Table 2.
Structural determinants of health | Intermediary determinants of health | Health consequences |
---|---|---|
Political views and practices in Canada Institutionalization of temporariness - Complexity of migratory system - Politically produced precarious immigration status Stigmatization/illegalization/criminalization - Considered morally inferior - Considered taking advantage of the system/costly - Threat to national security (Un)deservingness Invisibilization - Limited data - Unofficial healthcare provision - “Don’t ask, don’t tell” policy Rights - Health as human right - Health as a human right vs. right of citizens Myth of universal healthcare - Universal versus selective healthcare system Intersectional social position - Nationality/immigration status - Social class/occupation - Gender/sexuality - ‘Race’/ethnicity |
Living conditions - Poor housing conditions - Food insecurity Working conditions - Financial insecurity/low wages - Precarious working conditions - Deportability Social practices - Social isolation - Social network mobilization - Health care avoidance Psychosocial conditions - Lack of social support - (In)visibility - Fear of deportation - Fear of debt - Powerlessness/hopelessness - Autonomy and resilience Healthcare - Lack of coverage - Access does not ensure utilization - Barriers and facilitators: gatekeeping/administrative, sustainability, provider ideology - Limited access to healthcare - Fear of using services (deportation risk) - Differential utilization according to social position/intersectionality - Debt due to healthcare Social services - Lack of access to education - Barriers and facilitators: gatekeeping/administrative, sustainability, provider ideology - Limited access to social services - Fear of using services (deportation risk) - Differential utilization according to social position/intersectionality |
Broad impact on health and wellbeing Physical health - Increased risk of complications - Poorer health outcomes - Accidents - Domestic violence - Pregnancy and obstetric issues - Increased rate of HIV Mental health and wellbeing - Inability to plan for future - Stress/Fatigue - Anxiety - Depression - PTSD - Addictions Lower quality care - Limited or lack of continuity of care - Seeking care only for emergencies |