Blog Post

Immigrant Health in Canada - Exploring challenges and opportunities for Collective Action (webinar recording)

By: Marco Campana
June 7, 2024

Ensuring the long-term health and well-being of immigrants in Canada is vital for human rights, social justice, and the sustainability of Canada's health system and economy. This April 2024 IPAC event explored what affects immigrant health, aiming to gain a deeper understanding of the issue. Panelists identified opportunities for collective action across sectors and geographies to enhance the long-term health outcomes of immigrants in Canada.

Panelists:

  • Dr. Bukola Oladunni Salami - Professor at the Cumming School of Medicine, University of Calgary
  • Axelle Janczur - Access Alliance Multicultural Community Health Centre
  • Jessica Kwik - Peel Newcomer Strategy Group (PNSG)
  • Kareem El-Assal - Section 95 / Deloitte

Machine-Generated Transcript

What follows is an AI-generated transcript of the webinar using Otter.ai. It will contain errors and odd sentence breaks and is not a substitute for watching the video.

Suzanne Patterson 0:04
Suzanne, Greetings everyone. Thank you so much for taking the time out of your busy schedule to attend this important session. My name is Suzanne Patterson, and I'm the director of finance and International Programs at the Institute of Public Administration of Canada, or IPAC, as it's better known with participants joining virtually from coast to coast, we acknowledge and respect the ancestral and unceded territories of all First Nations Inuit and Metis peoples. We encourage everyone here to take the opportunity to learn about the diverse and unique histories, cultures and aspirations of the peoples on whose territories you work and live and determine how you can take action towards reconciliation. It is my great pleasure to welcome you to today's event immigrant health in Canada, exploring challenges and opportunities for collective action. The topic of today's webinar is and will be important to all levels of government across Canada. Today's speakers will focus on the significance, sorry, significance of ensuring the long term health and well being of immigrants in Canada, as immigrants are increasingly large population of the Canadian population, this is not only crucial for the Canadian health system, but also for the overall prosperity and wellness of our communities, as well as our country's economic development. These experts today will share their invaluable insights and perspectives, aiming to engage you in identifying opportunities for collective action to improve long term health outcomes among immigrants. I'd now like to introduce you to our moderator, Zara Javan, partner healthcare leader at Deloitte, Canada. Before I turn it over to Zara, I'd like to remind audience members to send in their questions using the Q and A function located at the bottom of your screen. We've allocated the last 10 minutes of the hour to answer any questions that you might have, so please reserve your questions until the end. Over to you. Zara,

Zahra Jivan 2:10
Thanks, Susan.

Zahra Jivan 2:12
Just Welcome everyone. Just to echo what Susan is saying, I think this is a really important conversation for today. As Susan said, I'm a leader at Deloitte within our healthcare practice, and a lot of the work that I do is with provinces and federally, working across a number of areas, including health system planning, design and digital strategy. Today, I'm joined by four panelists who are going to bring unique insights and perspectives across research, policy, advocacy, service delivery for immigrants and newcomers. We have Professor bukula salami. She's a professor in the Department of Community Health Sciences with the Cummings School of Medicine at the University of Calgary. Professor salami research program focuses on policies and practices shaping migrant health and black people's health. We also have Axel at jansker. She's the Executive Director for access Alliance, multicultural health and community services, a not for not for profit organization that provides services and advocates to improve health outcomes for immigrants, refugees and their communities. In Toronto, we also have Jessica quick, she's the director of the peel newcomer Strategy Group, a local immigration partnership project. You may also hear the term lip further so she that's for the Peel Region. That group engages local partners to collectively support newcomer settlement. We also have Kareem al Assal, Senior Advisor to Deloitte on immigration. He's a founder of Section 95 a really great website dedicated to analyzing Canada's immigration system. Just before we get into the conversation today, I thought it would be important to share, you know, a few statistics that pulled together as we prepped for this. So in 2021 statistics, Canada estimated that approximately 8.3 million people in Canada, or 23% of the population was or had been a landed immigrant or permanent resident. The Government of Canada is also on track to admit an additional 1.5 million new immigrants in the next three years alone. Research conducted in Canada has shown that, on average, recent immigrants are healthier than the Canadian born population. This is a phenomena that is commonly referred to as the healthy immigrant effect, and is observed across multiple metrics, including age standardization, mortality, hospitalization rates and self reported mental health. There's many reasons that could be contributing to this phenomena. One of it is the Canadians immigration app. Like applicants to Canada are subject to medical screening. If they are deemed to be in danger of public safety, they may not be admitted. And there is also the, you know, looking at what demand individuals could have on the health or social services in Canada. Um. In addition, what we've also seen and what we've also seen through the research, is that that health advantage that immigrants have when they come in diminishes over time. Studies have shown an inverse relationship between the duration of stay in Canada and the health of immigrants. So really, I would say, collectively as a society, we have a commitment to ensuring the long term health and well being of immigrants in Canada, and so that's really what we want to have the discussion on today and hear from the panel. So the first question that I want to put out is to Dr salami. I think if you can start by sharing you know, details around the research that you do, and also, what do you see as the drivers? I know there's a lot of insights around the social determinants of health and how those social determinants of health are impacting the declining health of immigrants.

