Health

Immigrants’ Access to Health Services

Scope of the Issue

The “healthy immigrant effect” refers to what researchers found in Canada and the United States. Immigrant newcomers were healthier than the native-born, but they lose this advantage over time(Gagnon 2002). Chen et al’s (1996) findings indicated that chronic health conditions, smoking, and disability were lower among recent immigrant (less than 10 years in Canada), versus long term immigrants (more than 10 years (Health Canada: Immigrants and Health).
Data from the 1990 Ontario Health Study shows that immigrants report health problems less often, but perceive their health less positively, than Canadian born (Metropolis: Immigration Health). Refugees’ health status is generally lower than that of immigrants due to the less stringent selection process they undergo (Metropolis: Immigrants and Health).
Newcomers are known to underutilize health services for which they are eligible due to barriers including: fear of jeopardizing immigration applications by seeking care, language barriers, culturally inappropriate care, and difficulties navigating the system, discrimination and racism (Gagnon 2002).
Twice as many lower-income immigrants report unmet health care needs in comparison to higher incomes (Chen, Ng, and Wilkins, 1996, Metropolis: Immigrants and Health).
At the same time, studies that analyze cost-benefit show that immigrants contribute more in taxes and productivity than they consume in government transfer payments and health care resources (Asch and Waitzkin 1992, Metropolis: Immigrants and Health).
Refugees, particularly women and children are considered to be at a higher risk of general and mental health problems (Gagnon 2003). In fact, a study shows that first-generation immigrant women have higher mortality rates from suicide than Canadian-born counterparts (Metropolis: Immigrants and Health).
Socio-economic status is one of the prime determinants of health, thus the increasing poverty rates in which immigrant live accounts for the loss of the healthy immigrant effect advantage.This is augmented by barriers to social inclusion such as language, education and employment opportunities, and discrimination (Health Canada: Immigrants and Health).

Impacts

Mental illness in Canada is costing the country approximately $4.7 billion dollars per year directly, and another $3.2 billion indirectly (Citizens for Mental Health Backgrounder).
The social integration of newcomers can be a healthy or unhealthy process that can lead to additional stress, depression and other health issues(Metropolis: Immigrants and Health).
Mental health issues among immigrants and refugees are due to negative attitudes toward immigrants and refugees, separation from family and community, inability to speak English and French, un/underemployment, being elderly/adolescent at the time of migration, being a woman from a country in which gender roles differ those in Canada (Metropolis: Immigrants and Health). In addition, immigrant and refugees also experience a drop in socio-economic status after migration, lack of support from ethnocultural community, traumatic experience prior to migration (Citizens for Mental Health Backgrounder)
Research shows that “many low income immigrants and refugees have no family, community of support in heir new homes and are profoundly isolated and alone” (Martin Spigelman Research Associates, Metropolis: Immigrants and Health). Social support networks is a major contributor to one’s health.
Statistics show that newcomer youth are twice as likely to suffer from depression as individuals older than 35. Immigrant youth faces issues of identity formation at the time of migration and depression. Their suicide rates indicate their distress and vulnerability (Citizens for Mental Health Backgrounder).
Persons who are experiencing mental health problems may be reluctant to seek help due to the stigma attached to mental illness, cultural and linguistic barriers (Citizens for Mental Health Backgrounder).
Discrimination also negatively impacts immigrants’ health status. In 1994, there were an estimated 60,000 hate crimes committed, of which 84% were against racial or religious minorities.
Studies also show the potentially higher rates of industrial accident. Immigrants and refugees were found to be over represented in high risk occupations such as manufacturing and construction (Metropolis: Immigrants and Health).

Current and Ongoing Initiatives

Federal

The Canada Health Act was developed with an “equalizing” focus on access to services, which was deemed a prime determinant of health (Gagnon 2002).
Canada has responded to certain needs for access to care of refugees and asylum seekers (who do not fall under the Canada Health Act) through the implementation of the Interim Federal Health Program (IFHP). This program still presents barriers due to delays in the immigration process, limitations in coverage to only essential services, and errors in form completion (Gagnon 2002). IFHP also places an administrative burden on service providers.
The Romanov Commission recommends addressing the “health care needs of Canadians”, which includes the needs of diverse groups of Canadians, including newcomers, and visible minorities. It also recommends ensuring “that the health care system responds to the unique needs of official language minorities”.
Health Canada’s determinants of health are a holistic perspective on well being. Their effort in recognizing culture, employment, social inclusion and education as particularly important determinants of health in immigrant population resulted in the promotion of cultural competence in the delivery and access of services.
The Metropolis Project brought together policy makes from the 3 levels of government, NGOs, and researchers to address the impact of migration on Canada’s major cities.
The Multilingual-Health-Education Network funded by Health Canada and Heritage Canada, aims to improve standards and procedures translating patient education and improving access by making translated materials easily available to the public.

Provincial

The Canada Health Act guarantees access to hospitalization and physician services to Canadians (Romanov 2002). Each province defines health services covered and varies according to the immigrant class of the individual.
The Alberta Public Health Association has approved Resolution 4, which calls for standards to mandated public health information for non-English speaking Albertans in 2003. This provides that the APHA will support and promote together with the Regional Health Authorities and Alberta Health and Wellness, “equal access to current, accurate, accountable health information materials” for non-English speaking minorities.

Municipal

Many Canadian hospitals are responding to diversity by implementing institutional change to address access issues such as interpreter services, bilingual workers, health information in first language etc.

NGOs

The Canadian Alliance on Mental Illness and Mental Health (CAMIMH) is a national coalition of consumer, family, professional and community organizations. It is working towards a national action strategy on mental illness and health and to ensure they are federal priorities. Their 2000 national strategy focused on public education and awareness as well as a national policy framework.
In 1998, the Canadian Council for Refugees published “Best Settlement Practices”, which are guidelines for optimal care. The core values are: access, inclusion, empowerment, user-defined services, holism, respect, cultural sensitivity, community development, collaboration, accountability, focus on positive change, and reliability.

Community Actions

Work with settlement agencies and ethnocultural groups to introduce newcomers to the Canadian health care system. “Private health care concerns immigrant people what would happen if the private health care came from true. Let’s work to stop it.”

Community Participants

Advocate for changes in health services for immigrants and refugees in the health care system.
Initiate dialogue with health service providers and institutions to increase their understanding of cultural issues affecting health.
Work with other groups to prevent stop of health care.

Programs and Services

“Universal healthcare should be increasingly responsive to the needs of ethnic minorities in affordability and accessibility as well as cultural competence. By recognizing the cultures brought by immigrants/ refugees, the delivery of health services should incorporate these to become more holistic and explore other issues related to health. An example is the integration of cultural practices into social service systems. Thus, the development of a national healthcare initiative should include alternative healing practices as part of health care practice.”
Community Participants New programs for ethnic minorities within a separate department to provide services relevant to various population groups.
Increase health coverage to cover dental health, vision etc.
Increase number of minority health care professionals in the health care system.
Culturally competent services and training should be part of the health professional’s curriculum.
Increase resources for interpretation and translation of services.
More research on the interrelation between culture and ethnicity and other health determinants involving minority researchers and professionals.
Research on contribution of foreign trained health care providers on immigration and health (Metropolis: Immigrants and Health).

Thoughts on Policy Actions

Develop and implement federal standards on culturally and Linguistically appropriate health care services.
Review the principles guiding health care policies to recognize diversity, cultural competence and equity.
There is a need to consider and examine how the privatization of the healthcare system will impact newcomers.
There is a need to promote and implement policy actions to address determinants of health.