Embodied Politics: Indigenous Migrant Activism, Cultural Competency, and Health Promotion in California

209 Pages·2022·2.552 MB·English

by  Rebecca J. Hester

Embodied Politics
Critical Issues in Health and Medicine
Edited by Rima D. Apple, University of Wisconsin– Madison and
Janet Golden, Rutgers University–C amden
Growing criticism of the U.S. healthcare system is coming from consumers,
politicians, the media, activists, and healthcare professionals. Critical Issues
in Health and Medicine is a collection of books that explores t hese contem­
porary dilemmas from a variety of perspectives, among them po liti cal, legal,
historical, soc io log i cal, and comparative, and with attention to crucial dimensions
such as race, gender, ethnicity, sexuality, and culture.
For a list of titles in the series, see the last page of the book.
Embodied Politics
Indigenous Mi grant Activism,
Cultural Competency,
and Health Promotion in California
Rebecca J. Hester
Rutgers University Press
New Brunswick, Camden, and Newark, New Jersey, and London
Library of Congress Cataloging- in- Publication Data
Names: Hester, Rebecca J., author.
Title: Embodied politics: indigenous mi grant activism, cultural competency,
and health promotion in California / Rebecca J. Hester.
Other titles: Critical issues in health and medicine.
Description: New Brunswick: Rutgers University Press, [2022] | Series: Critical issues
in health and medicine | Includes bibliographical references and index.
Identifiers: LCCN 2021035470 | ISBN 9780813589497 (paperback; alk. paper) |
ISBN 9780813589503 (hardcover; alk. paper) | ISBN 9780813589510 (epub) |
ISBN 9780813589527 (pdf) | ISBN 9780813598017 (mobi)
Subjects: MESH: Health Promotion | Transients and Mi grants | Indigenous Peoples |
Cultural Competency | California | Mexico— ethnology
Classification: LCC RA447.C2 | NLM WA 300 AC2 | DDC 362.109794— dc23
LC rec ord available at https:// lccn . loc . gov / 2021035470
A British Cataloging- in- Publication rec ord for this book is available from the British Library.
Copyright © 2022 by Rebecca J. Hester
All rights reserved
No part of this book may be reproduced or utilized in any form or by any means, electronic
or mechanical, or by any information storage and retrieval system, without written permis-
sion from the publisher. Please contact Rutgers University Press, 106 Somerset Street,
New Brunswick, NJ 08901. The only exception to this prohibition is “fair use” as defined
by U.S. copyright law.
References to internet websites (URLs) were accurate at the time of writing. Neither the author
nor Rutgers University Press is responsible for URLs that may have expired or changed since
the manuscript was prepared.
The paper used in this publication meets the requirements of the American National
Standard for Information Sciences— Permanence of Paper for Printed Library Materials,
ANSI Z39.48-1992.
www . rutgersuniversitypress . org
Manufactured in the United States of Amer i ca
Contents
Preface vii
Chapter 1 The Paradoxical Politics of Health Promotion 1
Chapter 2 Structural Vio lence, Mi grant Activism,
and Indigenous Health 30
Chapter 3 The “Mexican Model” of Health: Examining the
Travels and Translations of Health Promotion 55
Chapter 4 Números, Números, Números: Making Health
Programs Accountable 90
Chapter 5 Cultural Sensitivity Training and the Cultural Politics
of Teaching Tolerance 118
Chapter 6 La Lucha Sigue: Mi grant Activism and the Ongoing
Strug gle to Promote Indigenous Health 147
Acknowl edgments 163
Notes 167
Index 185
v

