Refugees as ‘Others’: Social and cultural citizenship rights for refugees in NZ health services

Citizenship, as effective social, cultural and economic participation for refugee groups, depends on appropriate institutional structures and processes in resettlement societies. This thesis using critical social theoretical perspectives addresses the paradox of being legally a citizen, but substantively excluded from the very rights that constitute such citizenship. The thesis draws on theoretical models of newcomer integration in order to promote the development of a more inclusive society for refugees in New Zealand. The issues to be considered include responses from central government and from public institutions—particularly health, education, employment and welfare—in addressing social exclusion and promoting integration. The questions of refugee integration to be addressed conceptually must take into consideration cultural and religious diversity, on the one hand, and socio-economic inequality on the other. In New Zealand, the 1987 review of refugee resettlement policy, which established an annual quota of 750 places, has given priority to those with the highest health and social needs and removed preferences for specific national, ethnic and religious groups. Significantly, in the 1990s radical neo-liberal economic reforms were introduced and publicly provided health, education and welfare systems were restructured. This posed serious challenges to the core idea of social citizenship in general in New Zealand society. Noticeable ethnic diversification has been just one element of the resettlement policy changes; the other has been long-term social and economic exclusion in the refugee groups settled since this time. This study indicates that New Zealand’s notably humanitarian refugee resettlement policy is not matched by adequate central government and public institutional responses and resources with which to integrate refugee groups. This qualitative study examines the role of one institution in particular, health care. The study takes a multi-method approach, using historical and social policy analysis to set the structural context for the interpretation of data from participant interviews. During fieldwork, twenty-eight semi-structured interviews were conducted with health care providers in community, primary and secondary care sectors in the Auckland region, in both governmental and non-governmental agencies. This research demonstrates at a service level, the consequences of overlooking refugee peoples in New Zealand social policy, data collection systems, research and health strategies. Importantly though, the research discovers a number of ‘activation points’—or approaches that have been developed by health care practitioners—that highlight future opportunities for the inclusion of refugee groups. One finding is that the New Zealand health system must address the question of how to effect a shift from universalist conceptions of generalised eligibility for health services to targeted interventions for refugees. The conclusions drawn from the study are: firstly, that an overarching integration policy for refugees, led by central government, is required. Secondly, institutional responses that accommodate the special psychosocial, socio-economic and cultural/religious requirements of refugee groups are needed. This would include the development of a locally relevant multiculturalism to guide social policy in New Zealand. In the long-term, for peoples from refugee backgrounds to become full political, social, economic and cultural members of New Zealand society, there needs to be a rethinking of the contemporary models of citizenship offered.