Review of Embodied Politics: Indigenous Migrant Activism, Cultural Competency and Health Promotion in California By Rebecca J. Hester, New Brunswick, NJ: Rutgers University Press. 2022. 208 pp.

Reviewed Book

Embodied Politics: Indigenous Migrant Activism, Cultural Competency and Health Promotion in California By Rebecca J. Hester, New Brunswick, NJ: Rutgers University Press. 2022. 208 pp.

Cover of Embodied Politics (2022)

Óscar F. Gil-García

University at Buffalo

Rebecca J. Hester’s Embodied Politics: Indigenous Migrant Activism, Cultural Competency and Health Promotion in California is a transnational study of how the logic of neoliberalism shapes health promotion strategies provided to Indigenous migrant communities in California. Many of Hester’s informants are Indigenous Mixtec and Triqui from Oaxaca, Mexico, where numerous government leaders have embraced neoliberal principles of personal responsibility over collective accountability. Simultaneously, the policy of mestizaje—an ideology used to regulate race and gender relations between the Indigenous and non-Indigenous—granting participants recognition by the secular state in exchange for Indigenous communities’ compliance with neoliberal economic policies have proved harmful to their autonomy (Blackwell, 2012; Hale, 2005). These factors, along with the rise of narcoviolence, and femicides have contributed to the outmigration of Indigenous Mixtec and Triqui to the United States.

Upon arriving to the United States, Indigenous migrants confront an increasingly unwelcoming national context. Barriers to health and social services limit these arrivals to nonprofit health agencies. Among these agencies is the Indigenous Health Project (IHP), a health promotion program housed in La Agencia de Bienestar Indígena (La Agencia), a non-profit with over 30-years of programmatic experience responding to the complex needs of this diverse population throughout southern California. Hester studies the IHP using the frameworks of governmentality and structural violence to document how staff, service providers, and philanthropists negotiate the delivery of services that purport to at once affirm, but also change Indigenous modes of life. This dual mission gives rise to what Hester calls a “paradoxical politics” whereby the language of cultural competence, a concept that essentializes difference for the benign purpose of fostering humility among service providers, provides cover to promote individual behavioral health approaches. Rather than argue that the adoption of medicalized biomedical approaches to health are antithetical to Indigenous collectivist forms of care, Hester notes how the paradoxical practice of essentializing and challenging static notions of Indigeneity serves as a pragmatic strategy to advance the political aim of survival. As IHP founders and service providers are Indigenous, their adoption of such a strategy reveals how their effort to instill personal responsibility for program participants’ health reveals how definitions of Indigeneity are redefined and embodied through performance.

The first chapter introduces the reader to the IHP and the community health workers (promotoras) who service a growing population of Indigenous Triqui and Mixtec along a central coast town and in the Central Valley of California. To complement ethnographic observations in these locations, Hester interviewed residents, promotoras, and doctors across three separate towns in Oaxaca, along with public servants who worked in the Mexican Institute for Social Security and Mexico City (IMSS). We also learn that Hester provided professional support in several of the IHP’s day-to-day activities and later accepted a position in La Agencia’s board of directors. Hester acknowledges how her deep engagement within a health promotion program “may subtly work against the social justice agendas that migrant activists advocate” (17). The author’s ability to acknowledge how researchers may be implicated in reinforcing the structures they critique illustrates how the ethnographic project is often an unequal one. Guided by a critical lens, Hester studies how the complex power dynamics operating in these various field sites, including “Western structures and systems of knowledge” (28) reshape how Indigeneity is lived and practiced among Triqui and Mixtec in California.

Chapter 2 shifts to identify the structural determinants that contribute to endemic adversity for Indigenous Triqui and Mixtec throughout Mexico and the United States. These factors contributed to the creation of the Binational Indigenous Resistance Movement (BIRM) and La Agencia. BIRM operates in Mexico and the United States and focuses on political organizing and rights education, whereas La Agencia is a fiscal agent that supports BIRM activities while also providing social services that foster civic participation and Indigenous cultural development throughout California. La Agencia’s Indigenous Health Project was born from the activism of farmworker women who developed health education workshops about “breast cancer, diabetes, pesticides in the fields, along with domestic violence” (49). Hester explains how Indigenous health workers, promotoras, played a central role in the IHP’s culturally competent approach to health and culture. Hester argues how La Agencia’s programs promote “structural competency,” which acknowledge how diverse structural factors contribute to poor health. Paradoxically, La Agencia’s structural analytic that identifies how immigration and health care policies are both barriers to health care access for the Indigenous and also embedded within the organization’s cultural competence guidebook. Hester argues that despite efforts to advance a structural analysis, La Agencia and the IHP also engaged in practices that reinforced the very inequalities they opposed.

Chapter 3 traces how the contradictory aims of La Agencia and the IHP are shaped by a neoliberal logic whereby powerful nation-states and multilateral agencies have both reoriented health promotion as a vehicle for empowerment to a “rubric of scarcity.” Impoverished countries, beholden to structural adjustment policies that required the repayment of onerous loans, were forced to adopt selective over comprehensive primary health care. The selective primary health care model relies on the promotion of cultural attributes whereby individuals recognize themselves as agents in the care of selves, families, and communities. Hester then traces how the priorities of affluent nation-states shape the “Mexican Model” of health that also included poverty alleviation schemes that have been shown to reinforce gender and racial inequality (Gil-García, 2016). The neoliberal logic that undergirds the “Mexican Model” of health, and that of other impoverished countries, leverage the discourse of empowerment to transmit ideas of how the Indigenous can exhibit idealized “‘healthy’ neoliberal consumer citizens” (89).