Bukola Oladunni Salami 5:51
Thank you so much for for having me. I in terms of the health of immigrants in Canada, the health of immigrant is influenced by pre migration factors, factors occurring during the migration process and post migration factors. So in terms of pre migration factors, for example, on average, the health of immigrants that are refugees or internally displaced before they came to Canada will be different from the out of those that were economic migrants and did not have precarious

Bukola Oladunni Salami 6:29
situations before migration factors that also occurred during the migration process. So we've seen news related to refugees coming through the border and their poor health status and post migration factors. In terms of post migration factors, we do also see in terms of some of the factors that may contribute, includes issues related to discrimination and racism, access to health services upon migration, language navigation challenges and so on and so forth. We did a research project looking at factors that contribute to the mental health of immigrants, and we analyzed the Canadian Health Measures survey, which is a Statistics Canada survey. And we analyzed across three or four cycles and about 17,500 participants. The factors that contributed to the mental health of immigrants from our analysis include that income, community belonging, and also employment status. And of course, many of these factors too. You know that income, for example, is situated within an is based on your employment status, and also intersect or is being reproduced also by inequities that people face within the system. And what we found no regardless of how much or what variable that we put in the model is community belonging and income, we are the strongest social determinant of health. And the good thing is that many of this, these factors are amendable to social intervention. So you know. And we went and we did interviews of immigrant service providers in the City of Calgary and also in the city of Edmonton. And we interviewed 55 immigrant service providers. And some of the things that they told us is, you know, community belonging, the the influence of community belonging. And we asked them, you know, how can we support community belonging? It's by creating a inclusive environment for immigrants. And we said, you know, what's an example? And they said, No, create natural environment. And what we said, Okay, what is the natural environment? They discuss parenting programs. That when you have a parenting program, it's not just for the children, it's also supports community belonging among immigrant population. So those are some of the factors I have also done work in the past related to racism, and racism does have influence also on health outcomes.

Zahra Jivan 9:17
That's great. Thanks for that insight. Dr salami, from the research, I do want to probe. I think there's a good connection here with Axel and Jessica, the work that you do in tying in with, you know, some of the research and the findings. Maybe Axel. I'll start with you. And then Jessica, if you want to add on, maybe Axel, just start with, you know, the work that you do within your organization. And if you can talk about the, you know, when we when we spoke, it was a lot of the work you do is centered around community engagement, I think if you can highlight why that's a priority, you know, what have you heard from immigrants in terms of the support that they need and what are the barriers that they face as they're looking to access health services? Yeah.

Axelle Janczur 10:01
Great. Thank you. Thank you very much, and thanks for being invited to this discussion. Access Alliance is a community based, community health organization, so we provide primary care, but also a range of programming that's focused on the determinants of health. So I mean, I completely agree, sense of belonging and poverty are those overarching factors that, in fact, shape so much of a newcomers

Axelle Janczur 10:27
experience in Canada, you know, the issue of why community engagement, which is what my what I first, you know, want to talk about is, you know, as service providers, researchers, policymakers and funders, funders, we do need to engage with newcomer and immigrant communities at Access Alliance, because we know that, in fact, it's, this is the system, and a lot of the challenges are related to systemic issues in our in our structures. We operate at that systems level, you know. So the why is, it's about change management. Because everything is changing, has changed, will continue to change, you know, even if you know dr salami. I was just thinking, if we think about research more than 30 years ago, when I started my work in this sector, there was, in fact, no research that explored immigrant and refugee community needs and issues access to determinants of health. It's a very different context now, where we have, in fact, a lot of research, in fact, a lot of research that's even been undertaken and CO created with these particular communities of interests, which is a significant change, thankfully, and it speaks to the engagement of community organizations. So this is an example of where we need to think outside of our current thinking models and institutional structures. Which, you know, which is the why of community engagement. So many of these were developed in different times by different stakeholder groups. And you know, when I say stakeholder groups, I mean government, political parties, educational institutions, business, churches, all of you know all of those institutions in in our our society. Dr Eileen de villa, who's the chief medical officer of health in Toronto, talks about 1 million people on the move globally. Canada, in fact, has not done as much heavy lifting in this regard as many other developed countries. And I'd say the pandemic certainly showed us that we are not ready to deal with any significant pressure on our systems, generally speaking, and we need to do a lot better. I mean, the pandemic certainly highlighted the kinds of challenges and barriers faced by immigrants, refugees, you know, access to healthcare services, access to, you know, better conditions of employment, access to information supports around system navigation. You know, this is, this is just the beginning. Our borders and our political systems will not be able to stop those folks who will come to Canada, driven by war, climate change, you know, economic and political conditions. You know, what do we really mean? And this is, these are conversations that we are having at Access alliance with the communities that we work with. What do we mean when we talk about decolonization and deconstructing white supremacy, we mean doing things differently, listening to different voices, centering different voices, giving up our mainstream power embedded in our systems, and really responding to existing and evolving external context. You know, quick reminder in terms of who we are as a society. And again, the pandemic certainly highlighted some of these deep, deep problems and challenges in urban areas in particular, and that's where the majority of the population of Canada is centered. There is no question that the paradigm has shifted significantly. We can't talk about minority populations. It's not possible to otherwise, otherwise newcomers in the way that we have been doing, politically, economically and socially, as has, you know, anymore. So you know, let me just give you an example of a construct that needs to change and exact. And this is directly related to the conversations we have with communities. You know, for those of us who are immersed in health system transformation, which has been going on for years with mixed results, one key principle value, North Star, you can't turn on the news at any time without hearing about the whole issue of attachment. You know, attachment to physicians that is seen like the solution in our healthcare system. It's positioned as a huge factor of success and objective. When we talk to immigrants and refugees, people with precarious status, uninsured, and we talk to 1000s every years, they are concerned about seamless and easy access to services, the right service, at the right time, in the right place. It might not seem very different, but it is. Let's remember that attachment to physicians. Has everything to do with our historic funding models and nothing to do with what are the needs of the most disadvantaged and vulnerable folks today in our system. Think of all of the other vulnerable groups. Today. We're talking about immigrants or refugees. What do they need? Access to services, and we know that in any transformation process if this, if the system does not work for the most vulnerable, it does not work for anybody. And there is research that speaks to that, the healthy immigrant effect. You know, what are the factors that contribute to the erosion of self rated health over time? It's social determinants of health people's access to these which has to be about doing things differently, and we know this. Thank you.

