Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis
Bibliographic record
Abstract
Abstract Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.014 | 0.022 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.007 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".