Preface
It is a bad time to question the politics of public health promotion. On the heels
of a devastating pandemic that has killed millions of people worldwide, and in
a country that has had the most deaths, including disproportionate numbers of
racialized minorities, it seems hardly the moment to question w hether we want
public health experts telling us what to do and how to act. The obvious response
is that we do want public health advice in order to keep ourselves and our loved
ones safe and alive in the middle of a deadly crisis.
Yet, precisely because of the gravity of the situation and b ecause health
messages have become both ubiquitous and highly politicized, it is import ant to
take a closer look at the politics of public health promotion, perhaps now more
than ever. As many p eople in the United States have resisted the mask mandate
and refused to social distance, compliant publics and health experts alike have
questioned what is driving their beh av ior. Why have so many p eople acted con-
trary to the scientifically informed public health messages that are flooding the
airwaves, populating the media, and being reinforced at the entrance of every
shop, gym, and restaurant? At the same time, t hose who refuse to wear masks are
calling into question the pol iti cal and scientific establishments in the United
States, contesting the perceived infringement on their individual liberties. Tak-
ing a step back from these debates, we can ask why those with differing opi-
nions and approaches to health messages have clashed on social media, in
po liti cal fora, and in the streets. Why do some p eople follow public health guid-
ance to the letter, while others won’t at all, and still others do, but only some-
times? What is it about public health promotion that, literally and figuratively,
gets under neath people’s skin?
As we have seen in the pandemic, health messages affirm and challenge
beliefs about the individual body, society, and the body politic. They confirm
and disrupt p eople’s sense of what is right, what is good, and how they should
live. These messages carry with them notions of freedom and oppression, risk
and safety, responsibility and deviance, truth and falsehood. At the same time,
health messages underscore questions of citizenship, national belonging, and
the value and rights of a h uman life. For all these reasons, public health, and the
messages it promotes, is about more than just science. It is also about social val-
ues. It is about teaching us how we should live— and die— together and apart.
vii
viii Preface
Embodied Politics seeks to illuminate the influential force of public health
promotion in our lives. Returning us to a time before the pandemic, it investi-
gates an initiative for indigenous mi grant communities in California that sought
to mitigate their structural vulnerability through health workshops, messages,
and social programs. Offering a snapshot in time of their programming, I recon-
struct how t hese programs came to exist and describe how they operate. At the
same time, I point out the conflicts, res is tances, and counteractions that emerge
through this initiative’s attempts to guide the beh av ior and practices of indige-
nous Mexican mi grants.
Based on two intensive years of binational ethnographic research from 2006
to 2008, Embodied Politics specifically focuses on the Indigenous Health Proj-
ect, a program implemented by La Agencia, a nonprofit with offices in vari ous
cities throughout California.1 Although my fieldwork ended in 2008, I contin-
ued to be involved in the organ ization as a board member and then as an exter-
nal adviser until 2015. Since that time, I have remained in touch with many of
the activists, advisers, board members, and employees involved in La Agencia’s
development and growth. In the years a fter completing my fieldwork I went to
work at a medical school in Texas, where I studied how doctors are trained to
deal with cultural and linguistic diversity. During that period I stopped work-
ing on this book in order to focus on teaching medical students to be ethically
sensitive and culturally competent. The more I taught and interacted with med-
ical trainees, however, the more convinced I became that the lessons I had
learned in my fieldwork were relevant to their training because they troubled
the commonsense approaches to bioethics and cultural competence in health-
care. The debates and controversies about public health, mask-w earing, and vac-
cines that occurred around the pandemic only solidified my conviction that
both public health and biomedicine could learn something from my experience
working with indigenous Mexican mi grants.
By examining the politics of health promotion before it became such a hot
button issue, I suggest that we can gain a greater understanding of health pro-
grams, practices, be hav iors, debates, cultures, and controversies. While much
of what is written here offers a snapshot of the time that I was in the field work-
ing closely with the organ ization staff, the information I provide offers lessons
for today insofar as community health worker, or promotora, programs have
grown exponentially across California and the United States, and many of the
health imperatives and approaches to cultural competency outlined h ere remain
at the core of these programs. Further, the structural racism, linguistic and cul-
tural marginalization, and social injustices experienced by indigenous Mexican
farmworkers in the early 2000s continue t oday. They have also had an impact
Preface ix
on recently arrived indigenous mig rants from Central Ameri ca. This is to say
that, while much has changed, many of the dynamics outlined in this book con-
tinue to be reproduced within and beyond the communities under study.
I write first and foremost for the activists, pract i tion ers, philanthropists,
and scholars who care about social justice, health equity, and the well- being of
mi grants, refugees, and indigenous peoples. But Embodied Politics is also for
those who may not understand how the promotion of health can work against
the values to which they aspire or against the values of the communities that
they serve. Before I began this research, I would have found such an idea to be
both scandalous and offensive. As a former nonprofit worker in a mig rant farm-
worker community, it was clear to me that to improve their health outcomes
people needed health information and health education delivered in their own
language by p eople from their own community. I knew that the provision of this
education was clearly an issue of social justice. Yet, as I came to learn, health
promotion is not just educating p eople about their health, it is teaching them to
behave, to think, and to live in certain ways—w ays that are often in tension with
their expressed cultural values and practices and, more importantly, that can
undermine their health. This is why I conceptualize health promotion as an
embodied politics.
I am also writing this book for indigenous Mexican mig rants who are strug-
gling to define and affirm their cultural values, ideas, and histories across time
and space in the face of numerous, often invisible, forces that undermine both
their health and their knowledge systems. I hope that this book is seen as work-
ing in solidarity with their strug gle.