With Canadian family size averaging 1.9 children per household in 2011 (Statistics Canada, 2012), immigration remains an economic imperative for Canada’s continued dominance as one of the world’s economic power. The country seems to balance its book and meet the shortage of labour through various forms of immigration including skilled migration programs and admitting an increasingly large number of refugees from abroad and those that claim protection from within Canada.

For instance, in 2010, Canada accepted 24,696 refugees in all classes and admitted a total of 280,681 permanent residents in all categories (Citizenship and Immigration Canada-CIC, 2012). This has led the country to become one of the most diverse countries in the world. In 2001, for example, the proportion of foreign-born reached the highest in 70 years, visible minority population increased three-fold since 1981 with more than 200 ethnic groups being reported (Statistics Canada, 2003).

However, with such large number of immigrants and refugees making Canada their second home, the country seems to not care for these segments of the population in a way that it should. This can be evidenced by the fact that immigrants’ health on arrival is better and decline the longer they stay in the country (Ng, 2011) and the prevalence of certain health conditions disproportionately higher. Supporting this claim, a study conducted by Fenta, Hyman and Noh (2004) suggested that a lifetime prevalence of depression among Ethiopian immigrants and refugees to be 9.8%; slightly higher than the lifetime prevalence rate among Ontarians (7.3%).

Studies have shown that such a disproportionate health status has a significant impact on individual’s ability to contribute to the Canadian economy. (Stansfeld et al. 1995) Adding insult to an injury, however, the current overhaul to the immigration policies and other related service provisions such as health care (specifically the Interim Federal health Program-IFH) (CIC, 2012) may further aggravate these disproportionate health outcomes.In this paper, I will explore the prevalence of depression among immigrants and refugees, its impact and possible implications to Social Work practice.

Impact of depression

In its 2001 World Health Report, the World Health Organization-WHO indicated that mental disorders are growing worldwide and that more than 25% of all people will be affected at some time in their lives. Similar report ranked depression as the fourth leading cause of burden on society (WHO, 2001). The situation in the Canadian context does not seem any different. About 4% of Canadians reported symptoms which suggested that they had suffered an episode of major depressive disorder in the previous year in 1998/99 (Statistics Canada, 2001) Studies related to depression have long existed and engaged attentions of researchers since 1911 (Beck, 1961).

Among refugees and immigrants too, similar interest in the study of depression has been observed. It was investigated more than other mental illnesses among these particular segments of the population. Emily and colleagues (2012) conducted a literature review on rates of mental illness and suicidality in immigrant, refugee, ethno cultural, and racialized groups in Canada. Their analysis indicates that most of the studies they reviewed on mental illnesses of immigrants and refugees focused on depression. Although depression has been given such a due attention, estimates to its prevalence show different rates among the specific studies. Some reported a lower prevalence rate of 4.5% among adult immigrants and refugees while other showed a higher rate of 24.1%. This is evidenced by a study conducted by Lindert and colleagues (2009). Their analysis further indicated that the combined estimated prevalence for depression among refugees was 44%.

The discrepancy in prevalence rate of depression could be explained by inaccurate population counts, demographic differences between groups, the diverse nature of immigrants and refugees who are often lumped a one population group by geographic location (Emily, Tuck, Lurie, and McKenzie 2012). Despite such discrepancy in the prevalence rate of depression among immigrants and refugees, however, studies have shown that immigrants’ health on arrival is better and decline the longer they stay in the country (Ng, 2011) and that a lower prevalence rate of depression is observed at early stages of migration compared to the Canadian population.

Supporting this, Ali (2002) reported that compared to the Canadian-born population; the odds that immigrants experienced a depressive episode in the previous year were lower for recent cohorts but not for longer-term ones while this advantage was less pronounced with increasing length of residence in Canada. At a national level, this declining trend in mental health status, together with disproportionate disease burden such as depression have significant impact on the level to which immigrants and refugees contribute to Canada’s socio economic standing; the very reason why the government admits them to the country in the first place. Mirella (2011) indicates that employees with a mental illness have a high probability of experiencing reduced concentration, poor memory and other symptoms, depending on their personal circumstances and this, in the workplace, can impact negatively on their performance and attendance. Globally, the impact of such reduced performance is estimated at 70 billion annually (Tanouye, 2001).

