Politicizing the White Coat: Physician Activism and Asylum Seeker Healthcare in Canada, Germany and England

Abstract

The Canadian identity narrative typically centres on two features: universal healthcare and a longstanding tradition of welcoming newcomers – in particular, refugees. In 2012, this mythology was troubled when, without warning, asylum seekers’ healthcare access was dramatically limited. In an equally dramatic fashion, physicians and the greater healthcare community took to the streets, occupied offices, and interrupted politicians in an effort to restore refugee claimants’ access to healthcare. While this physician-led response was unprecedented in Canada, physicians had previously rallied in a similar fashion in two other universal healthcare countries: England (2003) and Germany (1993). Across all three cases, formidable physician responses emerged following efforts to remove or restrict asylum seekers’ healthcare access. In Canada, asylum seeker health restrictions, and the successful social movement they spurred were unexpected entirely. In England, attempts to restrict access are expected, but the government’s failure to implement wide-scale reforms are not. Finally, in Germany, restrictions are potentially expected, but one also expects the decades-long advocacy movement to have created national-level change; instead, ripples of impact are seen unevenly across the country. This prompts two central questions: what conditions are necessary for a national government to successfully implement restrictions on asylum seeker healthcare? And, what conditions will support physician-led social movements’ efforts to reverse these legislative changes? This thesis examines these two questions in a three-case comparison of Canada, England and Germany. Drawing on over 60 qualitative interviews with physicians, policymakers, and politicians, this study takes an ecological approach to understanding what factors facilitate reform, and what factors shape advocacy movements. In particular, this study identifies factors at each of the macro, meso, and micro-levels of analysis to map advocacy movements against their institutional contexts and political climates. By examining social movements as creatures of their policy and ideational contexts, this thesis provides a holistic examination of the people, organizations, and institutions that shape asylum seeker healthcare. This study identifies features of movements and contexts that will impact advocacy efforts; these findings are of use to scholars of social movements but also everyday advocates and persons driving change in asylum seeker social policy.