Changing Immigration Policy:

Effects on Health Care

Interprofessional Education (IPE) Workshop
University of Toronto
October 22, 2014
Presented by: Rupaleem Bhuyan
Factor-Inwentash Faculty of Social Work
University of Toronto

Bhuyan., 2014

Overview
Goals for Interprofessional Collaboration
Immigration Status as a Social Determinant of Health
Trends in Canadian Immigration & Refugee Policy,
Health Care Coverage in Canada
How Changes in Immigration Policy are Impacting

Access to Health Care

Bhuyan, 2014

Interprofessional Collaboration
A process of communication and decision-making that

enables the separate and shared knowledge and skills of

healthcare providers to synergistically influence
client/patient care (Way et al., 2000)
IPE Skills: (Deutschlander and Suter, 2011)
Roll Clarification
Team Functioning
Interprofessional Communication
Collaborative Leadership
Interprofessional Conflict Resolution
Patient/Client/Family/Community Centered Care

Bhuyan, 2014

Immigration Status as a
Social Determinant of Health
The social determinants of health are the conditions in
which people are born, grow, live, work and age. These
circumstances are shaped by the distribution of money, power and
resources at global, national and local levels. (WHO, 2013).

Health

Equity asserts that all people have the opportunity to

reach their full health potential and should not be disadvantaged by

social and economic status, social class, racism, ethnicity, religion,
age, disability, gender, gender identity, sexual orientation or other
socially determined circumstance (Health for All, 2012)

Bhuyan, 2014

Social Determinants of Health Conceptual Framework

Context of Immigration in
Canada
Canada is a white settler state with ongoing colonization
Steady immigration since the 1980s
Family, Economic, Humanitarian
Changing demographics of Canada
Since 1980s, majority come from Asia, Africa, South America, the

Caribbean; Philippines, India & China are top sources

1 in 5 people in Canada and 48% of Toronto residents were born

outside of Canada

Growing poverty among immigrants

Since 1990s, harder for immigrants to gain employment
35% poverty rate for immigrants, <5 years in Canada

(vs. 10% for general population)

Bhuyan, 2014

Trends in Immigration & Refugee Policy

Shifting Who is Changing Immigration Policy:
In 2008, the Minister of Citizenship and Immigration was
empowered to issue regulations without legislative oversight.
Provinces and Municipalities are taking measures to protect

immigrants rights (e.g. City of Toronto, Sanctuary City Policy)

Bhuyan, 2014

Changes to the Family Class

2011 Citizenship and Immigration Canada (CIC)

introduced Parent and Grandparent Super Visa

CIC froze applications for parent/grandparent sponsorship
2012 CIC introduced 2-year Conditional Permanent Residence

for spouses
2013 CIC re-opened parent/grandparent sponsorship with higher

income thresh hold and cap of 5,000

2014 CIC changed definition of dependent from 22 to 19 and

younger

Bhuyan, 2014

Changes to Refugee Policy

2012, Bill C-31
Introduced a multi-tier refugee system with shorter time frames
Different protocols and rights for:

Refugees claimants arriving from countries on the designated

country of origin (DCO)

Irregular arrivals may be automatically detained; barred from

accessing permanent residence for 5 years

2012, Cuts to Interim Federal Health

Impact refugee claimants from DCO countries
Created confusion among health care providers; led to refugees in all

categories losing access to health care

2014, Ontario Temporary Health Plan for refugee claimants

Bhuyan, 2014

Changes to Economic Migration

New Streams for skilled immigrants
2008, Canadian Experience Class
Growth in Provincial Nominee Programs
2012, Revised Federal Skilled Worker Program (Points
system)Shift to younger workers and higher language proficiency
Live-In-Caregiver Program
2010, removed requirement for medical examination for Live-incaregivers applying for permanent residence
2010, extended time frame for LIC to accrue requisite 3,900 work
hours fro 3 to 4 years (to apply for PR)
2011, allowed LIC access to open permits, after they have
completed requisite work hours and are applying for permanent
residence

