A Socio-Legal Critique on Denials, Delays and Barriers to Care: Health Care Access for Medically Uninsured Migrants in Toronto & Edmonton

The relationship between the denial of health care services for migrants with precarious status and racial capitalism is undertheorized in migration literature. This dissertation begins by problematizing racial capitalism as an emerging dominant ideology and rationality across Canada in order to bring recognition to how the ongoing denial of health care services (including right to life) to migrants with precarious legal status has become normalized and ultimately characterizes public health care as a service that only those viewed as ‘belonging’ become entitled to. This research employs governmentality as a research method to help investigate the government of migrants in their effort to access health care in Toronto and Edmonton. By researching these ‘assemblages of health care barriers’, attention is placed on the types of processes and techniques engaged in the government and subjectification of migrants in their efforts to access health care. An analysis of health and immigration laws as well as interview findings (n=30) with health care workers, civil society members, NGOs and migrant participants across Toronto and Edmonton revealed three findings. First, the techniques of systemic denials for health care by employers, health care institutions and government agencies ultimately work to normalize delays, denials and barriers of care by recrafting who belongs and doesn’t belong in the process. Second, the systemic barriers and denials to health care for migrants with precarious status is supported by the dominant political rationality of racial capitalism. Through the legitimization of differentiated forms of labour that are often characterized by race, the denials of rights, such as public health care entitlements become normalized in the process. Third, reform and resistance efforts in support of expanding health care entitlements necessitate mobilization from both within and beyond the law. The limitations of court interventions at this time are documented by tracing Nell Toussaint’s legal efforts domestically and abroad to bring about change and calls for the support of a multilevel mobilization strategy when it comes to advocating for expanded health care entitlements. Interviewed participants employed the political framings of (1), firsthand story and rights-based framing, (2), economic framing and (3), consciousness raising of global asymmetries of power in effort to resist the taken for granted racial capitalist regime that underpins the government of health care and the normalization of denied care. Participant experiences ultimately reveal that the legacies of public health care as an exclusionary system continue to manifest today at the local level and that feelings of belonging and health care entitlements are uniquely intertwined.

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