The complexity of change : an interdisciplinary analysis of health care organizations’ responses to ethnic diversity in Vancouver and Montreal

Research demonstrates that immigrants and racialized populations continue to face notable barriers in accessing health care in Canada. The legislation and public discourse includes multiculturalism, human rights and universal health care, which should be a favourable climate for access; yet research demonstrates it can be challenging for immigrants and ethnically diverse communities to fully exercise those rights. This dissertation explores access barriers through bringing together an analysis of discursive practices in health care and an institutionalist account of responses to facilitating health care access for immigrants and ethnically diverse communities. Both direct attention to local and historical contexts, with health care discourses additionally focusing on the relationships and engagement between health care providers and diverse communities. The aims of this study are to understand the convergence and divergence of framing health care access between health service providers and representatives of immigrant associations, and to explore initiatives to foster access. This research provides a review of Canadian federal and provincial policy on health care, human rights and multiculturalism. I also held interviews with immigrant associations and health service providers in Vancouver and Montreal, who were asked to identify access barriers, and to discuss and assess strategies they are engaged in to address these barriers. The examination of engagement processes provides an exploration of potential sites for change. The dissertation examines processes of engagement between health care service providers and immigrant associations aimed at improving access, and shares participants’ perspectives on the changes attributed to these engagement processes. The data demonstrate that despite a favourable policy climate for ensuring service access, all respondents felt that immigrants face barriers when accessing health care services. Engagement can bring together respective and complementary knowledge of the social contexts, institutional norms and experiences to inform strategies for improving access, although there are additional factors that frame if and how these recommendations are realized at the point of care. The results demonstrate that strategies to address immigrants’ access barriers to health care should take on the structural constraints that shape access, and changes in practices on the ground that address interpersonal relationships between patients and care providers.Graduate and Postdoctoral StudiesGraduat