Bhuyan, 2014

Changes for Temporary Workers

2011, Introduced the 4-in-4 out rule for TFWs in low-

skilled occupations.
April to June 2014, moratorium on hiring temporary

foreign workers in the Food Services Sector

2014, overhauled temporary worker program
Reduced visa for low-wage jobs from 2 to 1 year
Requires employers to provide more information to

demonstrate that Canadian workers are not available

Bhuyan, 2014

Changes to Citizenship, 2014 Bill C-214

Making Citizenship Harder to Get
Language and citizenship tests apply to more people; ages 14-64
Increases the fees (for application, citizenship text, language test)
Extends residency requirements:
4 years out of 6 years for citizenship eligibility
Must be present in Canada a min. of 183 days/year a min of 4 of 6 years
Time spent in Canada as non-permanent resident does not count

No right to appeal if refused

Making Citizenship Easier to Lose

For naturalized citizens, government can revoke citizenship if it
believes you do not Intend to reside permanently in Canada
For Canadians with potential dual citizenship, may lose citizenship
for a criminal conviction in another country

Bhuyan., 2014

Overview of Trends

Marked growth in temporary migration

Temporary foreign workers (high skilled & low-skilled)

International students
New conditions on family sponsorship
Refugee claimants

Shift to more precarious immigration

Temporary migrants have limited rights
Restrictions on access to permanent residence
Shift to criminalize immigrants as bogus refugees, marriage
fraudsters, terrorists, and criminal immigrants
Increase in immigrant detention and deportation; including families
with children

Bhuyan., 2014

2012: Permanent vs. Temporary

Permanent Residents
Category
Family Class
Economic Immigrant
Refugees
Other Immigrant
TOTAL

Temporary Residents
Number

Category

Number

79,586

31

Foreign Worker

446,847

44

148,037

57

Foreign Student

301,842

30

23,968

Humanitarian

131,522

13

7,028

Other

139,083

13

258,619

100

TOTAL

1,019,294 100

Adapted from CIC (2012)

Bhuyan., 2014

Canadian Council for Refugees (2013). http://ccrweb.ca/en/traffickingbulletin/march2013

Bhuyan., 2014

Health Care Coverage Options

OHIP (Ontario Health Insurance Plan)
Single-payer system for citizens, permanent residents and some

temporary foreign workers (Full-time)

UHIP (University Health Insurance Plan)
Subsidized private insurance for international students and their

dependents
Interim Federal Health Program
Publically funded health care for some refugees and protected persons
Covers first 12 months for resettled refugees receiving government support

Private Health Insurance

Supplementary insurance for things not covered by OHIP (i.e. dental,

drugs, professional services, etc.)

For people waiting to get on OHIP
For parents and grandparents on a Super Visa
For temporary foreign workers, visitors, business travelers who are not
covered by OHIP

Bhuyan., 2014

Source: www.health4all.ca

Bhuyan., 2014

Source: www.health4all.ca

Bhuyan, 2014

IFH Coverage by Refugee Status

(Hynie, et al, 2014)

Social Determinants of Health for Immigrants with

Precarious Immigration Status
(Adapted from Mikkonnen and Raphael, 2010)

Income
Education and profession
Language capacity in English/French
Unemployment and job insecurity
Work conditions
Dependence on sponsor (i.e. spouse, employer)
Food insecurity
Housing
Isolation and social exclusion
Immigration status; Mixed Status Family
Multiple family roles
Race and country of origin
Gender
Disability and health status

Bhuyan, 2014

Strategies to Confront Health Inequity

(Association of Ontario Health Centres, n.d.)
Assigning priority to populations who have the greatest

health needs and least access to services

Involving the communities we serve in the design of
programs
Developing anti-oppression strategies to identify and
confront oppressive practices in our organization
Collaborating with health partners and the broader
community
Supporting and collaborating with groups that are
challenging the conditions that case health inequities
Advocating for public policy responses to reduce health
inequities

Bhuyan, 2014

Strategies when working with nonstatus or

precarious immigrants
Know your local resources that can help you offer

comprehensive support
Do not involve Canada Border Services Agency, or
function as immigration enforcement
Examine assumptions about culture and different
immigrant groups
Address ethical issues and effectiveness of Access
without Fear policies
Know the rights of non-citizens
Know the rights of the immigration system
Ensure privacy and confidentiality

Bhuyan., 2014

Immigration Policies and Access to Services

An estimated 500,000 people are uninsured in Canada
70% drop in new refugee claims since 2012
Many service providers are overwhelmed and confused about the

new immigration policies; When service providers do work with

nonstatus persons, they typically do not document this work;
Information sharing between CBSA and Ontario Works has led to

refugees being cut off prematurely from social assistance

Service providers are discriminating against immigrants/refugees,

due to heightened suspicion and hysteria of immigrants abusing

the system;
Criminalization of immigrants is leading to racial profiling and

increasing the threat of immigration enforcement.

