Canada s Health Care Debate The Impact on Newcomers

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1 Canada s Health Care Debate The Impact on Newcomers Many have called the recent Supreme Court decision regarding access to private health care a wake-up call to governments, to work faster and better to improve public health care. The debate on whether the existence of a private tier of health care provision will eventually undermine the strength of the public tier is critical. The Canada Health Act provides for a publicly financed and delivered health care system that would include public administration, comprehensiveness, universality, portability and accessibility. This system is not currently a reality in Canada. Private health providers already administer a number of basic health care services (i.e. dental services, access to prescription medication). When new immigrants arrive in Ontario, they must wait 3 months for provincial health care coverage to begin. They have no choice but to turn to private health care during this time. The first experience new immigrants to Ontario have with the Canadian health care system is, ironically, both the private tier, and a waiting list. The Supreme Court decision appears to recognize the importance of access to health care as essential to protect our right to life and security. However, it calls for a solution that, in fact, takes the obligation away from the government to protect such rights, and places it onto individuals themselves to assert and protect their rights. Government must ensure that our public health system is adequately funded and not shift the responsibility onto Canadians to provide health care for themselves through accessing private health insurance. A multi-tiered system that does not provide equitable access to basic health services is unacceptable and in conflict with Canada s values and principles of equity. Inequities in health care access already exist for marginalized groups such as newcomers and racialized communities. The Supreme Court decision does not address this situation. In fact, it threatens to perpetuate the inequities and risks putting vulnerable groups under a second tier, or third tier, of the health care system. OCASI wishes to broaden the existing debate to ensure that the voices of marginalized equity seeking groups, such as recent immigrants and refugees to Canada, especially those from racialized communities, are heard. No matter what model of health service delivery exists, government must ensure that it promotes and improves the health and wellness of all Canadians, particularly those who are marginalized. Ontario Council of Agencies Serving Immigrants (OCASI) - June

2 Canada s obligation is to ensure that all residents basic health-care needs are met. Equitable access by marginalized groups in society must be explicitly factored into all decisions regarding the future of health care in Canada. How Are New Immigrants Vulnerable? The Healthy Immigrant Effect Ongoing issues of access to medically necessary services and prohibitive costs for newcomers are well documented. According to Dynamics of Immigrants' Health in Canada: Evidence from the National Population Health Survey immigrants generally arrive with better health than the Canadian-born population. However, as time passes, this healthy immigrant effect tends to diminish. Over time, newcomers health status decreases to become more aligned with the average Canadian s level of health. While some health issues are age-related, other health problems are due to the stress of settlement and integration. More and more frequently, this includes a lack of suitable employment, increased poverty, disillusionment and desperation, adverse mental health effects and an inability to pay for health coverage not available through the public health system. Immigrant women and children are particularly affected. This overall lack of wellness among new immigrants and refugees contributes directly to their deteriorating health. Studies have repeatedly illustrated the increasing racialization of poverty in Canada - newcomers are increasingly from racialized communities and live in poverty. Across Canada, more than one-third of recent immigrants are considered poor. Newcomers to Canada lack the necessary social support networks and are falling into long-term disadvantage at an accelerating rate, becoming socially excluded and working in contingent and unsafe work environments. Other areas affecting individual and family health adequate housing, education, non-discrimination, and community integration are not adequately considered without a comprehensive social determinants approach to health and health care. According to Region of Waterloo Public Health, Employment and income are critical influences of a person s or community s health. Research indicates that people with lower incomes are more likely to be unhealthy. At the most fundamental level, employment and adequate income allow people to afford basic necessities such as housing, food, and clothing - items which are essential for good health. Nationally, recent immigrants (those who arrived in the previous five years) tend to have higher rates of unemployment and low-income than nonimmigrants. The Longitudinal Survey of Immigrants to Canada indicates that, of those newcomers who reported problems in accessing health care services, 34% said their most serious difficulty was long waiting lists. 19% stated that the services, as well as dental and prescription medication, cost too much. Nationally, one- Ontario Council of Agencies Serving Immigrants (OCASI) - June

