6th
International Metropolis Conference
November 26-30, 2001
Rotterdam, The
Netherlands
Workshop Title:
Shifting Paradigms from Quarantine to Migration Health.
Population Mobility,
Health, and Globalization.
Workshop
Paper:
Canada's
Immigration Health Program
Neil Heywood
Director
Immigration
Health Policy and Standards
Medical
Services Branch
Citizenship
and Immigration Canada
Ottawa, CANADA
Canada's
Immigration Health Program
Canada's Immigration Act (1976) requires that all immigrants and certain
visitors shall undergo medical examination and that no person shall be granted
admission who is suffering from any disease, disorder, disability or
other health impairment and who is likely to be a danger to public health or
public safety or might reasonably be expected to cause excessive demands on
health or social services.
While public health and public safety
were carried forward from the Immigration
Act (1952), the notion of excessive demands was stimulated by the late
1960s introduction of publicly funded health care services, commonly known as
'Medicare'.
The adoption of Canada's Charter of Rights and Freedoms (1982),
which contains an equality clause that includes mental and physical disability
as factors, added to concerns over the medical assessment process. There have been ongoing efforts to address
these concerns by developing a transparent and objective definition of
excessive demand.
As part of the medical examination
process, applicants who are identified with inactive tuberculosis (TB) or
adequately treated positive syphilis serology, may enter Canada subject to
agreeing to undergo medical surveillance - clinical review by a public health
authority. This process provides for
both the maintenance of the individual entrant's health status and protection
of close family and the Canadian public.
In 1993, the Immigration Act was amended so as to remove the excessive demands
assessment for in-Canada refugees and that in-Canada refugee claimants must
undergo an immigration medical examination before being issued a work permit.
A number of events concerning refugee
movements generated other initiatives:
·
Kosovars
(1999): the need for early removal from a hostile environment resulted in a
rapid pre-travel 'fitness to fly' screen which was followed by a post arrival
medical examination.
·
In 1999, some
in-Canada refugee claimants found to have active TB, some multi-drug
resistant. This stimulated concerns
that the sixty (60) day period granted to complete the immigration medical
examination post refugee claim resulted in delayed investigation and treatment
as well as increased risk of transmission of infection to Canadian
residents. This generated an early
medical examination pilot in one province wherein refugee claimants were required
to undergo medical examination within seven (7) days of their refugee
claim. The results of this pilot have
been very encouraging and consideration is being given to expansion of the
early medical examination process to in-Canada refugee claimants in other
provinces.
·
African
Refugees (2000-01): during August 2000, some 230 refugees arrived in
Canada. There was clinical suspicion of
malaria during the flight, which was followed by symptoms after arrival. This had serious impact on emergency room services. Subsequent arrivals in November 2000 and
January 2001 underwent blood testing for malaria, with treatment of test
positive persons. In June 2001, a
further 200 plus refugees underwent blood sampling and antimalaria treatment
prior to departure for Canada. To date,
no clinical case of malaria has been reported in this group. Final follow-up and analysis is yet to be
concluded.
In late 1996, the Immigration
Legislative Review was created to study and provide recommendations on the
immigration system - their report, Not Just Numbers, was submitted in
1997. Subsequent policy work led to the
tabling of a new Immigration Bill C-31, in April 2000. Owing to an election call, this Bill died on
the order paper in October 2000. A
similar bill, Bill C-11, was tabled in February 2001 and is now nearing
completion of the legislative process.
Bill C-11, the Immigration and Refugee Protection Act, maintains the concepts of
risk to public health, safety and excessive demand. It is anticipated that supportive Regulations will introduce the
notion of cost based excessive demand assessment and a requirement that there
be consideration of impact of potential entrants upon health and social service
waiting lists.
Additionally, Bill C-11 extends the
exemption from excessive demand assessment to sponsored spouses/common law
partners; Convention refugees and protected persons; and their dependent
children, or other family members as prescribed in Regulations.
On the operational front, the medical surveillance
process has undergone in depth review and, in cooperation with public
health authorities, amendments have been made to improve entrant. s
reporting compliance and timeliness. Since persons requiring medical
surveillance are granted conditional entry to Canada, i.e. their entry is
dependent upon meeting the condition imposed, namely reporting within thirty
(30) days of entry to Canada, a compliance feedback process is to be developed
so that CIC may monitor compliance.
Canada's immigration medical
examination has for many years included three routine tests - urinalysis, chest
X-ray and syphilis serology at 5, 11, and 15 years and over, respectively. Health Canada, which provides technical
advice to CIC, has advised that Hepatitis B and HIV be added to the routine
tests on public health grounds and that test positive persons who are granted
entry be referred for counselling in Canada.
Canada's immigration health screening
process has undergone significant evolution over the past twenty odd
years. This evolution has resulted from
many factors - Court rulings, and comments from the Canadian Bar Association,
non-governmental organizations, other federal government departments and
migrant receiving provinces.
Additionally, the global sociopolitical environment has undergone change
as a result of which the pattern of migration has altered significantly. Partly in response to these changes and
partly due to Canada's commitment to achieve an immigration goal of 1% of
population admission annually, there have been amendments to legislation and
process which are to the benefit of migrants and Canadians alike.
The challenges posed by large numbers
of people moving around the world with increased ease and speed are
considerable. It is likely that the
health screening of certain migrant groups will be retained for some time, to
meet legislative requirements. However,
greater emphasis may be placed on post-arrival health management - the extent
of this will be dependent on several factors, including health care access and
payment issues.
