Graduation Year


Document Type




Degree Granting Department


Major Professor

Nancy Romero-Daza, Ph.D.

Committee Member

Jay Sokolovsky, Ph.D.

Committee Member

David Himmelgreen, Ph.D.


barriers to care, cultural competence, torture, refugee, asylum


Despite the fact that the United States spends more per capita than any other nation on healthcare for its citizens, the quality of American health outcomes lags well behind every other developed country in the world. This paper proposes that it is no coincidence that the United States is also the only developed nation that does not guarantee the right comprehensive coverage of medical services for its citizens. Instead, we rely on a fee-for-service system which functionally denies quality health care to those without the means to pay for it. In this paper I document the experiences of various clients and staff of the Center, a torture survivor treatment and support agency, the majority of whose clients are or were refugees or political asylees, with the healthcare systems in the United States and elsewhere. I also analyze documented differences in the efficiency, efficacy, and levels of satisfaction with these foreign health care systems to that of the United States. The barriers to good quality health care experienced by the participants in this research are systemic, rather than individualistic, in nature. I therefore argue that the American ideology of health as a commodity to be bought and sold directly contributes to the inferior health outcomes of the United States health care delivery system, as compared to other nations whose ideology of health holds it to be a universal human right.