This research is grounded in a body of scholarship that examines how healthcare access is shaped by policy, governance, and broader systems of inequality. Rather than viewing barriers to care as isolated issues, this work draws on multiple fields to understand how inequities are produced, experienced, and sustained.
Social Citizenship and Conditional Access
Social citizenship frames healthcare as a core social right linked to inclusion within society. However, access to this right is not always universal in practice. Research shows that non-citizens, including asylum seekers, often experience what has been described as conditional or partial access to social protections. In this context, healthcare access becomes unstable and dependent on legal status, administrative eligibility, and institutional processes.
Governance and Institutional Practice
Public sector governance research highlights how policy is translated into practice through administrative systems and frontline decision-making. Programs such as the Interim Federal Health Program operate through complex eligibility rules and reimbursement processes, requiring interpretation by healthcare providers and administrators. As a result, access to care is shaped not only by policy design, but by how policies are applied in real-world settings.
Migration, Health Inequities, and Structural Determinants
Research on migration and health demonstrates that refugees and asylum seekers experience significant barriers to healthcare access. These barriers are shaped by structural factors such as legal precarity, discrimination, language, and unfamiliarity with healthcare systems. This work emphasizes that inequities are not simply individual challenges, but are produced through broader social, economic, and institutional conditions.
Narratives of Deservingness
Access to healthcare is also influenced by broader social and political narratives about who is considered entitled to care. Research shows that ideas about deservingness can shape policy decisions, institutional practices, and interactions within healthcare settings. For asylum seekers, these narratives may influence how access to care is interpreted and delivered.
Intergovernmental Fragmentation
In Canada, healthcare and immigration are governed at different levels. Federal programs such as the Interim Federal Health Program operate within provincially administered healthcare systems. This division creates a fragmented policy environment, where responsibilities are distributed across jurisdictions and coordination is often uneven. These dynamics can contribute to gaps and inconsistencies in access to care.
Community Responses and System Gaps
Community organizations play an important role in supporting access to healthcare for asylum seekers, particularly where formal systems are difficult to navigate. While these organizations provide essential services, their role also highlights the limits of existing systems and raises questions about how responsibility for care is distributed across state and non-state actors.
Bringing These Perspectives Together
Taken together, these areas of research show that healthcare access is shaped through the interaction of policy design, governance structures, institutional practices, and lived experience. This study draws on these perspectives to examine how access to care is structured and experienced by asylum seekers in Ottawa, with particular attention to how barriers are produced across different levels of the system.