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From its inception, the public safety net in the United States has excluded many people because of their race, gendered roles, or other factors. As a result, they must prove their moral worthiness to get resources for themselves and their families. In When Care Is Conditional, sociologist Dani Carrillo reveals the ramifications of this conditional safety net by focusing on one particularly vulnerable population: undocumented immigrants.

Through in-depth interviews with Latinx immigrants in northern California, Carrillo examines three circumstances—place, gender, and immigration status—that intersect to influence an individual’s access to health care, food assistance, and other benefits. She demonstrates that place of residence affects undocumented immigrants’ ability to get care since more services are available in urban areas, where many immigrants cannot afford to live, than suburban areas, where public transportation is limited. She also shows that while both men and women who are undocumented have difficulty obtaining care, men often confront more challenges. Undocumented women who are pregnant or mothers are eligible for some government safety net programs and rely on informal coethnic networks or a “guiding figure”—a relative, friend, neighbor, or coworker—who explains how to get care and makes them feel confident in accessing it. Most undocumented men, in contrast, are not eligible for public programs except in a medical emergency and often lack someone to guide them directly to care. Men sometimes steer one another to jobs through worker centers—where they may learn about various services and take advantage of those that increase their employability, like English or computer classes—but a culture of masculinity leads them to downplay medical problems and seek health care only in a crisis.   
 
As undocumented immigrants navigate this exclusionary system, Carrillo finds that they resist the rhetoric stigmatizing them as lawbreakers. Dismissing the importance of “papers” and highlighting their work ethic, they question the fairness of U.S. immigration policies and challenge ideas about who deserves care.

Carrillo offers concrete recommendations, such as improving labor conditions and reexamining benefit eligibility, to increase access to care for not only undocumented immigrants but also people who have been excluded because of their race, criminal record, gender identity, sexual orientation, or disability. She argues that working with and across populations creates a powerful form of solidarity in advocating for inclusive care.
When Care Is Conditional provides compelling insights into how safety net and immigration policies intersect to affect people’s everyday lives and calls for a cultural shift so that the United States can provide unconditional care for all.
 

A provocative chronicle of how US public health has strayed from its liberal roots.

The Covid-19 response was a crucible of politics and public health—a volatile combination that produced predictably bad results. As scientific expertise became entangled with political motivations, the public-health establishment found itself mired in political encampment.

It was, as Sandro Galea argues, a crisis of liberalism: a retreat from the principles of free speech, open debate, and the pursuit of knowledge through reasoned inquiry that should inform the work of public health.

Across fifty essays, Within Reason chronicles how public health became enmeshed in the insidious social trends that accelerated under Covid-19. Galea challenges this intellectual drift towards intolerance and absolutism while showing how similar regressions from reason undermined social progress during earlier eras. Within Reason builds an incisive case for a return to critical, open inquiry as a guiding principle for the future public health we want—and a future we must work to protect.