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Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan


  • Huffman, Samantha A.
  • Veen, Jaap
  • Hennink, Monique M.
  • McFarland, Deborah A.


In recent years, Kazakhstan has become an important destination for primarily undocumented seasonal workers from Uzbekistan. In a context of high tuberculosis (TB) incidence, TB treatment is provided free for all residents in Kazakhstan, but migrants rarely access these services. This paper reports findings from a qualitative study conducted with migrants, TB patients and health care workers between July and September 2008 to understand the mechanisms that impede migrants’ access to care. Findings describe three structural contexts – the employment, legal and health care contexts – which act in concert to render migrants vulnerable to exploitative work conditions and cause a series of barriers to health care. These conditions contribute to increased exposure to TB, heightened risk of reactivation due to weakened immunity, treatment-seeking delays, and increased severity of disease. Seasonal migration patterns also contribute to treatment interruption, which constitutes a risk for the creation of drug resistance. Using the theory of structural violence coupled with the concept of cumulative vulnerability, this paper analyzes how illegality interacts with exploitation and social marginalization to produce vulnerability to TB and restrict access to treatment.

Suggested Citation

  • Huffman, Samantha A. & Veen, Jaap & Hennink, Monique M. & McFarland, Deborah A., 2012. "Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan," Social Science & Medicine, Elsevier, vol. 74(6), pages 864-872.
  • Handle: RePEc:eee:socmed:v:74:y:2012:i:6:p:864-872
    DOI: 10.1016/j.socscimed.2011.07.019

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    References listed on IDEAS

    1. Castañeda, Heide, 2009. "Illegality as risk factor: A survey of unauthorized migrant patients in a Berlin clinic," Social Science & Medicine, Elsevier, vol. 68(8), pages 1552-1560, April.
    2. Ensor, Tim, 2004. "Informal payments for health care in transition economies," Social Science & Medicine, Elsevier, vol. 58(2), pages 237-246, January.
    3. Joana Godinho & Jaap Veen & Masoud Dara & James Cercone & José Pacheco, 2005. "Stopping Tuberculosis in Central Asia : Priorities for Action," World Bank Publications, The World Bank, number 7256, Juni.
    4. Crighton, Eric J. & Elliott, Susan J. & Meer, Joost van der & Small, Ian & Upshur, Ross, 2003. "Impacts of an environmental disaster on psychosocial health and well-being in Karakalpakstan," Social Science & Medicine, Elsevier, vol. 56(3), pages 551-567, February.
    5. Lönnroth, Knut & Jaramillo, Ernesto & Williams, Brian G. & Dye, Christopher & Raviglione, Mario, 2009. "Drivers of tuberculosis epidemics: The role of risk factors and social determinants," Social Science & Medicine, Elsevier, vol. 68(12), pages 2240-2246, June.
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    Cited by:

    1. Gulnaz Isabekova, 2019. "The Contribution of Vulnerability of Labour Migrants to Drug Resistance in the Region: Overview and Suggestions," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 31(3), pages 620-642, July.
    2. Doris Burtscher & Rafael Van den Bergh & Ulan Toktosunov & Nilza Angmo & Nazgul Samieva & Eva P Rocillo Arechaga, 2016. "“My Favourite Day Is Sunday”: Community Perceptions of (Drug-Resistant) Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-16, March.
    3. Bruno Abarca Tomás & Christopher Pell & Aurora Bueno Cavanillas & José Guillén Solvas & Robert Pool & María Roura, 2013. "Tuberculosis in Migrant Populations. A Systematic Review of the Qualitative Literature," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    4. Pam Kumparatana & Francine Cournos & Assel Terlikbayeva & Yelena Rozental & Louisa Gilbert, 2017. "Factors associated with self-rated health among migrant workers: results from a population-based cross-sectional study in Almaty, Kazakhstan," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(5), pages 541-550, June.


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