1. Directions in national immigrant health National Symposium on Immigrant Health Citizenship and Immigration Canada Citoyenneté et Immigration Canada Medical Services - Services medicaux March 2003

2. 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

3. 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

4. CIC Medical Services - Services medicaux Canadian Immigration - Historical Perspectives (1860-2000)

5. CIC Medical Services - Services medicaux Policy Basis of Immigration Health frontier based historic quarantine linkages housed in immigration legislation focused on denial of admission

6. CIC Medical Services - Services medicaux Image: US National Library of Medicine

7. 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

8. CIC Medical Services - Services medicaux Needs Increased focus on outcomes Increased flexibility to monitor a rapidly evolving migrant population

9. 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

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11. Canadian Immigrant Source Regions Past 40 Years (MacDonald BS Transatlantic Economic Issues and their Security Implications Atlantic Council Members Paper 03/02)

12. 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

13. 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)

14. 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

15. 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

16. CIC Medical Services - Services medicaux Distribution of reported TB cases by origin in Canada : 1980 - 2001 Foreign born Canadian born non-aboriginal Canadian born Aboriginal l

17. 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

18. CIC Medical Services - Services medicaux Immigration by Province - 2001

19. CIC Medical Services - Services medicaux Metropolitan Destination

20. 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

21. 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

22. 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

23. 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

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25. The Future of Immigration Health Continued regulatory purposes –Public Health and Safety –Demand issues Entry point for health care sector –immunization –prevention –promotion

26. 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

27. 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