Landscapes of Care: Immigration and Health in Rural America by Thurka Sangaramoorthy (review)

Reviewed by:

• Landscapes of Care: Immigration and Health in Rural America by Thurka Sangaramoorthy
• Theodore L. Michaels and Seth M. Holmes

Thurka Sangaramoorthy. Landscapes of Care: Immigration and Health in Rural America. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2023. xxii + 174 pp. $22.95 (978-1-4696-7417-9).

In Landscapes of Care, Thurka Sangaramoorthy invites readers to Maryland’s Eastern Shore, a profoundly rural area that has seen a significant rise in immigration over the past decades for its low-wage employment opportunities in seafood, livestock, and agriculture. Through compelling vignettes, the book guides readers through the Eastern Shore’s “landscape,” as its history and current state shape its residents’ health: from macro features of racial capitalism and health care corporatization to local geographies of care, to ethnic hierarchies at workplaces (p. xiv). As a dual-trained medical anthropologist and public health practitioner, Sangaramoorthy aptly integrates concerns for pressing material disparities with diverse theorizations of precarity, infrastructure, and temporality.

This book foregrounds the “inextricability of immigration and rural health” through three primary claims (p. 16). First, Sangaramoorthy contests “myth-making” about the rural as “pristine” and white to frame it instead as an area of remarkable poverty and flux of migrant workers (p. 15). Second, she situates racial capitalism as the fundamental organizing principle of immigrant health; immigration status, which has frequently occupied this position for popular media and many academics, is then shown to be a sequela of corporate interests.¹ Third, neo-liberal policies and extractive capitalism have withered rural health infrastructure to leave only an “archipelago” of “Band-Aid” care for those most in need (p. 113).

Sangaramoorthy revises common portrayals of the rural United States as “overwhelmingly white and racially homogenous, geographically isolated, and stuck in time” (p. 25). Throughout rural areas, the historical decline of manufacturing and concomitant white flight engendered an influx of low-paying employers that attracted migrant workers. The Eastern Shore exemplifies the variegated nature of these patterns. The activity of U.S. Immigration and Customs Enforcement (ICE), the primary governmental body incarcerating and deporting people without documentation, varies across geographic locales, thus corralling migrants to areas that experience less surveillance (p. 85). This tendency effectively reproduces segregation with a capitalist complexion: geographic overlap between low-wage industry and little surveillance indicates a functional collusion between the state and corporations. Compounding the complexity of these geographies, many migrants seasonally shuttle between Maryland and other locations, such as Florida, [End Page 335] for work. Sangaramoorthy’s incisive analysis of the rural recasts an antiquated stereotype into a topology of racist, bureaucratic, and political-economic vectors.

In a second re-presentation, Landscapes of Care endeavors for racial capitalism to supplant immigration status as the conceptual center for interpreting issues of migrant labor and health. Sangaramoorthy problematizes the analytic of immigration for, on one hand, “[flattening] immigrant knowledge, experience, and social identities” (p. 11) and, on the other, limiting the horizons of interventions from questioning the state’s “foundational tenets” to creating “more humane” conditions for migrants (p. 121). Matters of immigration status frequently surface as this argument unfolds, though Sangaramoorthy consistently articulates them in relation to racial capitalism. For example, employers extensively drive immigration through H-2A and H-2B work visas (e.g., pp. 33, 50). To offer employment under these visas, companies must demonstrate the need for foreign workers, which motivates these companies to artificially portray need by inadequately advertising jobs (p. 57). When insufficient visas are granted, employers petition congress for visa expansions (p. 132). In this creation of a nationalist hierarchy, private interests effectively control the entrance of migrants and thus state policy. Ethnic and gendered hierarchies at the workplace imbricate as local corollaries to these transnational processes. Where Sangaramoorthy finds a tension between her analysis of these issues and those that employ theories of structural vulnerability (e.g., pp. 11, 50), we find an excellent focalization of certain critical elements in that literature that has articulated citizenship, class, racialization, gender, etc.² We admire Sangaramoorthy’s trenchant critique of how the racial and the gendered dimensions of labor interface with the capital-infused U.S. border.³

The third central argument of this...