directions in national immigrant health national symposium on immigrant health citizenship and...

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


What is the presentation about?

• A short explanation of how immigration health developed

• A description of new challenges • A review of new policy approaches


Canadian Immigration - Historical Perspectives

(1860-2000)


Policy Basis of Immigration Health

• frontier based• historic quarantine linkages• housed in immigration legislation• focused on denial of admission


Image: US National Library of Medicine


New Challenges

• Demography– different than when the initial policies

were developed

• Global disparity– Continuing and in some cases

increasing– Migration up the development scale


Needs

• Increased focus on outcomes• Increased flexibility to monitor a

rapidly evolving migrant population


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


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


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


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)


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


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


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


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


Immigration by Province - 2001

0

20000

40000

60000

80000

100000

120000

140000

160000N

FLD NS

QU

E

MA

N

ALT

A BC

YU

K


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


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


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


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


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


HIV Positivity by StatusNovember 12, 2002

N = 231

Claimants45%

Refugees 23%

All Others32%


The Future of Immigration Health

• Continued regulatory purposes – Public Health and Safety– Demand issues

• Entry point for health care sector– immunization– prevention– promotion


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


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

directions in national immigrant health national symposium on immigrant health citizenship and...

Documents

health systems

health outcomes

specific attention slide

health sectors

health experiences

health changes

development scale slide

denial of admission