Zahra Jivan 15:41
Thanks. Axel, that's really great. I think you highlighted some really great, great points. And even just the, you know, the the 1 million people on the move, like, that's a reality, and so how are we going to be able to set up and, you know, even do some redesign to be able to support that known factor on the number of people on the move? Jessica, turn it over to you if there's, you know, more that you want to add. And you know from you know where you are in the type of work, you know the communities

Zahra Jivan 16:07
the you know, speak about the community engagement, and what are you hearing from those that you work with?

Speaker 1 16:14
For

Jessica Kwik 16:14
For sure, happy to and thanks so much again to be part of this panel.

Jessica Kwik 16:19
We're a local immigration partnership, as you mentioned, and they're really forums where collaboration can take place across different sectors. And I think, as Dr salami and Axel mentioned, we really need to think about this in different ways, as our population grows with more immigration, and that's so important to sustain our population. I'll just mention that we're based our local immigration partnership is based at United Way, which is really helpful for us to do some of the conversations and community engagement. For example, we were doing some qualitative research around healthcare, and in talking with some newcomers, communications on some of the costs are really at the forefront just having a common understanding of, you know, what are the costs if I'm not eligible for OHIP, or, you know, if I'm coming through a different pathway of immigration, and that outreach is really important. We've seen through the pandemic, community ambassadors that help people work through some of those issues. Language Interpretation is always an issue that can go along the continuum of care. So you may have language interpretation at that first point of intake, but as you move through to other more specialized services, can that interpretation carry forward, or else people may drop off from their services and use of it. Childcare is another issue. You know, in terms of use of services and obviously transportation as well, there's a bit of a tension sometimes between settlement agencies who serve newcomers and other sectors such as healthcare and and how can we get people to the care that they may need? And so in our forums, we really provide a table to have some of these strategic conversations about, how can we look at providing more welcoming communities so that we can have that sense of belonging, and so maybe the units of care are not necessarily always at the individual level, but could also be at that neighborhood or regional level as well.

Zahra Jivan 18:36
That's great. I love those just to be able to like what you're hearing from those that you support. And I think that really, as we get into the next, you know, part, when we talk about, okay, what can we do differently? I think these are really great points that we can weave in. Kareem, I think now to turn to a different lens, just given the work that you do around policy and the research that you do on immigration policy, what's your lens and where do you see? Like the way that policy is set up, how does that impact the health of immigrants to Canada?

