Is ‘Candidacy’ a Useful Concept for Understanding Journeys through Public Services? A Critical Interpretive Literature Synthesis

Across the public sector there is concern that service uptake is inequitably distributed by socio-economic circumstances and that public provision exacerbates the existence of inequalities either because services are not allocated by need or because of differential patterns of uptake between the most and least affluent groups. A concept that offers potential to understand access and utilization is candidacy' which has been used to explain access to, and utilization of, healthcare. The concept suggests that an individual's identification of his or her candidacy' for health services is structurally, culturally, organizationally and professionally constructed, and helps to explain why those in deprived circumstances make less use of services than the more affluent. In this article we assess the fit of candidacy to other public services using a Critical Interpretive Synthesis of three case studies literatures relating to: domestic abuse, higher education and environmental services. We find high levels of congruence between candidacy' and the sampled literatures on access/utilization of services. We find, however, that the concept needs to be refined. In particular, we distinguish between micro, meso and macro factors that play into the identification, sustaining and resolution of candidacy, and demonstrate the plural nature of candidacies. We argue that this refined model of candidacy should be tested empirically beyond and within health. More specifically, in the current economic context, we suggest that it becomes imperative to better understand how access to public services is influenced by multiple factors including changing discourses of deservedness and fairness, and by stringent reductions in the public purse.