In the Canadian context, the estimated total burden of $14.4 billion places mental health problems among the costliest conditions with the health care system sharing an estimated $278 million due to consultations with psychologists and social workers not covered by public health insurance (Stephens & Joubert, 2001). The mental health commission of Canada (2012), in its recently released national strategy, highlights how the impact of on individuals and family care givers cannot be over estimated. According to the strategy, depression and other similar mental illnesses overtake the lives of individuals and families by grief and distress.

Furthermore, stigma related to these conditions generate a tremendous sense of unwarranted shame and guilt, which can undermine caregivers’ confidence and well-being and have a long-lasting impact. The strategy also notes the negative impact on people living with mental health problems and illnesses, such as depression, affecting all aspects and stages of their lives– dealings with friends, family, communities, educators, employers, mental health service providers, and health care system. (Mental Health Commission of Canada, 2012)

Implications for Social Work Practice:

Systemic Level Advocacy on policy changes related to Interim Federal Health Program-IFHP Up to and including June 29, 2012, the services covered by the IFHP for all eligible beneficiaries included basic coverage (i.e., treatments normally covered by provincial or territorial health insurance plans); supplemental coverage (i.e., health-care benefits similar to those provided through provincial social assistance plans, such as drugs and dental and vision care); and costs related to the Immigration Medical Examination (IME) (CIC, 2012).

Refugee claimants, resettled refugees, persons detained under the Immigration and Refugee Protection Act, victims of trafficking in persons and the in-Canada dependants of these groups who are unable to pay for health care are eligible for benefits under the IFHP until they become eligible for provincial/territorial or private health plan coverage. Under this program, resettled refugees with provincial/territorial health coverage are provided with supplemental coverage for one year from the date of entry to Canada (CIC, 2011). After the changes are in place, the IFHP will offer only two basic types of coverage.1) Health-care services that are only of urgent or essential nature; medications and vaccines only when needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern or 2) Public Health or Public Safety Health-Care that will cover the cost of products and services only to prevent or treat a disease posing a risk to public health or a condition of public safety concern (CIC,2012).

The changes introduced to the Interim Federal Health Program become of critical importance for mental health status of refugees and new immigrants as they continue to face particular challenges that put their mental health at greater risk. They often have difficulty getting a job that matches their level of skills and education, earning a decent income, obtaining adequate housing, and face significant barriers to their seeking or obtaining help. (Mental Health Commission of Canada, 2012)

The new changes state that refugees and immigrants will receive Health-care services that are only of urgent or essential nature; medications and vaccines only when needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern (CIC, 2012). This means that a refugee who suffers from depression will not be able to receive adequate treatment; further aggravating his/her condition because such condition may not be perceived to be neither urgent nor a danger to the public. Mental health services in general are already given a lesser priority than most other services.

This is clearly reflected by the fact that only one in three people who experience a mental health problem or illness—and as few as one in four children or youth—report that they have sought and received services and treatment (Mental Health Commission of Canada, 2012). Given these, the restrictions introduced to the Interim Federal Health Program will create additional barrier to an already compromised system; adding insult to an injury.

Furthermore, the changes will gravely affect refugees’ and immigrants’ mental health situation in general who are at an even more disadvantage due to their culture and the systemic discrimination they face when it comes to accessing health services in general and mental health services in particular. For instance, a qualitative phenomenological study conducted by Martin and colleagues (2010) indicated that lack of trust in doctors and race of doctors were among factors that were influenced by culture and discrimination that participants faced. Furthermore, Gender and language of immigrants have also been found to greatly impact their access to health care (Pottie et al, 2008) adding more barriers to refugees’ and immigrants’ health care access.

Highlighting these significant impacts, Social Workers can and should challenge the government’s recent policy related to the interim Federal health Program-IFHP. This is primarily because they are uniquely placed to stress the impacts of such changes; especially through their professional value related to social justice. The validity of this unique Social Workers’ role to affect policies, according to Katz (1961) historically stems from the competency of professional social workers, the goals of social work itself, and its related professional ethics Hence, Social Workers can and should mobilize other professionals in the health field in an inter-professional collaborative manner to reverse these recent policy changes. They, for example can learn from best practices and join the call for action that has already been started by the Canadian Doctors for Refugees (2012).

