Immigration Status as a Social Determinant of Health: The Canadian Perspective

Updated: Aug 26, 2020

Canada has gained a reputation of being a welcoming nation globally, attracting hundreds of thousands of immigrants. According to the last census in 2016, 21.9% (i.e. about 7.5 million) of the Canadian population were immigrants (i.e. foreign-born), and 1.5% (i.e. 506,000) were non-permanent residents [1]. In 2019, Canada welcomed about 314,000 immigrants, and there have been about 493,000 international students between 2000 and 2017 [2]. Needless to say, the percentage of immigrants in Canada would keep increasing following the federal government’s objective to attract 1.3 million more permanent residents between 2018 and 2021 [3]. The non-permanent residents would also increase as these residents are mainly international students who flock to Canada for better opportunities.

As the number of immigrants increases in Canada, their health and settlement must become a public health priority as evidence suggests that the health of immigrants deteriorates the longer they stay in Canada. When foreign-born immigrants first come to Canada, they are generally healthier than the Canadian-born population. This phenomenon has been dubbed the “healthy immigrant effect”. Some factors contributing to this phenomenon include the strict health, and medical screening process immigrants go through before being granted status in Canada, the immigration process that screens for younger and healthier candidates, and the generally healthier lifestyles in the various countries of origin [4]. However, this health advantage declines the longer immigrants remain in Canada [4].

The inequalities immigrants face in Canada is a significant reason for this decline in health. For example, immigrants have lower earnings than the Canadian-born population. Statistics Canada compared the immigrant community with the third generation and higher Canadian-born population, and they found that the immigrant population earned less [5]. Furthermore, immigrants who are degree holders in their home countries are typically unable to find gainful employment in their field in Canada despite having years of experience; thus, they are classified as low-income. Given what we know about income as a social determinant of health (SDOH) and its intersectionality with other SDOHs, the negative health outcome should not come as a surprise.

Additionally, the majority of immigrants in Canada belong to visible minority groups; thus, they face similar issues as the Black, Indigenous and People of Colour (BIPOC) community. Furthermore, the lack of Canadian experience and traditional names work against job-seeking immigrants. Which begs the question, how do you gain Canadian experience when employers won’t employ you without said experience? I also remember being told to use my English name for job applications during a career session at school to increase my chances of getting interviews, especially without Canadian experience. Another reason for the decline in health is the lack of a robust social support system for immigrants. Even when families immigrate together, the support system here is not reliable due to cultural and sometimes language barriers. Additionally, immigrants are left

out of various support initiatives in Canada. I cannot count how many times I have been unable to access appropriate help because I am neither a permanent resident nor a citizen. A very recent example would be the $9 billion student aid package the Canadian government rolled out to support students affected by the pandemic. International students were left out despite the support we provide to the Canadian economy. In 2018, it was estimated that international students contributed $21.6 billion to the Canadian GDP [6]. As if being left out was not bad enough, some students also had their tuition go up during this pandemic, up to 15% (6). Mind you, international students already pay up to four times their Canadian classmates [6].

Additionally, students are unable to secure summer employment because most of the job postings require you to be a citizen, permanent resident, refugee or someone of protected status. Factor in lack of Canadian experience or overall experience, and these students are significantly disadvantaged. International students are eligible for a Post Graduate Work Permit (PGWP) upon graduation and can begin full-time work as soon as they submit the application for it. This is known as “implied status”. However, a lot of employers are not aware of this, or they are but are not comfortable with it. This usually means international students have a hard time finding a job after graduation. All these factors lead to poor physical and mental health outcomes as students try to support themselves, especially during this pandemic. Finally, universal healthcare in Canada is not as universal as you think. Immigrants often have a hard time accessing healthcare in Canada. Like the BIPOC community, immigrants are often met with biases and stereotypes when accessing healthcare. Language and cultural barriers also interfere with their access to healthcare. Furthermore, refugees and international students are typically not covered by provincial insurance when they first come into Canada. For refugees, they are temporarily covered by the Interim Federal Health program until they are eligible for provincial coverage. In contrast, students are covered by the University Health Insurance Plan until they graduate, at which point they are typically uninsured until they are eligible for provincial coverage. Not all healthcare providers are familiar with either insurance plans, and this often limits the care these groups receive.

Immigration status acts as a social determinant of health for immigrants by placing barriers to necessary services like healthcare and negatively impacting immigrants’ health. However, the SDOH lens has not yet been used to understand immigrants’ health [7]. I believe more research is needed to fully understand immigration status as an SDOH as well as to provide evidence so the appropriate actions can be taken. Additionally, I believe that more needs to be done to make Canada as welcoming as it claims to be, especially since it is inviting more immigrants. Healthcare providers should be aware of the various insurance coverages and how they work, and there should be social and language support for immigrants. Tuition hikes need to be addressed, as they negatively impact the physical and mental health of international students. As for employers, it is not enough to put a brief

statement about welcoming diversity in job postings. It needs to be translated into action as well. As immigrants work to assimilate into Canadian culture, I believe there is room for Canadians to meet us halfway and learn about the struggles we face.

REFERENCES [1] Statistics Canada. 2017. Focus on Geography Series, 2016 Census. Statistics Canada Catalogue no. 98-404-X2016001. Ottawa, Ontario. Data products, 2016 Census. [2] Duffin, E. 2020. Immigration in Canada – Statistics & Facts. Statista. Retrieved from https://www.statista.com/topics/2917/immigration-in-canada/ [3] Mental Health Commission of Canada. 2019. Immigrant, refugee, ethnocultural and racialized populations and the social determinants of health: A review of 2016 census data. Retrieved from https://www.mentalhealthcommission.ca/sites/default/files/2019- 03/irer_report_mar_2019_eng.pdf [4] Islam, F. 2013. Examining the “Healthy Immigrant Effect” for mental health in Canada. UTMJ, 90(4). Retrieved from file:///Users/oluwatosinoluwayemi/Downloads/105- Article%20Text-135-1-10-20190205.pdf [5] Houle, René. 2019. “Results from the 2016 Census: Earnings of immigrants and children of immigrants in official language minority populations”. Insights on Canadian Society. May. Statistics Canada Catalogue no. 75-006-X. [6] Charles, C.H. & Øverlid, V. 2020. Tuition hikes exacerbating existing challenges for international students. Policy Options. Retrieved from

https://policyoptions.irpp.org/magazines/july-2020/tuition-hikes-exacerbating-existing- challenges-for-international-students/

[7] Castēnada, H., Holmes, S.M., Madrigal, D.S., Young, M.D., Beyeler, N. & Quesada, J. 2015. Immigration as a social determinant of health. Annual Review of Public Health, 36(1), 375- 392. https://doi.org/10.1146/annurev-publhealth-032013-182419