Kareem El-Assal 19:08
Well, like you noted at the outset, Zara, Canada is poised to welcome 1.5 million permanent residents over the next three years, and the majority of these immigrants are going to be welcomed under the economic class, and this has been the case in our country since the mid 1990s and so when we focus on the economic class, we tend to cherry pick these individuals based on certain characteristics, one of which is their age. So the point system maximizes age points. If you're between the ages of 20 and 29 unfortunately, from the age of 30 and onward, you begin to lose points for your age. And then the other important factor that comes into play with economic class immigrants is they're required to complete what is called an immigration medical exam. And so they have to show Canadian government authorities, in essence, that they're healthy and healthy enough to move here on a permanent basis and not pose what the government terms as an excessive demand to our health care system. We're also doubling down on this approach by transitioning more temporary residents to permanent residents. The largest category of these folks are international students, who obviously are very young in age. A lot of them are transitioning in their early and mid 20s, and so essentially, the game plan from a Canadian policy perspective is, let's harness the the talents of our economic class immigrants in the labor market so that they can support the healthcare services for other newcomers who are more in need, as well as other Canadians amid our rapidly aging population. Our immigration system isn't 100% cerebral. We are very compassionate at the same time. So going back to our immigration levels plan, about 15% of the immigrants that we welcome each year are for humanitarian purposes. We do not screen for their age, their human capital characteristics, or even their health status, we simply screen them based on whether or not they need a second lease on life. And typically, these folks because of the trauma that they've experienced, as well as perhaps from the source countries they originate from, they often will require more healthcare supports than other classes of immigrants. However, I want to offer an extension of what Axel rightly pointed out. We obviously live in a global village, and unfortunately, global conflict remains prevalent, and Canada's often responding, and one of the major ways we respond is by welcoming folks from these countries as refugees. And despite this disposition that we've had, and we've had this disposition since the end of the Second World War, oftentimes we don't have a crisis response framework in place. We treat each of these instances as if they're isolated, and we kind of sell ourselves short, because we have over 70 years of know how in this regard. And so rather than beating up on us too much, I do want to point out that there are some good practices out there where the three levels of government, as well as other stakeholders on the ground and healthcare stakeholders have worked together to respond effectively to global crises. Back in 2015 and 2016 the federal government decided that as a country, we would pursue a major refugee initiative with Syrians, and so for us to execute that initiative, we saw a significant amount of collaboration between the three levels of government and other stakeholders with the three levels of governments. They essentially met seven days a week, and this was at the senior most levels of government, and they were able to welcome 10s of 1000s of Syrians within several months, as well as to ensure that we had our bases covered in terms of offering them supports in all areas they needed support, including healthcare. And so there's a lot that we can learn from this and other examples so that we can be more equipped moving forward to respond to these global crises as these emerge, and unfortunately, we know that they're coming, right? And so it's incumbent on us, because of our humanitarian disposition, disposition, to always be prepared.

Zahra Jivan 23:55
That's great. Kareem, I think you made the segue into, you know, what can we do differently, and what are some of the opportunities for change, and I like that perspective you bring in from the policy and just sharing some of that insight and that background. Dr Salmi, I want to turn it back to you just I know you shared a lot of insights around the research and what the research is saying. What are your thoughts in terms of the role that academia can play to help support, you know, immigrants with with their health. How can the research be used to be able to make change? And we've heard from from the other panels, in terms of what they're doing, is there anything else that you want to add in that you're seeing?

Bukola Oladunni Salami 24:38
So I like to point for the need for data about immigrant health, and also the need for that data to be disaggregated in terms of also in terms of race disaggregation for the data many of the databases available. For example, when I looked at the Canadian Health menu. Survey to look at immigrant mental health, I could not disaggregate by race because of the sample size of different racial groups within that. I think you know one thing that is also very important is oftentimes researchers only involve immigrant organization or immigrants at the data collection stage of their research. That needs to change for us to ensure the maximum integration and mobilization of knowledge. We need to integrate immigrants, people with lived experience before the research begins. In defining the research questions and to the dissemination and mobilization of knowledge. I know that a lot of my research that I have been able to move into policy. It is because of that engagement throughout the research process that I have been able to do that. And I would point out that the United Nations was here not specifically on immigrants, but black population in 2017 and the conclusion they made was that Canada's history of enslavement racial segregation has left a legacy of anti black racism, which must be addressed in collaboration with affected communities. And I would stress that the need in terms of the partnership and collaboration with affected communities. And often times, you know people, things are often done for people, rather than with people. So again, using a not by us, without us, approach in terms of community engagement and development, while also building capacity of of communities as fruitful actors in in advancing their needs.

Zahra Jivan 26:48
Doctor, if I could just probe on that a bit, because I think that's a good way forward. Um, what are you finding? Are the barriers right now to being able to do that? Um, like to be able to bring in the lived experience? Is it like capacity of people that are running this type of research? If you can share a bit about that of like, what then needs to change to get there? Yes.

Bukola Oladunni Salami 27:08
So I recently did a study for Public Health Agency of Canada to look at culturally sensitive approach to research with black communities. Now a lot of and I did a scoping review to look at the methods that have been used to research black communities, and also interviewed researchers that have done work with black communities in the past. A lot of the things that researchers talked about is, we have a lot of flying, you know, is it flying by night that it's called, you know, people that, basically, you know, maybe there's a refugee crisis, they come, they collect data. They don't have any commitment, um, basically, they just see, okay, there's, you know, funding available. I will apply for this. I'll move forward without really, actually translating knowledge. So there is the will, there is the intention. And I would say, you know, I come from a very decolonial perspective to research. And when you think about what is really, really the crooks of decolonial is thinking about research for what? And I think often times people just do research for the purpose of doing research without actually a change. And I think you know, having that commitment to social justice to actually using the research for benefit of communities is very important. There are researchers also that have good intentions but do not have the skills in terms of working with communities. So it is, you know, equipping researchers to be able to have the skills in terms of engagement with communities and also researchers that have good intention in terms of you know how they are going to benefit the communities they are serving.