Individual level Evidence based and culturally competent practice of specific interventions Advocacy and policy change takes time. Furthermore, policy changes might only be attainable through changes in the current political landscape. Social Workers, in the mean time, can have another key role in addressing immediate impacts of these policy changes by providing individual level interventions. As counselors and therapists, they can utilize evidence based and culturally competent approach to find effective intervention strategies that could address such mental illnesses as depression.

For instance, Stressing the fact that Cognitive Behavioral Therapy (CBT) recommended to be among the most effective treatments for major depression, Interian and Díaz-Martínez (2007) outlined a comprehensive analysis and Considerations for culturally competent cognitive-behavioral therapy for the treatment of depression with Hispanic patients. However, although the effectiveness of CBT as a intervention for the treatment of depression, Social workers need to consider other factors and look for more evidence before implementing such interventions. In cases of co-occurring conditions such as substance abuse, for example, the effectiveness has been found to be inconclusive by some studies.

Hides, Samet and Lubman (2010) did systematic review of clinical trials and found only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. Despite this conclusion, however, their study indicated that there is growing evidence that that the effects of CBT are durable and increase over time during follow up. In addition to other co-occurring conditions, some studies found limitations on the effectiveness of CBT for the treatment of depression among specific population too.

A study by Sandil (2006) found no empirical evidence for the efficacy of Cognitive behavioral therapy for adolescent depression among Asian immigrants in the United States and advised on the need to validate the use of CBT with this population. These studies indicate how it is important for practitioners to identify the person in an environment, be cognizant of cultural and individual factors and the extent to which interventions such as CBT must be guided by Evidence.Given their practice model, ethics and professional value, Social Workers remain uniquely placed to deliver on these.

Conclusion

Canada remains a multi-cultural country where immigrants and refugees contribute a great deal. However, studies show that they are at a disadvantage when it comes to their health and mental health status with disproportionate disease burden such as depression. Further aggravating this situation, misguided, recent policy changes seem to put them even at a greater disadvantage. Social workers, through their unique professional values such as Social Justice and effective practice models such as indentifying the person in an environment using a Biopsychosocial lens, can play a key role to effectively address these issues. They have a key role in advocacy and policy change, both as policy makers and implementers, on behalf of the people that they serve. On top of these, they must remain committed to provide culturally competent, effective and evidence based interventions at an individual level. Collaboration with other professional working for the wellbeing of society could greatly add to the effectiveness of these key roles Social Workers have.

References

Ali, J. (2002). Mental health of Canada’s immigrants Canadian community health survey – 2002 annual report. Health Reports, 13, 101. Beck, A. T. (1961). A systematic investigation of depression. Comprehensive Psychiatry, 2(3),163-170

Canadian Doctors for Refugees. (2012, June 18). Day of Action. Retrieved October 1, 2012, from Canadian Doctors for Refugees: http://www.doctorsforrefugeecare.ca/day-of-action-june-18.html

Canada’s ethno cultural portrait: The changing mosaic (2003). . Ottawa, ON: Statistics Canada. CIC. (2012, February 16). Facts and figures: Immigration overview- Permanent and temporary residents. Retrieved September 20, 2012, from Citizenship and Immigration Canada: http://www.cic.gc.ca/english/resources/statistics/menu-fact.asp CIC. (2012, April 25).

News Releases – 2012. Retrieved May 24, 2012, from Citizenship and Immigration Canada:http://www.cic.gc.ca/english/department/media/releases/2012/2012-04-25.asp CIC. (2012, June 11).

Refugees: Health Care. Retrieved October 3, 2012, from Citizenship and Immigration Canada:http://www.cic.gc.ca/english/refugees/outside/arriving-healthcare.asp

Emily, K. H., Tuck, A., Lurie, S., & McKenzie, K. (2012). Rates of mental illness and suicidality in immigrant, refugee, ethno cultural, and racialized groups in Canada: A review of the literature. Canadian Journal of Psychiatry, 57(2), 111.

Fenta, H., Hyman, I., & Noh, S. (2004). Determinants of depression among Ethiopian immigrants and refugees in Toronto. The Journal of Nervous and Mental Disease,192(5), 363-372.

Hides, L., Samet, S., & Lubman, D. I. (2010). Cognitive behavior therapy (CBT) for the treatment of co-occurring depression and substance use: Current evidence and directions for future research. Drug and Alcohol Review, 29(5), 508-517.

