limited agency and poor social and health outcomes. The lived experience of structural vulnerability prefigures the actions and efforts of undocumented Latino contingent workers. In this article, the capacity for Latino laborers to maneuver and negotiate the travails of everyday life is explored.
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http://dx.doi.org/10.1080/01459740.2011.576904DOI Listing
July 2011

Structural vulnerability and health: Latino migrant laborers in the United States.

Med Anthropol 2011 Jul;30(4):339-62

Department of Anthropology, San Francisco State University, 1600 Holloway Ave., San Francisco, CA 94132, USA.

Latino immigrants in the United States constitute a paradigmatic case of a population group subject to structural violence. Their subordinated location in the global economy and their culturally depreciated status in the United States are exacerbated by legal persecution. Medical Anthropology, Volume 30, Numbers 4 and 5, include a series of ethnographic analyses of the processes that render undocumented Latino immigrants structurally vulnerable to ill health. We hope to extend the social science concept of "structural vulnerability" to make it a useful concept for health care. Defined as a positionality that imposes physical/emotional suffering on specific population groups and individuals in patterned ways, structural vulnerability is a product of class-based economic exploitation and cultural, gender/sexual, and racialized discrimination, as well as complementary processes of depreciated subjectivity formation. A good-enough medicalized recognition of the condition of structural vulnerability offers a tool for developing practical therapeutic resources. It also facilitates political alternatives to the punitive neoliberal policies and discourses of individual unworthiness that have become increasingly dominant in the United States since the 1980s.
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http://dx.doi.org/10.1080/01459740.2011.576725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146033PMC
July 2011