Zahra Jivan 28:51
Thank you. I see lots of hearts and thumbs up flying out, so that definitely resonated with those that are listening. Axel. I want to just go back to you, you know, I know Kareem talked about, you know, the work that was done with the Syrian community. And we talked about, you know, this kind of, this dance that happens around this, if you can just talk about from your lens, like, what needs to change? Where did, where does there need to be more effort placed? Or, you know, we talked already about collaboration. I wonder if there's other things that you can point out.

Axelle Janczur 29:26
Okay, for sure, but before I do that, I just want to respond to Dr Salamis comments a little bit, because I think they're critical and crucial. I mean, data. I'm not even get started on data. We could talk about data and race based data and other, you know, for hours and hours, that's another that's another webinar. I'm just putting that out there for you that we'd all come back and talk about. But you know, community based research partnerships and research is critical to ensure. Knowledge mobilization that's required, because I think that's where, you know, in the past, historically, researchers have fallen down. You know, they they're not the knowledge mobilizers, and it's those partnerships with organizations. Access Alliance has a community based research program. We partner with academics, with hospitals. I just saw a comment from Professor Ibu there. We partner, you know, like it's, it's really compelling and ultimately transformational stuff. And, you know, going back to, sort of like old constructs years and years ago, when we were doing research, you know, one of the things that we encountered, and, you know, we tussled with with our research partners at that time. And, you know, I'm happy to say there's been a lot of movement forward. Is this whole notion of ownership of knowledge. You know, we would sometimes partner with academics and CO create knowledge with community members. But then there was a real resistance to anybody talking about this knowledge other than the academics because of, you know, historical constructs in terms of ownership of knowledge. And that's an example of how, you know, research has to continue to change in our understanding of of this knowledge that's that's co created, in terms of, you know, what has to change. I'm going to pull back a little bit to the kind of 10,000 feet level. You know, let's not remember, we're talking about the not for profit and charitable sector, health care, education, social services, universities, housing, all of these are not for profit sector for the most part. And I would say that the sector is at an existential crisis point. It's a huge piece of the Canadian economy. In fact, people are not fully aware of that, and are surprised, you know, at how many people we employ and the value, you know, our collective budgets and the impact of the work we do. Imagine Canada a huge, you know, advocate and think tank in the sector has been sounding alarm bells for years over our looming social deficit, which is essentially the gap between projected demand for services of charities and nonprofits and the financial resources available to them if current trends continue, imagine Canada projects a gap of 25 billion within two years, you know. So what is needed to address this, to ensure the capacity of this sector, which is the sector which will be responding to and leading and driving these changes, is, you know, first of all, inclusive income growth benefiting more people, you know, and I don't think anybody needs to be convinced of that, but the prevalence, well, I mean, the gig economy and precarious employment has overtaken all other forms of engagement in our labor market, and this is hugely problematic. We need economic policy made with the social lens, you know. And that's part of what we're talking about today. What voices need to be at the table and what are the factors that we need to be consist considering in a more centered way, there has to be reform of regulations governing charities and not for profit organizations, leading to a modernized relationship. You know, this includes addressing how not for profits are funded, and moving away from Project and piecemeal contracts to sustained core funding that allows us to strengthen and maintain our core operating capacity. And this is a very political issue, and it's been very apparent, especially at a provincial and municipal level, I have to say, interestingly, federal funding has, you know, building on Koreans. You know, everything is not doom and gloom, like there are good examples. You know, the IRCC, which is a federal funder for Immigrant Services, has moved very progressively to five year funding cycles. They do fund, you know, real costs related to running these programs, and they have, in fact, fairly recently, so very responsive to demands of, you know, these changes in immigrant population growth, they have moved to integrating aspects of health and mental health services, which for Many years were completely outside of what they funded. You know, they very clearly said, That's provincial jurisdiction. We have seen significant change in that regard. And so I think that's important to flag and to build on some of these changes. There is other work going on at the federal level that I think is important to keep an eye on. For example, Senator Omid far is a huge advocate for reforming the charitable sector. Introduced a bill has done all kinds of research. She advocates for diversity and governance of all of our not for profit and charitable sector institutions. You. She advocates for loosening of restrictions on operations. She's been very engaged in access to professions and trade. So that's just an example of where there is activity going on in terms of access to professions and trades. Again, going back to this whole issue of having no sort of Crisis Response Framework, and then we find ourselves scrambling. But then things happen that do serve as a basis during the pandemic, there was, I can't remember what it's called now, I think it was like the angels of Mercy program, maybe Karim, you know better, where actually fairly large number of foreign trained healthcare professionals were very quickly, you know, had their hair, their credentials validated to be able to work in the healthcare system, given the huge pressures were We were so we do need to, you know, look at where there are these initiatives that have identified clearly what we have to do, as well as on the ground examples that we can build on, and then not forget, you know, you know, the Syrian example. What did we learn from that? Let's build on that. I'm not always sure that we carry some of this learning forward in a consistent way.

Zahra Jivan 36:09
Thank you. That's excellent. There. Axel, just to summarize a number of just different points. And I think really just the way you ended it around, like how to learn from what's being done and be able to carry that forward. Jessica, I do want to give you some time. I know you we talked about a refugee health report that is underway. Can you share what that report is about, and any key themes that you know are coming out of that work that can help think about, you know, what needs to be done to continue to support immigrants with their health?