Interian, A., & Díaz-Martínez, A. M. (2007). Considerations for culturally competent cognitive-behavioral therapy for depression with Hispanic patients. Cognitive and Behavioral Practice, 14(1), 84-97. Katz, A. (1961). The social worker’s role in social policy. International Social Work, 4(2), 1-11.

Lindert, J., Ehrenstein, O. S. v., Priebe, S., Mielck, A., & Brähler, E. (2009). Depression and anxiety in labor migrants and refugees – A systematic review and meta-analysis. Social Science & Medicine, 69(2), 246-257.

Martin, S. S., Trask, J., Peterson, T., Martin, B. C., Baldwin, J., & Knapp, M. (2010). Influence of culture and discrimination on care-seeking behavior of elderly African Americans: A qualitative study. Social Work in Public Health, 25(3-4), 311-326.

Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary, AB Mirella S De, L. (2011).

Managing hidden illnesses that impact on performance and absenteeism. The Business Review, Cambridge, 19(1), 77.

Ng, E. (2011).The healthy immigrant effect and mortality rates. Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Santé / Statistique Canada, Centre Canadien d’Information Sur La Santé, 22(4), 25.

Pottie K, Ng E, Spitzer D, et al. Language proficiency, gender and self-reported health: An analysis of the first two waves of the Longitudinal Survey of Immigrants to Canada. Canadian Journal of Public Health 2008; 99(6): 505-10

Sandil, R. (2006). Cognitive behavioral therapy for adolescent depression: Implications for Asian immigrants in the united states of America. Journal of Child and Adolescent Mental Health, 18(1), 27-32

Stansfeld, S., Feeney, A., Head, J., Canner, R., North, F., & Marmot, M. (1995). Sickness absence for psychiatric illness: The Whitehall II study. Social Science & Medicine (1982), 40(2), 189-197.

Stephens, T., & Joubert, N. (2001). The economic burden of mental health problems in Canada. Chronic Diseases in Canada, 22(1), 18.

Statistics Canada. (2012, September 19). The Daily. Retrieved September 20, 2012, from Statistics Canada:http://www.statcan.gc.ca/daily-quotidien/120919/dq120919a-eng.htm Statistics Canada. Stress and Well-being. Health Reports (Statistics Canada. Catalogue 82-003) 2001; 12(3): 21-32

Tanouye E (2001). Mental illness: A rising workplace cost —- one form, depression, takes $70 billion toll annually; bank one intervenes early. Wall Street Journal World Health Organization (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva: World Health Organization.

 Introduction  

            Recent changes introduced to the Canadian Immigration Policy have been a subject of heated debate between the conservative government and various groups that advocate for immigrant and refugee rights. Major areas of debate focus on the government asserting its right to choose who should be allowed to settle in the country on one hand and advocate groups calling for the government to respect and abide by its international obligations on the other.

            One area of such debate is the change in the Interim Federal Health Program (IFHP); a temporary health insurance plan which is funded by the Citizenship and Immigration Canada to provide immigrants and refugees who are unable to pay for health care become eligible for benefits until they become eligible for a provincial/territorial or private health plan coverage.

            The government’s reasons for changing such a life saving and crucial health insurance plan is to reduce cost and the “extra” healthcare coverage supposedly provided to refugee claimants and to deter “bogus” refugees who come here to take advantage of Canada’s “Generous” immigration policy.

            However, the per capita cost for refugee claimants under the IFHP is only about 10% ($660 per year) of the average per capita cost for Canadians (CIC,2012); immigrants’ health on arrival is better and decline the longer they stay in the country (Ng, 2011) and the per capita refugee load Canada hosts is lower than that of the poorest countries (UNHCR, 2011).

            In this paper, I will provide a history lens on Canadian Immigration Policy to show possible reasons for the changes, their impact on health and mental health of refugees and how the rationale for changing the Interim Federal Health Program is another way to discriminate between deserving and undeserving immigrants.

Historical background

            Looking back at how Canada’s Immigration policy has been shaped during various periods of its history enables us to put the current debate in perspective and look back to see forward. Similar to the ongoing debate, Canada’s immigration policy have always been shaped by demographics, history, geography, economics and personal biases of those who are in charge of shaping and implementing it.

            During the mid-nineteenth century, Canada had a “Whites only” immigration policy that primarily stemmed from the xenophobia of that period. Reflecting such bias, the Immigration Act of 1910 established the right to prohibit “immigrants of any race deemed unsuited to the climate or requirements of Canada” (Hawkins, 1991).