3 quarter of immigrants surveyed reported difficulties accessing health care services. Challenges include long waiting lists, high costs, language barriers, and an inability to find a doctor accepting new patients. Access to health care and wellness is a challenge for immigrant and refugee women. According to the Ontario Health Coalition, Women have little say in how, where and when health care policy reform happens, despite the fact that they are the majority of both care recipients and care providers. Women's choices about care are increasingly restricted, especially for the elderly, differently abled, poor, and racialized women without resources in the community. For immigrant, refugee and racialized women, racism, poverty and economic inequality, rather than lifestyle choices are amongst the most dominant predictors of poor health. Privatizing of health care and creating two tiered systems will further impact the current gender disparities that disadvantage women s health. De-listing of services covered by health insurance programs, releasing people from hospitals without first establishing adequate home care services, the failure to provide adequate attendant care services for people with disabilities and the lack of racially, culturally and linguistically appropriate health care information all create severe disparities in the access to health care services. Newcomers face specific barriers to successful settlement that affect their health and well being: Documented discrimination and racism against particular newcomer populations, including issues of religious, ethnoracial and cultural insensitivity. Refugee claimants and Convention Refugees receive emergency and essential health care coverage under the federal Interim Federal Health (IFH) program. A move away from publicly funding specialized health care programs, such as IFH, will mean making refugees much more vulnerable. Refugees and refugee claimants may have suffered torture or trauma before arriving to Canada and have specific and long-term needs, such as Post Traumatic Stress Disorder (PTSD). Knowledge and understanding of the Canadian health care system is generally lacking and it takes time for newcomers to become familiar with the system, eligibility requirements and range of coverage. This is compounded by a lack of understanding of the roles and availability of professional/health practitioners. Language barriers can exist when newcomers are given complex and detailed health information that they may not be able to access in their own language or in clear English. Health concerns of immigrant and refugee groups in smaller cities may not receive the attention or resources necessary to provide adequate care. Ontario Council of Agencies Serving Immigrants (OCASI) - June

4 Access to health and social services for those without formal immigration status in Canada is restricted by their status or by their fear of authorities and possible deportation. Equity and Health Care How would further privatization affect public health programs for basic health services, especially for marginalized groups in Canada? While the federal and Ontario governments have begun reinvesting in health care services, the effects of past cuts are still being felt by healthcare professionals and Canadians. The phenomenon of increased health taxation in Ontario, coupled with the de-listing of specific health services (i.e. optometry, physiotherapy and chiropractic services) perpetuates the perception that the existing public tier cannot provide the care that Canadians need. The Canadian health system already has systemic inequities. This situation must be remedied. A future system cannot further disadvantage already marginalized populations and must protect people who cannot afford to pay for privatized health care. OCASI recommends that a comprehensive equity analysis be conducted to determine how a shift in health care funding and delivery may affect marginalized populations. We echo the assertion of the Toronto District Health Council (TDHC), in their report Toronto Health System Monitoring: Equity Analysis : when examining the impact of health care reforms it becomes imperative to carry out equity analysis since the reforms may adversely affect the health of vulnerable subgroups in the population. Vulnerable groups include the socio-economically disadvantaged, immigrants, racialized communities, refugees and those without status, women, seniors, children, aboriginal communities, people with disabilities, homeless, street youth, mental health consumer/survivors, LGBTQ communities, people living with HIV/AIDS and other marginalized groups. Such an equity analysis would ensure that public resources are distributed according to individual and community needs in order to substantially narrow the gap between the advantaged and disadvantaged and to achieve improved levels of health and well being. (TDHC) OCASI welcomes the federal government budget promise of an infusion of $41 billion dollars into the Canadian health system. However, the money must be allocated and distributed well ahead of the announced 10-year time line, and in such a way as to enhance the quality and equity of health services to all Canadians. Ontario Council of Agencies Serving Immigrants (OCASI) - June

5 OCASI thanks the following agencies for their contributions to the development of this paper: Women s Health in Women s Hands Metro Toronto Chinese & Southeast Asian Legal Clinic National Anti-Racism Council of Canada Kitchener Downtown Community CHC (KDCHC) Regent Park Community Health Centre St. Joseph Immigrant Women s Centre Related Resources and Documents: Chaoulli v. Quebec (Attorney General), Dynamics of Immigrants' Health in Canada: Evidence from the National Population Health Survey Longitudinal Survey of Immigrants to Canada: Process, progress and prospects Health of Immigrants - Waterloo Region 7f5e1/4AD3E53C78B52E E780060EDDD/$file/Health%20of%20Immigra nts%20fact%20sheet.pdf?openelement Equity Analysis - First Report March 2001 (Toronto District Health Council) pdf Privatization of Medicare and Women (Ontario Health Coalition) Canadian Health Coalition Ontario Council of Agencies Serving Immigrants (OCASI) - June

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