Jessica Kwik 36:39
Yeah, that's a great segue from what Axel is saying that needing to learn from our lessons, and I think that's what we're hoping to do with this refugee health care report, which will be generally focused on Peel region, but really thinking about how can we bring in the innovations and the successful approaches from other jurisdictions across Canada or otherwise, and Be proactive in our planning, so that we can have very clear processes for the many sectors that are involved with health care and and think about the diversity of groups. We think of refugees as maybe a narrow band of people, but there's various pathways, including government assisted refugees, those who are asylum claimants, for example, and so the different care pathways may need to be adjusted based on, sort of our funding structures, for example, and just making sure that people are getting the care that they need as they're coming in. And just, you know, a note around how we can collaborate further. We've been working with our regional government around putting together a resettlement support working group, and we've been meeting monthly since with the Syrians coming in, but also the Afghan initiative, as well as looking at Ukrainians and asylum claimants now, and really trying to surface some of those issues that providers are hearing. And I think those perspectives are so important too. Sometimes providers are people who have experience as refugees as well. So really trying to bring those perspectives in, and as we start to build forward, I guess another piece is just, how can we be proactive in our planning between and across sectors at different levels? So I'm just thinking about the healthcare sector is, you know, definitely starting to look into digital health. But also the immigration sector is starting to look at, how can we, you know, continue with the success with digitizing, digitizing some of the services, but thinking about what Dr salami was saying about data, if we're each sector is doing some intake, are there abilities that we can think about ahead in terms of building that data ecosystem from intake, whether it's intake into a settlement service or into a healthcare service or into a social service agency, so that we can have that disaggregated data and the ability to think who's missing. And you know, how can we ensure that our services, whether they're online or in person, are as inclusive as possible?

Zahra Jivan 39:21
Thanks. Jessica. When is that report coming out? Maybe they'll be helpful to let people know.

Jessica Kwik 39:27
Sure, yeah, we're working towards later in this calendar year to have a version that we can perhaps have a forum in early 2025 around,

Zahra Jivan 39:38
yeah. Okay, amazing, grim. There's, you know, I had a question for you, just in terms of policy changes, there's also questions in the in the chat, I don't know if you've seen them. I don't know if there's any that you want to address, or you want me to ask you to talk about, or if you want to speak more about, like, you know, policy. Think they're all related, actually, as you talk about policy changes and some of the questions here around the points and changing up the points, yeah,

Kareem El-Assal 40:08
let me go ahead and ask answer Nathan's question. Okay, it's a great question. So

Zahra Jivan 40:17
which question Will you answer? Maybe I'll just read it out if some, if those on the maybe on the phone, can't see, are you going to answer the one around the birth rate? Birth rate?

Kareem El-Assal 40:26
Okay, yeah. So the essence of Nathan's question is, Canada's birth rate is at rock bottom. I believe now it's at 1.5 births per family, which is obviously below our replacement rate of 2.1 and he's asking, doesn't it make sense for us to prioritize in our immigrant selection criteria applicants who have children as a means of growing our population? It's a very provocative question. I think the essence of his question is, should Canada have a population growth strategy? And interestingly, despite our profound efforts to welcome newcomers, population growth is not a formal strategy of the Canadian government. The strategy, in essence, is to promote economic development through immigration. And so rather than us prioritizing immigrants with children, I think perhaps the question is, how can we maximize the economic contributions of immigrants? One thing to keep in mind is that if you are looking to bring in immigrants with kids, you have to play the long game. And I'm not sure we have that sort of patience, because all of us, in the first 25 or so years of our lives are economic burdens to society. We're taking more out of the system through education and healthcare and other things, and we're contributing. And then, typically, nowadays, after we finish our schooling in our mid 20s, we start to work full time, and we start to become a net benefit. From an economic point of view, we're paying taxes. We're contributing to the economy in other ways. And so does Canada have the patience to bring in newcomers with children and wait 20 plus years for them to start contributing to the economy? Another means of addressing the school of economic development is by simply looking to maximize the economic contributions, making sure that immigrants are seeing their credentials and other competencies recognized within the labor market, so that they can achieve their maximum economic potential, which in Turn will will achieve the goal of economic development. I

Zahra Jivan 42:46
I wasn't on. I was I was muted. Thank you, cream. Nathan, if there's any more follow ups that you have to put in in the chat, please do or in the Q and A thank you for cream, for that that that perspective on that question. Dr slammi, there's a question that's come in that I think would be great for you to respond to, to how do you recommend engaging academia, academia and government and policy, development and implementation.

Zahra Jivan 43:20
You're still there. Okay,

Bukola Oladunni Salami 43:22
I'm sorry. My I have a problem with my computer engaging academia. I tell my colleagues that, you know, one way to to engage is really presence. We need to be more visible to to the communities. And as I said, you know, one of the challenges that we do have is, you know, people that come in and get your data and go out. So we need to create forums where academia communities come together and exchange and dialog. And that's one of the reasons why I have why I like Metropolis, you know, it's a forum where researchers are there, community agencies are there. Maybe we could have more community more immigrants with lived experience at the event, especially newcomers with lived experience. So I think it is something true, some of this event and knowledge exchange that we may be able to get people to have, you know, dialog between each other. And as I said, early involvement is very important.