            Such exclusionary immigration policies that primarily discriminated between deserving and undeserving immigrants had various forms. Some stated explicitly as a policy while others took a more subtle and implicit form. For example, the “head tax” on Chinese migrants in both Canada and the US began in 1885 and continued into the twentieth century with an annual head tax of $500 being applied to Chinese migrants and prohibition of Chinese women to Canada, which ensured that male migrants would not settle and raise families (Ralston, 1999).

            These historical accounts of exclusionary Canadian immigration legislations and procedures clearly show explicit ways of an anti-Asiatic bias and a preference for migrants fitting an Anglo centric and Gallic norm that persisted through the early 1960s (Richmond, 1976)

              Other implicit ways of restricting immigration and excluding undeserving individuals to settle in Canada have also been part of the immigration policy. For instance,  in 1907, the Canadian Government reached an agreement with its Japanese counterpart that the latter would allow no more than 400 Japanese to leave the country for Canada (Mongia 1999).   

            Similarly, British subjects from India were prevented from arriving in (British) Canada during the early 1900s by imposing a series of restrictions, such as the “continuous journey” requirement, that were racially exclusionary, but did not explicitly name “race” or “nationality” as the basis for keeping them out for a simple reason that they were seen as being an undeserving immigrants. The continuous journey requirement meant that all Indians arriving in British Columbia had to prove “continuous passage” (travel on a single ticket from India to Canada) at a time when no such single journey existed (Mongia, 1999). Such  explicit racial discrimination, however, was abolished later in 1962 when the then government established the “points system” (Richmond, 2001).

            Although these changes should be given a lot of credit for shaping the multicultural demographics of the country today, the current government seems to take it’s immigration policy back to the previous times when immigrants and refugees were stigmatized, excluded and discriminated against. For instance, explicitly stated Immigration messages characterize asylum seekers in a biased and stereotypical ways, suggesting that they are ‘bogus’ and are a drain on Canadian society. These beliefs, and not evidence, seem to be the primary sources of changes to policies and programs such as the IFH.

            Canada is not facing “floods of refugees”, as most suppose. Reports indicate that in 2010, 80% of the world’s refugees lived in the world’s poorest countries  and countries like Canada had only 4.2 refugees to GDP per capita compared to Pakistan at 709.7, Congo at 475, Kenya at 247.3 and Chad at 224.5 (UNHCR,2011). As such, there was no need to tamper with such life saving and crucial public policies and programs.

 

The Interim Federal Health Program (IFHP)

            In 2010, Canada accepted only 24,696 refugees in all classes; 11,000 fewer than the 35,776 refugees accepted in 2005. That same year, refugees in all classes accepted in Canada were about 13% of all permanent resident arrivals. Refugees accepted in 2010 were only 8% of all permanent resident arrivals, a drop of almost 5%. In 2005, the number of refugee claimants present in the country constituted approximately 0.3% of the Canadian population. In 2010 the percentage of refugees compared to the Canadian population was slightly lower at 0.28%. In 2010, 3,438 fewer refugee claimants entered Canada compared to 2005. (CIC, 2012)

            While such a declining trend is seen with respect to admission of forcibly displaced persons to Canada, the number of such population is on the rise globally. According to the UNHCR Global Trends Report 2010 released in 2011, roughly 43.7 million people are displaced worldwide out of which 27.5 million people are displaced within their own country due to conflict (UNHCR, 2011).

            The 1951 Convention Relating to the Status of Refugees, while not referencing health care specifically, sets out in other cases that refugees should have the same rights with regards to welfare as other nationals (e.g. public education, public relief as other nationals). Article 7 of the Convention states that, “except where this Convention contains more favourable provisions, a Contracting State shall accord to refugees the same treatment as is accorded to aliens generally.” (UNHCHR, 2007).        

            This suggests that a person who has the same access to healthcare as a national in a country of asylum is subject to a favourable protection situation, i.e. with regards to healthcare they are not at any particular disadvantage in the country of asylum relative to other refugees, foreign nationals, or nationals.

            Given such an international provision to which Canada is party, granting refugees access to healthcare is a matter of Canada carrying out its international obligation and not charity and/or generosity. As a result of such international conventions that the country signed, it’s policy has so far been consistent with implementing it. Especially when it comes to health care, where the Citizenship and Immigration Canada funds the Interim Federal Health Program (IFHP).

