Different subjects: the health care system's participation in the differential construction of the cultural citizenship of Cuban refugees and Mexican immigrants

Med Anthropol Q. 2004 Dec;18(4):472-89. doi: 10.1525/maq.2004.18.4.472.


This paper explores the public health system's differential construction of Mexican and Cuban immigrants' "deservingness" of citizenship benefits and its preparation of them for different roles in U.S. society. Civic institutions such as the public health care system are charged with inculcating normative behavior in immigrants and instilling in them different conceptions about their rights and responsibilities. Faced with limited resources under the implementation of Medicaid managed care, hospital administrators created new categories of "deserving" and "undeserving" immigrants based on neoliberal standards of individual responsibility and self-discipline. As a result, hospital policies construct different types of "cultural citizenship" for Cuban and Mexican immigrants, preparing the former to be active citizens and discouraging the latter from pressing demands on American civil institutions. I show that this negative construction of Mexican immigrants' moral worth leads to unmet health needs and poor health outcomes.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cuba / ethnology
  • Delivery of Health Care / organization & administration
  • Emigration and Immigration*
  • Health Services Accessibility* / organization & administration
  • Hospital Administration
  • Humans
  • Legislation, Hospital
  • Medicaid / organization & administration
  • Mexico / ethnology
  • New Mexico
  • Politics
  • Public Policy*
  • Refugees*
  • Socioeconomic Factors
  • United States