Zahra Jivan 44:39
I think the big theme there is how to bring in that the voices of immigrants, and to be able to bring them into the conversation to share their their lived experience. There's a couple more questions in the chat. I'm going to put this one out there. And, you know, I think just jump in if you want to respond to this one. So there's a comment in the chat around. You know, there's a tension surrounding immigrants. They don't bring votes. How can this population be prioritized within provincial agendas? Considering this tension,

Axelle Janczur 45:10
I'd like to start maybe I saw that question, and I guess there's a couple of things, I mean, not specifically about provincial but, um, you know, right now, the federal government, a couple years ago, announced a plan to introduce some kind of regularization program to create pathways for people who have no status or precarious status, and which is a very positive thing. And all community organizations who work with immigrant newcomer populations are supporting and we're doing advocacy. We're meeting with MPs, and we specifically address that question. The reality is, you know, immigrants and people who are, you know, have lived experience, or are adjacent to the immigrant experience, that is a large percentage, and in urban settings, actually a majority of the populations. And so you know, people with no status, or people who aren't Canadian citizens don't vote. But many Canadian citizens who were originally immigrants or come from that background, no have family members, have friends, have acquaintances. My children went to school with they had friends who were from undocumented and precarious status families. So it is a broader societal issue. You know, let's not underestimate, you know, Canadian citizens, we don't have such a narrow view and have these broader considerations. And you know, this example of a regularization program, which, in fact, there have been quite a few years, especially under the Harper government, there was nothing in terms of pathways, or very little in terms of pathways. Who are undocumented residents of Canada. They are the people who or precarious status. They are the people who produce, prepare, serve, and deliver our food. They take care of our children. They take care of our seniors. They work in millions of different ways, contributing to the economy. And, you know, and you're completely right cream in terms of the long game. But these are, you know, hundreds of 1000s of productive, you know, working age folks that are here, and we need to create these pathways, you know, with all of the appropriate parameters and criteria. So the you know, this is of concern to voters, and is an example of a program and pathway that will have positive, positive benefits. The other thing I just want to comment briefly on is sort of related. But, you know, all this conversation stimulates my thinking. I mean the local immigration partnerships, which are, it's a national model. So every province has an equivalent. Every single lip that I'm familiar with, which is quite a few have research committees where they support the engagement of folks with lived experience. And it's, again, a very progressive and positive and, you know, they have found ways to support that sustained engagement. So, you know, going back to what you were saying, Dr salami, about how do we find ways? You know, again, let's, you know, building on these initiatives. I

Zahra Jivan 48:23
Anyone else want to comment that? I do want to pull maybe some questions out of the chat that are more like immigration, health related, but I do want to give an opportunity if anyone else wants to respond to that one,

Jessica Kwik 48:35
I'll just maybe add something that I found really interesting at Metropolis conference, was the demographer from Statistics Canada who mentioned that Canada's population for working age is shrinking, and so the support ratio is an important factor, I think when questions come up about immigration, and it's important. So 50 years ago, there were seven workers to each senior in Canada. Now we're at three to each senior, and the share is projected to be close to one or only two users to each senior in the foreseeable future. So I thought that was a great statistics that IRCC is also mentioning as well in their in their work,

Zahra Jivan 49:19
maybe just to take us back to some of the health pieces, and actually, I know you talked a bit more about, you know, digital and technology from your lens, I would love to just hear from all of you. Where do you see better opportunities to leverage innovative approaches or technology to support immigrants in their health needs and social needs? I Yes, Jessica, I'll start with you. I'll go around what was on my screen. For

Jessica Kwik 49:48
sure. I think communications is such an important piece for newcomers as they may not know how to navigate systems in Canada, and so at the pre arrival. Stage, I think is key. And I think a lot of people have to use, you know, the internet for, you know, that type of information. So if we can bring more of that information up front of, like, what kind of nuances do people need to be aware of for prescriptions and bringing some of their medical information with them as they move to Canada, that can be really helpful for providers. And also, how can we be more inclusive? So not everyone is has the digital literacy. Some may not even have literacy in their home language, so that's another piece. But how can we be as inclusive as possible as we move towards more digitized services? How can we make sure that we're not leaving significant portions of the population behind and that we really carry forward the best practices to be very inclusive of various populations?

Zahra Jivan 51:02
Yeah, that's a good point. Jessica on my on the inclusivity, even in the design and more things are moving digital, but you don't want to continue to leave some of the population behind. Kareem, any thoughts there in terms of technology and how it can support immigrants, or even a perspective of, you know, what role can immigrants play in their own health and well being when they come into Canada?

