title: 'Underclassism' and access to healthcare in urban centres.
abstract: In this article, we draw on findings from an ethnographic study that explored experiences of healthcare access from the perspectives of Indigenous and non-Indigenous patients seeking services at the non-urgent division of an urban emergency department (ED) in Canada. Our aim is to critically examine the notion of 'underclassism' within the context of healthcare in urban centres. Specifically, we discuss some of the processes by which patients experiencing poverty and racialisation are constructed as 'underclass' patients, and how assumptions of those patients as social and economic Other (including being seen as 'drug users' and 'welfare dependents') subject them to marginalisation, discrimination, and inequitable treatment within the healthcare system. We contend that healthcare is not only a clinical space; it is also a social space in which unequal power relations along the intersecting axes of 'race' and class are negotiated. Given the largely invisible roles that healthcare plays in controlling access to resources and power for people who are marginalised, we argue that there is an urgent need to improve healthcare inequities by challenging the taken-for-granted assumption that healthcare is equally accessible for all Canadians irrespective of differences in social and economic positioning.
authors.affiliation: School of Nursing, York University, Toronto, Ontario, Canada.
authors.forename: Sannie Y
authors.initials: SY
authors.lastname: Tang
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Browne
authors.affiliation: Sal'i'shan Institute Society, Chilliwack, British Columbia, Canada.
authors.forename: Bill
authors.initials: B
authors.lastname: Mussell
authors.affiliation: Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Smye
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rodney
mesh_terms: D002170:Canada; D004636:Emergency Service, Hospital; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006786:Hospitals, Urban; D006801:Humans; D007198:Indians, North American; D008297:Male; D011203:Poverty; D063505:Racism; D012959:Socioeconomic Factors; D012962:Sociology, Medical; D014505:Urban Population
keywords: Canada; Indigenous peoples; healthcare access; healthcare inequities; poverty; racialisation; social inequity; urban health; ‘underclass’