            Refugee claimants, resettled refugees, persons detained under the Immigration and Refugee Protection Act, victims of trafficking in persons and the in-Canada dependants of these groups who are unable to pay for health care are eligible for benefits under the IFHP until they become eligible for provincial/territorial or private health plan coverage. Under this program, resettled refugees with provincial/territorial health coverage are provided with supplemental coverage for one year from the date of entry to Canada (CIC,2011).

            The IFHP cost was $84.6 million in the 2010-2011 fiscal year. During the same year, 128,000 persons were covered by IFHP which means that the average IFHP cost was about $660 per refugee claimant per year. However, the current government plans to cut this budget by $20 million each year starting June 30, 2012 and this will apply to all current beneficiaries, as well as those who apply after that date (CIC,2012).

            Up to and including June 29, 2012, the services covered by the IFHP for all eligible beneficiaries included basic coverage (i.e., treatments normally covered by provincial or territorial health insurance plans); supplemental coverage (i.e., health-care benefits similar to those provided through provincial social assistance plans, such as drugs and dental and vision care); and costs related to the Immigration Medical Examination (IME) (CIC,2012).

            After the changes are in place, the IFHP will offer only two basic types of coverage.1) Health-care services that are only of urgent or essential nature; medications and vaccines only when needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern or  2) Public Health or Public Safety Health-Care that will cover the cost of products and services  only to prevent or treat a disease posing a risk to public health or a condition of public safety concern (CIC,2012).

            In an effort to justify this action, Minster Kenney stated that “Canadians are a very generous people and Canada has a generous immigration system. But we do not want to ask Canadians to pay for benefits for protected persons and refugee claimants that are more generous than what they are entitled to themselves. With this reform, we are also taking away an incentive from people who may be considering filing an unfounded refugee claim in Canada” (CIC,2012).

            As briefly discussed in the previous section, such changes can only be explained by the bias and attitude of those who are in charge of setting the policy. In this case, an official of a Minster capacity seems to continue perpetuate a bogus claim that refugees and immigrants are receiving more assistance than Canadians; a misperception that has been debunked by the government itself (CIC,2010)

            The government already has an exclusionary policy which effectively screens out individuals who are unable to contribute to the Canadian economy due to their “excessive demand” on health care. Under Paragraph 38(1)(c) of the immigration and refugee protection act, a foreign national is inadmissible on health grounds if their health condition might reasonably be expected to cause excessive demand on health or social services (DOJ,2012).

            Part 1, Division 1 of the Immigration and Refugee Protection Regulations, defines “excessive demand” as: “a demand on health services or social services for which the anticipated costs would likely exceed average Canadian per capita health services and social services costs over a period of five consecutive years immediately following the most recent medical examination required by these regulations, unless there is evidence that significant costs are likely to be incurred beyond that period, in which case the period is no more than 10 consecutive years”;  Or “a demand on health services or social services that would add to existing waiting lists and would increase the rate of mortality and morbidity in Canada as a result of the denial or delay in the provision of those services to Canadian citizens or permanent residents” (DOJ, 2012)

            Given such exclusionary immigration policies, the rationale provided by the Minster that protected persons and refugees add cost to the health care remains unfounded as his own policy explicitly states that individuals who have more health care needs are not allowed to come to Canada in the first place.  

            Furthermore, the cost of IFH per protected person per year, according to the government’s  own figures, was about $660 for the 2010-2011 fiscal year (CIC,2012) while the current overall per capita cost for health and social services for Canadians is about $6,141.2.(CIC,2012); clearly indicating that protected persons and refugees are not getting a better deal than Canadians as the minster suggested.

            Even if the minster’s wrong justifications were true, a good public policy would aim at insuring all people in the land have access to a better health care instead of finding a certain group to exclude and deny them access to health care for a mere fact that he considers them undeserving.

            These biases are also clearly reflected by public statements made by the Minster who stated that he does not expect people to come to Canada and become completely dependent (CBC, 2012).           Such comments are basically not true as they have an underlining wrong assumption that people who come here are unhealthy and stay the same over time. However, evidences have shown that immigrants’ health is generally better than that of the Canadian born and that it declines as their years in Canada increase.

