Title: Towards a Migration Health Framework for the 21st Century

Investigator Name: Dr. Sheela Basrur

Project Completion Date: June 2003

Research Category: Conference

Institution: Association of Local Public Health Agencies

Project Number: 6795-15-2002/4420003

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Summary

On March 25 and 26, 2003, Toronto Public Health (TPH) and the Association of Local Public Health Agencies (alPHa) held a day and a half conference on Migration Health in Ottawa, under the auspices of, and with funding from, Health Canada. This national conference provided a forum to meet and discuss the current state of research on migration health in Canada. The conference was segmented into four main themes: communicable diseases; non-communicable diseases; access to health services; and, other issues.

Migrant health is a quickly emerging, complex new issue. Due to growing globalization and technological development, migration now addresses everything between short-term trips to permanent resettlement. The impacts of these different forms of migration can be quite diverse. Some studies have found that this increase in population mobility has become a significant factor, which affects the health of communities. Other studies suggest that immigrants are healthier, at least in the short run than the endemic population - the so-called healthy immigrant effect, due to Canada's rigorous entry health requirements.

In order to study the effects of migration on health, a variety of factors have to be considered, including geographical, behavioural, environmental, educational and social determinants. At the beginning of relocation, a migrant's health reflects the health environment at the point of origin. Then, the type and nature of the migratory journey itself may also affect the health of migrants. Factors such as the duration of the journey, the nature of transportation and the type of entry at destination (legal or illegal) can all have significant impacts.

Once migrants have arrived and are settled, evidence indicates that they access and use health services significantly less than the endemic population. Lack of awareness and access to health programs play a role in the under-utilization of health services by migrants. Over time, a migrant's health starts to reflect that of the endemic population. With increasing population mobility, it is vital to fully understand the impact on public health. Traditionally, research on migrant health has exclusively focused on communicable diseases. It is now expanding to include non-communicable diseases, social determinants and emerging infectious diseases.

On the first main theme of the conference, communicable diseases, the desired goals were identified as the protection of public health, optimization of health in migrant populations and elimination of health disparities in source countries. It was agreed that the current epidemiological model needs to be re-evaluated. As well, better research is dependent upon improved quantitative information on epidemiology and cost of specific diseases. Other issues that were identified for improvement include studying different segments of migrant populations, the sustainability of the health service infrastructure in relation to immigration quotas, and access to services.

Many of the issues identified for communicable diseases also apply to the second theme, non-communicable diseases. Other relevant areas for future research into non-communicable diseases were identified as establishing research priorities, building momentum towards a program of research and developing a forward-thinking, proactive agenda. To achieve these goals it is vital to expand data collection, supported by a long-term program structure. There also needs to be a better theoretical understanding of the relationship between migration and health and co-operation between key players.

Access to health services, the third main theme, was identified as a key area for concern, both in relation to communicable and non-communicable diseases. Immigrants face a variety of barriers to health care services: the three-month waiting period; the limitations of the Interim Federal Health Plan; lack of awareness of available health services; regionalization; culture; and, language. In order to overcome these barriers, it is important to study the cause and effects of barriers to access.

Another aspect that was identified at the conference was regionalization, and its effects on migrant health. Identifying the specific needs of immigrant groups in different regions should be addressed in future research. Creating an initiative that allows researchers across Canada to exchange findings will also help to provide a better understanding of the effects of regionalization.

The fourth theme of the conference, "other issues", encompasses a variety of areas related to migration and health. It was pointed out that health considerations need to be recognized and included in all official immigration matters. Migrant health in relation to human rights, race relations and discrimination also needs to be explored. Other aspects that were highlighted were improving access to professional training for migrants by assisting with language and regulatory matters and also facilitating easier transfer of credentials acquired outside Canada. As with the other themes, more research is needed and, most importantly, there is a strong need to establish a strong network among stakeholders and professionals.

Strong partnerships among stakeholders, communities, research institutions, and all levels of government pave the way for community development, health promotion and disease prevention. Each stakeholder brings different experiences and responsibilities to the table. Government's focus is on access and equity, non-discrimination, and human rights, while community service agencies and NGOs have direct contact with migrant communities and have an in-depth understanding of their complex health needs. Public health units operate at the local level, providing a link between government and local organizations. A strong network will allow for these different players to align their interests and objectives for future research.

In sum, participants at the conference strongly recommended that existing research needs to be expanded, since the current migration health model is no longer adequate. A new approach should focus on the dynamics of population mobility, its impact on immigrants' health, public health, communities and on government policies. It is important that research includes and examines refugees and illegal immigrants, as well as travellers and short-term migrants. As well, non-communicable disorders, emerging infectious diseases, access and regionalization need to be incorporated into this new model. A new strategy needs to be proactive and flexible, based upon an encompassing vision.

The views expressed herein do not
necessarily represent the views of Health Canada

In addition to the above summary, the full report can be accessed in the following ways:

• The print version of the full report can be obtained in the language of submission from the Health Canada Library through inter-library loan.
• An electronic version of the report in the language of submission is available upon request from Health Canada by contacting the Research Management and Dissemination Division.

This research has been conducted with a financial contribution from Health Canada's Health Policy Research Program. For permission to reproduce all or part of the research report, please contact the Principal Investigator directly at the following address: sheela.basrur@moh.gov.on.ca.

The Health Policy Research Program (HPRP) funds research that provides an evidence base for Health Canada's policy decisions. The HPRP is a strategic and targeted program with a broad socio-economic orientation and connections to national and international endeavours. The research can be primary, secondary or synthesis research, a one-time contribution to a developing research endeavour, or a workshop, seminar or conference.