For example, applying for a refugee claim can now result in detention;

Bhuyan., 2014

Resources for the Uninsured in Toronto

Community Health Centres (examples)
Access Alliance
East End Community Health Centre
Central Toronto Community Health Centre
Womens Health in Womens Hands
The Scarborough Clinic for the Uninsured
Grassroots Campaigns
Health 4 All http://www.health4all.ca/
Solidarity City http://solidaritycity.net/
No One Is Illegal http://toronto.nooneisillegal.org/

Bhuyan., 2014

Till immigration tears us apart

Migrant Mothers Project
Digital Stories

Bhuyan., 2014

A Time to Recognize Human Rights

I think it is time to recognize the human rights, that we are people.

That we are worth it. That we have dignity. That we can provide to
society, that we are not criminals, no? . For all the people who are
suffering, who are being hunted, they are being hunted in a figurative
way, no?, but it isyes, it is something against our, our dignity, our
right to live, to have aa safe life, a place, a job.....
The life of the human being is not being valued But I think that it is

not the time for this, no? We live in a time that I think must change,
no? A change must be made.
(Laso, refugee claim dismissed, awaiting decision on H&C

application, interviewed August 2011)

Bhuyan., 2014

Contact Information
Rupaleem Bhuyan, PhD
Associate Professor
Factor-Inwentash Faculty of Social Work
University of Toronto
r.bhuyan@utoronto.ca

Project Website: http://migrantmothersproject.com

Find us on Facebook MigrantMothersProject

Bhuyan., 2014

References
Battered Womens Support Services. (2010). Toolkit for lawyers. Best practices

in working with battered immigrant women. A BWSS Toolkit.

Bhuyan, R. and Smith-Carrier, T. (2010). Precarious migratory status in Canada:
Implications for social work and social services delivery. Canadian Social Work
Journal, Vol. 12(1), pp. 51-60.
Canadian Council of Refugees, Ontario Council of Agencies Service Immigrants,
Metro Toronto Chinese and Southeast Asian Legal Clinic, Colour of Poverty
Campaign (2012). State of Immigrant and refugee womens status in Canada
2012. A joint report. Available at www.ccrweb.ca
Citizenship and Immigration Canada (CIC) (2012). Facts and figures 2012:
Immigration overviewPermanent and temporary residents. Ottawa. CIC.
Deutschlander, S. and E. Suter (2011). Interprofessional Mentoring Guide. Health

Systems and Workforce Research Unit, Alberta Health Services.

Health For All (2012). Winnipeg regional health authoritys position statement on health
equity. Available at
http://www.wrha.mb.ca/about/healthequity/files/HealthEquityworddocBWwebsite.pdf

Bhuyan., 2014

References continued
Hynie, M., A. Korn, K. Canic (2014). Refugee integration in Ontario: A tale of

six cities. Paper presented at the International Association of Forced

Migration, Bogota, Colombia.
Jiwani, Y. (2001). Intersecting inequalities: Immigrant women of color, violence

and health care. Vancouver: FREDA Centre for Research on Violence against
Women and Children.
Mikkonen, J. and D. Raphael (2010). Social determinants of health: The Canadian
facts. Toronto: York University School of Health Policy and Management. Available
at http://www.thecanadianfacts.org/The_Canadian_Facts.pdf
Way, D, L. Jones, and N. Busing (2000). Implementation strategies: Collaboration
in primary care: family doctors & nurse practitioners delivering shared care.
Toronto: The Ontario College of Family Physicians.
World Health Organization (2013). Social Determinants of Health. Webpage.
Available at www.who.int/social_determinants/en/