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Directions in national immigrant health National Symposium on
Immigrant Health
Citizenship andImmigration Canada
Citoyenneté etImmigration Canada
Medical Services - Services medicaux
March 2003
CIC Medical Services - Services medicaux
The Evolution of Immigration Health
• A meeting of history and science• A function of globalization• An important aspect of the process
of population mobility• An important component of future
population health
CIC Medical Services - Services medicaux
What is the presentation about?
• A short explanation of how immigration health developed
• A description of new challenges • A review of new policy approaches
CIC Medical Services - Services medicaux
Canadian Immigration - Historical Perspectives
(1860-2000)
CIC Medical Services - Services medicaux
Policy Basis of Immigration Health
• frontier based• historic quarantine linkages• housed in immigration legislation• focused on denial of admission
CIC Medical Services - Services medicaux
Image: US National Library of Medicine
CIC Medical Services - Services medicaux
New Challenges
• Demography– different than when the initial policies
were developed
• Global disparity– Continuing and in some cases
increasing– Migration up the development scale
CIC Medical Services - Services medicaux
Needs
• Increased focus on outcomes• Increased flexibility to monitor a
rapidly evolving migrant population
CIC Medical Services - Services medicaux
Modern Aspects of Migration that can Affect Health
• Changes in patterns of source countries
• Continued and profound disparities in the health sectors between source and destination– economic– social – epidemiological
CIC Medical Services - Services medicaux
CIC Medical Services - Services medicaux
Canadian Immigrant Source Regions Past 40 Years
(MacDonald BS Transatlantic Economic Issues and their Security Implications Atlantic Council Members Paper 03/02)
0
20
40
60
80
100
Europe Americas Asia Africa
1961 1971- 80 1991- 96 2000- 01
CIC Medical Services - Services medicaux
Results
• Increased #s of arrivals with health “experiences” more common at the migrant’s origin than Canada– potential for future impact on health systems
and sector– rapid national population shifts in as short as
a decade (3 million arrivals in 10 years)– arrivals of groups of migrants who may need
specific attention
CIC Medical Services - Services medicaux
Current Challenges and Policy Initiatives
• Historic focus was inadmissibility – screening focus limited to exclusion (few)– limited attention on long term impacts of
arrivals (TB good example)– limited attention on forward looking issues of
those who arrive– the impact of the unscreened arrivals
(refugee claimants)
CIC Medical Services - Services medicaux
Policy is designed for Homogeneous Populations -
Migrants Vary
• While the unifying factor may be being foreign born, other characteristics can be markedly different:– History– Economic status– Education– Legal status– Local environment
• All of these characteristics can affect health outcomes
CIC Medical Services - Services medicaux
Limits of “Foreign Born” Approaches
• Great disparity in the immigrant population– subpopulations with great need may
be lost in denominator
• Rapid shifts in migration demographics challenge systems– particularly true of refugee
populations
CIC Medical Services - Services medicaux
Distribution of reported TB cases by origin in Canada : 1980 - 2001
0
10
20
30
40
50
60
70
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Perc
ent o
fCas
es
Foreign born
Canadian born non-aboriginal
Canadian born
Aboriginal
l
CIC Medical Services - Services medicaux
Limits of “National” Approaches
• Dispersion patterns are non uniform– variable population-based
consequences in some locations– differential needs based on prevalence
• Results in greater impact in metropolitan areas– specific needs – predictive capacity
CIC Medical Services - Services medicaux
Immigration by Province - 2001
0
20000
40000
60000
80000
100000
120000
140000
160000N
FLD NS
QU
E
MA
N
ALT
A BC
YU
K
CIC Medical Services - Services medicaux
Metropolitan Destination
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
St.
Jo
hn
s
Hali
fax
St.
Jo
hn
Qu
eb
ec
Mo
ntr
eal
Ott
aw
a
To
ron
to
Ham
ilto
n
Win
nip
eg
Reg
ina
Ed
mo
nto
n
Calg
ary
Van
co
uver 1992
Metropolitan Destination the 90's
1992 2001
CIC Medical Services - Services medicaux
Looking at the Future
• The legislative requirements for medical screening will remain– the need to manage admission– health as determinant
• The process presents an opportunity– the introduction to the national health
system
CIC Medical Services - Services medicaux
Greater Focus on Those Admitted
• It is the health of those who arrive that affects national outcomes
• Historically limited to TB and syphilis.– Now consideration for other conditions– Non infectious illnesses– Immunization– Health prevention and promotion
CIC Medical Services - Services medicaux
Use of the Immigration Medical Exam as an opportunity for Health Intervention
• Pre-arrival treatment for illnesses prevalent in migrant groups and uncommon at destination– tropical diseases
• malaria• intestinal parasites
CIC Medical Services - Services medicaux
Use of the Immigration Medical Exam as an opportunity for Health Intervention II
• Immigration required HIV testing– not for exclusion– for identification of those who need
counselling and treatment• clear high risk migrant groups• even though totals are low
CIC Medical Services - Services medicaux
HIV Positivity by StatusNovember 12, 2002
N = 231
Claimants45%
Refugees 23%
All Others32%
CIC Medical Services - Services medicaux
The Future of Immigration Health
• Continued regulatory purposes – Public Health and Safety– Demand issues
• Entry point for health care sector– immunization– prevention– promotion
CIC Medical Services - Services medicaux
Policy Directions
• Better data linkages• Better long term modeling
– impact of existing prevalence gaps• chronic infections• preventive practices
• More attention to specific sub groups /locations with increased risks– refugees and vulnerable populations– metropolitan issues
CIC Medical Services - Services medicaux
Conclusions
• The demography and national population characteristics demonstrate that immigration will be one of the most significant factors for future health
• Improved understanding of immigration health dynamics will be need to better manage the issues