Chapter 4 explores how audit culture pervaded the day-to-day activities of La Agencia and the IHP. According to Hester, audit culture, which requires quantifying the services provided by nonprofit organizations to targeted populations, is a logical extension of “global health” priorities that privilege targeted selective health promotion (under the guise of empowerment) for the world’s poor. Unfortunately, the author reveals how the demand for numerical accountability fueled mistrust and anxiety among staff who competed with one another, and at times caused ethnic resentment over perceived favoritism when a promotora provided resources to program participants. Operating in a resource poor environment meant that even service providers were not immune to the worries shared by program participants. For example, at an organizational retreat, La Agencia announced how the financial budget could not adequately support everyone’s salary, prompting a series of discussions on how to maintain operations under an even tighter budget. Of all the options provided, an agreement was made for all members to give back a percentage of their income to prevent layoffs. Hester, however, aired her disagreement with the BIRM and La Agencia leadership as an unsustainable arrangement that would place vulnerable workers in further financial precarity. Despite her role as a board member and adviser to both organizations, the rest of the leadership dismissed her concerns, and instead likened the arrangement to tequio, “a form of unpaid labor common among Indigenous communities that is organized for collective benefit” (106). These structural constraints undermine Indigenous Mexican migrants’ health standing, but also legitimate the existence these nonprofits as they can claim to have the “expertise” needed to use Indigenous culture to “empower” participants to adopt risk-averse behaviors that may foster optimal health.

Chapter 5 revisits La Agencia’s paradoxical politics that informs its use of a cultural competency lens to represent the Indigenous to non-Indigenous health and social service providers in cultural sensitivity training workshops. The goal is: “to improve the well-being of [I]ndigenous communities and educate providers on the functioning of the US health and social service systems” (126). Presenters, including the author, engage in a practice that essentializes Indigeneity as a monolithic identity shaped by a political economy of mutual reciprocity. Building on Wendy Brown’s insight on how the discourse of tolerance is leveraged by those in power to mark the practices engaged by abject groups as deviant, Hester argues how La Agencia trainings replicate this unequal dynamic by not questioning how health and social service audience members maintain their superior position to practice tolerance. According to Hester, use of cultural sensitivity trainings by La Agencia can be disempowering because it elides how dominant groups are implicated in the historical and structural factors that contribute to forms of everyday racialized violence experienced by the Indigenous throughout the Americas (135–38). Despite the depoliticizing orientation of cultural competency trainings, what Hester calls a “new racism” (146), she alerts readers that La Agencia’s pragmatic strategy of essentializing culture should not be read as foreclosing the organization’s potential for promoting a more radical political project. While the author briefly mentions how the organization works with others throughout the hemisphere engaged in advancing social justice claims for Indigenous groups, a deep examination of how these took shape and the exact claims made are unexplored.

Chapter 6 summarizes the book’s major arguments and identifies institutional and ideological changes within La Agencia. The author identifies how two women now lead the organization that has historically been run by men. Hester attributes this change to the organization’s youth leadership program, as instrumental in actively nurturing female leadership. Hester interviewed the incoming executive director who shared her vision in shifting the organization’s focus on helping clients navigate social and health services, which due to racialized immigration laws, are overwhelmingly inaccessible to them. While the new incoming leader expressed an interest to focus on more structural change, exactly how this would be pursued was left unanswered. Also left unexplored is the gendered dynamics that shaped the day-to-day functioning of the organization. How did gender power dynamics inform the organization’s decision to enforce tequio among staff? Was the sexual and gendered identity of most or all health workers cisgendered female? Does this explain the use of the Spanish term promotoras, the gendered plural form to identify female health workers? Did unequal gendered power relations within the organization inform the creation of a youth leadership program? And to what degree do youth inform the political orientation of La Agencia? Given the book’s opening account of femicides in Mexico as part of a broader system of structural violence that contribute to the outmigration of Indigenous Triqui and Mixtec from Oaxaca, Mexico, the absence of a critical gendered analysis is a missed opportunity to illuminate how Indigenous migrants engage in decolonial antiracist activism to reclaim the dead and dignify the living.

Overall, Embodied Politics makes a valuable contribution to the field of medical anthropology. The text is well suited for upper-division undergraduate and graduate courses in medical anthropology, applied anthropology, and cultural anthropology. The book will complement other readings that explore the structural dynamics that shape international migration and the processes of racialization that delimit the human potential of Indigenous peoples.


Blackwell, Maylei 2012. “The Practice of Autonomy in the Age of Neoliberalism: Strategies from Indigenous Women’s Organizing in Mexico.” Journal of Latin American Studies 44(04): 703–732.

Gil-García, Óscar F 2016. “Gender Equality, Community Divisions, and Autonomy: The Prospera Conditional Cash Transfer Program in Chiapas, Mexico.” Current Sociology 64(3): 447–469.

Hale, Charles R. 2005. “Neoliberal Multiculturalism: The Remaking of Cultural Rights and Racial Dominance in Central America.” PoLAR: Political and Legal Anthropology Review 28(1): 10–19.