“Over-Foreignization” or “Unused Potential”? A critical review of migrant health in Germany and responses toward unauthorized migration

Persons of migrant background, a highly heterogeneous group, now comprise one-fifth of the total population in Germany. However, delayed and conflicted responses to social inclusion have resulted in clear deficits in the health care system, with few serious attempts to assess migrants’ profiles and needs. This article provides a critical review based on meta-analysis of literature indexed in MEDLINE, a qualitative review of German medical and nursing curricula, and original ethnographic data. It examines discourses and practices embedded within larger national debates on migrant integration and their specific manifestations in the health sector in order to explain the current situation of unauthorized migrants. The historical arc of the last fifty years can be viewed as a progression of key themes based on interrelated concepts of deservingness and selective investment. Relative deservingness is evident in differential social positioning and access to resources, resulting in selective investment and decades of continued social inequality.

► In Germany, conflicted responses to migrants’ inclusion resulted in health deficits.
► Critical review based on literature meta-analysis, curricula, and ethnographic data.
► Historical debates on integration explain current situation of unauthorized migrants.
► ‘Relative deservingness’ and ‘selective investment’are useful analytical concepts.