Marginalisation and the Work of Making Healthcare Accessible

Dr Elisabeth Langmann, Caroline Miles Visiting Scholar

Navigating healthcare can be difficult for almost anyone. For some people, however, access to appropriate care depends substantially on others who help prepare questions, interpret information, coordinate between services, or insist that a concern is taken seriously. This support may be particularly important when healthcare institutions fail to accommodate different communication needs, forms of knowledge, or capacities to navigate complex systems. While such work is often indispensable, it also remains largely invisible.

Informal supporters may be partners, family members, friends, neighbours, or other trusted persons. Their involvement can make healthcare accessible, where institutional arrangements, procedures, or expectations would otherwise create barriers. At the same time, their work raises a more fundamental question: What does it tell us about a healthcare system when some people can access and participate in care only because another person performs this additional labour?

These questions were at the centre of my research as a Caroline Miles Scholar at the Ethox Centre in May 2026. During my month in Oxford, I worked on a broader project examining marginalisation not simply as a condition affecting particular groups, but as a relational and context-dependent process through which healthcare institutions generate and sustain disadvantage. Drawing on interviews with informal supporters, I explored what their experiences reveal about the marginalisation of people whose access to care depends on this additional support, as well as the less visible ways in which exclusion is produced and compensated for.

Much of my time at Ethox was spent bringing the empirical and conceptual strands of this work into closer conversation. The scholarship gave me the opportunity to step back from my day-to-day responsibilities, focus on the normative implications of the findings, and develop a manuscript that connects them with debates in feminist bioethics, structural approaches to healthcare, and theories of epistemic injustice.

The stay offered something that is often difficult to create in academic life: sustained time to remain with an argument. I was able to write, revise, return to the interview material, reconsider distinctions, and gradually develop the different parts of the project. This concentrated writing time was one of the most valuable aspects of the scholarship. During this process, I also had the opportunity to present the developing work at an Ethox seminar. This was a great chance to share the argument at a stage when some questions were still open and to discuss their scope and limitations. It was valuable to see which parts of the argument resonated and where further clarification was needed.

Beyond my own project, I particularly appreciated how quickly I felt included in the everyday life of Ethox. Weekly meetings, talks by other visitors, shared lunches, and conversations over coffee, created many opportunities not only to learn about other areas of research, but also to get to know the people behind the projects. Some of these conversations continued in Oxford’s pubs, where discussions moved easily between current research, academic life, and the larger questions that kept occupying us. These moments were among the parts of the stay I valued most. Over the course of the month, this everyday rhythm also made Oxford feel less like a place I was simply visiting and more like a place in which I had briefly developed a routine of my own.

The wider university environment also formed an important part of the experience. I attended talks, workshops, and reading groups across Oxford and met colleagues at the Institute for Ethics in AI, where I had great conversations about technology, institutions, and justice. At the same time, the month was not only about attending events and working on my manuscript. It also gave me a taste of what it is like to live and work in Oxford: walking through the city, spending time in libraries and cafés, discovering different colleges, and gradually developing familiar routines and places. Spending a month there in spring was, of course, a pleasure in its own right, with many of the college gardens in bloom and the city at its most beautiful.

I left Ethox with substantial progress on my writing and a clearer articulation of an idea at the centre of the project: marginalisation becomes visible not only in moments of explicit exclusion, but also in the additional work required to make healthcare accessible in the first place. I also left with many wonderful memories, new connections, and friendships that I hope will continue beyond the scholarship.

I am very grateful to everyone at the Ethox Centre for welcoming me so warmly and making it so easy to feel part of the community, and to the Caroline Miles Scholarship for giving me the time and space to advance this work. I hope to remain connected to the Centre and to continue the academic and personal conversations that began during my month in Oxford.