Kareem El-Assal 51:28
I'll just make a brief comment relating to what Jessica said. So the literature shows that language is a major barrier to healthcare accessibility for newcomers, and so in this regard, technology can be a huge asset in terms of, you know, helping us provide language training to newcomers in our official languages, but also in terms of health, helping them access medical professionals who speak their native languages. So, you know, there are ways that we can tackle this barrier thanks to technology.

Axelle Janczur 52:11
Yeah, absolutely. I mean, there are. There are increasingly lots of examples, and especially when you think about remote and smaller urban centers where you just don't have the concentration of different groups. So, yeah, there are, you know, remote access, I think, you know, the healthcare sector and broader social services. And this was, this was a positive example, I think, coming out of the pandemic, because we had to do such a hard, a hard turn to online, virtual and I do think we've learned a lot by it. I want to flag again I mentioned Dr Ibukun. We partner, she, she's leading, and we've participated in a very interesting research around what is immigrants experience in this digital environment, evolving digital environment. So I think there's a lot to learn and a lot of work to do. You know, the whole issue of access to Wi Fi, increasingly is being positioned as a basic human right. You know, people need to have access to Wi Fi. You just simply cannot navigate the world as we know it if you don't have access to it. So, you know, there are different initiatives that have to be funded. The other thing is, you know, system navigation is such a huge issue. I you know, on one hand, I think sometimes we make things so complicated, unnecessarily complicated, until we figure that out. We need to support these different initiatives, you know, community ambassadors, peer outreach workers, these are tried and true strategies which, in fact, engage with people who have lived experience, who build capacity. And these initiatives build capacity in communities. And so they're, they're very, very positive. The last thing I want to say, and this goes back to, you know, some of our historic constructs that we need to move away from. And this is related to system navigation. I mean, we are so multi funded, and there are so many different eligibility criteria. And honestly, we as service providers sometimes can't even figure out eligibility criteria for access to programs and services. It's so hard for people on the ground and it, you know, in fact, I don't know if some of you have been hearing about there's this whole notion of, like moral, moral injury or moral distress, which people on the ground are experiencing, because we increasingly, you know, service providers are increasingly turning people away, turning people away, and people who have critical and compelling needs because there aren't enough resources, and it's these eligibility criteria. So I think that is something that we have to be thinking about as well, in particularly in this. Digital space. I mean, how many? There are lots of people, like just seniors. Think about it like are just getting lost. Yeah, yeah,

Zahra Jivan 55:07
for sure, Doctor Swami, I saw you, put your hand up. Did you want to comment on the technology piece or Yes,

Bukola Oladunni Salami 55:14
yes, I agree with my colleagues in terms of the the capacity we have to be able to use technology. When you think about the current, you know, what are the main global transformations that we are currently experiences? It is no technology increasing migration and the consequence of that, and also climate change, I think, will be one that would be considered when I have done research in the past, not specifically about immigrants, but it's some black youths on the impact of the covid 19 pandemic on the mental health of black youths. Black youths talked about the increasing use of technology, which is good for them, but at the same time, also give some caution with the use of technology. I have a mentorship program for black youths in in Alberta, and it seeks to socially and economically empower black youths to contribute meaningfully to the society. And I think during the pandemic, you know, the youths, we couldn't do programs in person. We had to do programs online, and I had to ship around four computers to the homes of youths to be able to actually join the program. And because they just, I mean, what they have is, what do you call this? You know, someone one phone in the house, that everyone shares the one phone in the house. And I'm not so, so we should be aware, and I think someone did mention this in terms of the inequities that exist in access to technology, and seeing in terms of how to breach that, that then we don't know, try to create, try to improve access, while also at the same time creating barriers. The other thing that black youth with mental challenges have said is they, for example, get a call from healthcare professional about their health status, and their parents are right there, so you know, the the issue about confidentiality. I know some youths have said, you know, you know they called me and you know they're asking me questions, and it's like my parents are right there. I can't say anything with the use of technology. So we need to be aware of some of those contextual elements that shapes the use of technology as we move into this and as we embrace it, also be aware of how to mitigate some of the challenges.

Zahra Jivan 57:49
Yeah, I think, well said, Dr salami, you said a lot of really great points there, even just around, you know, can help with access, but it can also be a barrier, just thinking about the timing around, like, you know, when you're using technology and those calls come in, I think just a really good way to end what we talked about today. I do want to thank every all the panelists here. I think you all share different perspectives and come from different perspectives and have your own learned experience through the work that you do and really added to a very dynamic conversation. Just to share. There will be a survey that goes out after this, as well as the recording link will be shared lots of really good conversation in the chat. And I think just really speaks to a lot of questions that you know, people have around immigration and health and you know, just wanting to learn more and to be able to do more. Susan, I'll pass it over to you to close us off for today.

Suzanne Patterson 58:48
Great. Thank you. I would like to thank everybody for attending this event and endorsing how critical this work is to the future of Canada's communities and economic development. I hope everybody's been energized and motivated by this session to continue their dedication to collective action to improve immigrant health in Canada as well. I would like to thank Deloitte for their commitment and support for this issue and their support for the important work that IPAC does. Thanks everyone, and have a fantastic rest of your day and.

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