Equity in Policy and Health: Examining Inequalities in Job Quality of Caregivers, Refugees’ Health Care Access, and the Health Disparity of Health Care Workers in Canada

Abstract

This dissertation examines how structural inequities in Canada’s health and labour systems shape the well-being and inclusion of marginalized populations, with a focus on the convergence of migration, social policy, and health. Across three chapters, it integrates qualitative, policy, and quantitative analyses to explore how institutions and labour markets perpetuate health disparities among Personal Support Workers (PSWs), refugees, and immigrant or visible minority health care workers. Together, the studies demonstrate ways that systemic inequality, policy design, and institutional neglect sustain vulnerabilities that undermine both population health and workforce stability.

Chapter 2 is a qualitative study that investigates the multidimensional challenges of frontline eldercare work and the job quality of personal support workers (PSWs). The study employs semi-structured interviews with participants who played different roles at eldercare settings (N = 8). The sample included personal support workers (PSWs), Directors of Care (DOCs), and other frontline and supervisory eldercare personnel. Applying the OECD Job Quality Framework, the study finds that PSWs and other eldercare staff experience chronic employment insecurity, emotional exhaustion, and limited institutional recognition. All these conditions worsened during the COVID-19 pandemic. Participants reported heightened physical and psychological strain, severe shortage of staffing, and inequitable workloads, particularly in long-term care facilities. The study highlights how gendered and racialized or visible minority jobs reinforce structural and systemic inequities. The findings of this study suggest that the sustainability of eldercare depends on comprehensive policy reforms that address wages, regulation, and professional recognition.

Chapter 3 is a study that applies social justice theories to critique the equity implications of federal refugee health care policy reforms. It critically assesses the 2012 IFHP cuts, which restricted refugees’ access to health care services, and the 2016 reinstatement that only partially restored refugees’ health care coverage. The analysis situates these policy shifts within Canada’s neoliberal transformation toward market-oriented governance, emphasizing cost containment over social equity. Drawing on migration studies literature, the chapter demonstrates how refugee health care policy operates as a mechanism of “differential inclusion”, where societal status hierarchy (i.e., citizen, claimant, asylum seeker) determines access to care. These exclusions reinforce health inequities among refugees and contravene Canada’s stated commitments to health care’s universality and health care as human rights. The study concludes that equitable health care access to all is both a social justice imperative and a public health necessity.

Chapter 4 is a quantitative study on health care workers’ health disparity in Canada. It utilizes data from the Survey on Health Care Workers' Experiences During the Pandemic (SHCWEP) to examine how immigration background and visible minority status are associated with perceived health. Using survey-multivariate logistic regression, the study finds that both immigrant and visible minority health care workers have significantly higher odds of reporting poorer perceived health compared to their non-immigrant, non-visible minority counterparts. Findings reveal that immigrant visible minority health care workers experience the greatest disadvantage. Socioeconomic and age gradients were also observed and were consistent with existing literature. Overall study results demonstrate that systemic inequalities within health care institutions mirror that of broader society, which underscores the need for inclusive policies and targeted supports.