            For instance, a study based on the 1991-2001 census mortality follow-up found out that for Canada’s adult population overall, the age-standardized mortality rates (ASMRs) per 100,000 person-years at risk were 1,230 for men and 703 for women. Immigrants had significantly lower ASMRs than did Canadian-born adults: 1,006 versus 1,305 for men, and 610 versus 731 for women. However, as immigrants’ time in Canada lengthened, their ASMRs tended to rise.

            The AMSRs among men were 720, 913 and 1,054 for recent, medium-term and established immigrants, respectively. Among immigrant women, the corresponding rates were 491, 546 and 637. Nonetheless, these rates remained significantly lower than those of the Canadian-born population. Such upward trends in ASMRs reflect a loss of immigrants’ health advantage over time (Ng, 2011). Given such a declining health status of immigrants, restricting access to health care remains a bad policy.

            The changes introduced to the Interim Federal Health Program become of paramount importance for mental health status of refugees and new immigrants as they continue to face particular challenges that put their mental health at greater risk. They often have difficulty getting a job that matches their level of skills and education, earning a decent income, obtaining adequate housing, and face significant barriers to their seeking or obtaining help. (Mental Health Commission of Canada, 2012)

            The new changes state that refugees and immigrants will receive Health-care services that are only of urgent or essential nature; medications and vaccines only when needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern (CIC, 2012). This means that a refugee who suffers from depression or other similar mental illness will not be able to receive adequate treatment; further aggravating his/her condition because such condition may not be perceived to be neither urgent nor a danger to the public.

            Mental health services in general are already given a lesser priority than most other services. This is clearly reflected by the fact that only one in three people who experience a mental health problem or illness—and as few as one in four children or youth—report that they have sought and received services and treatment (Mental Health Commission of Canada, 2012). Given these, the restrictions introduced to the Interim Federal Health Program will create additional barrier to an already compromised system; adding insult to an injury.

            Furthermore, the changes will gravely affect refugees’ and immigrants’ mental health situation who are at an even more disadvantage due to their culture and the systemic discrimination they face when it comes to accessing health services in general and mental health services in particular.

            For instance, a qualitative phenomenological study  conducted by Martin and his colleagues (2010) indicated that lack of trust in doctors and race of doctors were among factors that were influenced by culture and discrimination that participants faced. Furthermore, Gender and language of immigrants have also been found to greatly impact their access to health care (Pottie et al, 2008) adding more barriers to refugees’ and immigrants’ health care access.

 

Conclusion/recommendation

            As indicated above, Canada’s immigration policy have come a long way to abolish systemic discrimination between deserving and undeserving refuges through explicit and implicit policies. These changes in public policy have resulted in the current multicultural demographics of the country which calls for celebration.

            Unfortunately, there are still possible ways by which assumptions, and not evidence, are used to shape it. This is clearly reflected by the rationales used to change Interim Federal Health Program. Evidences show that although Canada’s willingness to accept and host refugees is commendable, its per capita share of such a global crisis is not comparable to other poor countries; that refugees and immigrants’ health decline the longer they stay in Canada and the cost of providing life saving health programs such as the IFH is not more than what Canadian’s get as most would presume.

            Such changes in public policy have a grave consequence at an individual level. Tampering with an already compromised health care system where access is restricted from the very onset aggravates the declining health status that refugees and immigrants face over the long run.

            Given these facts, the changes introduced to the IFH should be reversed. A rather inclusive approach should be used as a strategy instead of an exclusionary one where categorical groups are identified and become further labile to stereotyping and discrimination. Efforts have to made to identify and solve issues that lead to refugees’ and immigrant’s health decline over time, not worsen it. The government must be able to provide a transparent and publicly available aggregated cost data which could be comparable with similar datasets for Canadian born individuals, and last but not least, the overall immigration policy has to become bias proof.

References

CBC radio. (2012, May 14). CBC-The Current with Anna MariaTremonti. Retrieved May 25,       2012, from CBC: http://www.cbc.ca/thecurrent/episode/2012/05/14/health-care-for-refugee-claimants/

CIC. (2012, February 16). Facts and figures: Immigration overview- Permanent and temporary residents. Retrieved May 27, 2012, from Citizenship and Immigration Canada:             http://www.cic.gc.ca/english/resources/statistics/menu-fact.asp

CIC. (2012, April 25). News Releases – 2012. Retrieved May 24, 2012, from Citizenship and       Immigration Canada: http://www.cic.gc.ca/english/department/media/releases/2012/2012-04-25.asp

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