Health Status of Immigrants in Canada - Case Study Example

THE UNANSWERED  HEALTH NEEDS OF CANADIAN IMMIGRANTS Canada’s cultural diversity is highly regarded locally and globally as one of the country’s greatest assets. But even as the country deems Pluralism as important, there are some difficulties faced on multiculturalism for the policymakers in the healthcare industry; and the most relevant issue seen here is about making services and resources equally available to migrants. Research must be consistent and aligned with practice and policy to guarantee that the migrants who are given clean bills of health remain healthy. As communities need basic health care services, response for this vital service must consider and include non-Canadian residents, such as refugees and immigrants, on their list. The Canadian Health Act of 1984 stated the "primary objective of Canadian Health Policy is to protect, promote, and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers." This meant that Canada’s obligation to its inhabitants is the commitment to health promotion and protection. Since the 1950’s, there was a noticeable change in Canada’s ethnic constitution of immigrants. Back then, European countries were the top 10 immigrant source countries. Kessel (1998) reported that in 1997, non-European countries represent eight of the top 10 source countries. Two years later, the Canadian Statistics Office (charted from1996, to 2001) stated that Asia-Pacific countries (with 51% share), UK / Europe (with 21% share), and Africa / Middle East (with 18% share) (Citizenship and Immigration Canada, 1999). Statistics Canada (1996,2001) declared that the country might be facing population decline due to the lack of adequate migrants to make up for its low fertility rate. Canadian immigrants are classified into several categories, according to reasons for migrating: Independent class, which consist of the skilled workers or business people; migrant families; refugees; caregivers; retirees and others. As a number of the migrants come from nations with relatively different cultures with that of Canada, this population is not considered homogenous; it is also expected that they may find difficulty adjusting to their new community and / or landing on the right job. Tastsoglou & Miedema (2000) postulated that although this is the usual case, there are some immigrants who may easily adapt and assimilate into the Canadian culture as well as in the country’s workforce. Ethnicity Usually depicted as diverse clusters of natives with a common race, language and / or culture, Feagin (1978) characterizes ethnicity as a secondary unit of the society that differentiates by itself or by others based from qualities that are cultural in nature. In the same light, Ethnicity is also described as “people sharing the same ancestral origins and cultural traits, with a sense of peoplehood and Gemeinschaft-type relations; usually of immigrant background, and possessing either minority or majority status within a larger society." (Isajiw ,1975) Culture Defined as "the totality of the ideas, beliefs, values, knowledge, and way of life of a group of people who share a certain historical, religious, racial, linguistic, ethnic, or social background" (France,Henry, et al., 1995). Parallel to this definition, it was also said that Culture is the "lifestyle of a group of people implicitly acknowledging their uniqueness from others in terms of beliefs, values, weltanschauung, and attitudes about what is right, good, and important”. Basing from the two descriptions given, it would be assumed that ethnic groups are small sections of the society that may reflect cultural dissimilarities. Immigrants Health Status In issues of health, particularly in service accessibility and circumstances, there are relatively obvious differences. Usually, immigrants and evident minority group health issues are pooled, even if there are dissimilar aspects involving accessibility. Canada’s new entrants do not typically experience problems with regard to health services as it is available when needed, though there are impediments in presenting the need to them. They may be unfamiliar or perhaps unable to comprehend the facts about their privileges to health services, what health providers should do or what the requirements are. It was observed that for a number of groups, the issue is aggravated by the deficiency in either English or French proficiency. Also, there were issues of underutilizing preventive health services which may pose risks in aspects of inaccurate cures and wrong diagnoses. Normally, the new immigrants show a clean bill of health upon entering Canada. US and Canadian studies show that presence of the prevalent “Healthy Immigrant Effect”. This may be attributed to the criteria for the extensive medical screening process administered prior to admittance. Statistics show that these healthy immigrants are in far better condition than the natural born citizens of Canada. Permanent resident visas are not issued to immigrants whose health conditions fall below the country’s standard that may possibly endanger the country’s health safety or may require an increase in the immigrant’s demand in health and social services compared with the natural citizens. Provincial health cards are distributed to these immigrants within half a year upon their immigration to Canada, which already entitles them to a wide array of health services. Given the case, why and how do the migrants lose the advantage of this government-mandated benefit? Research enumerates the factors affecting the issue: it was noted that migration, as an activity, is stressful; exacerbated by the lack of social support for these individuals, it was considered as a risk factor for health decline. Moreover, additional studies imply that the new migrants supposedly show that they modify their old health habits in habituation with the health behaviors of the new country that is considered as unhealthful. These are manifested with the incidence of eating high-cholesterol diets, nicotine use and alcohol consumption. The occurrence of chronic health conditions, chain smoking and physical disabilities was seen to be lesser with the new immigrants (those who have been in Canada for ten years or less) in relation to those immigrants who have stayed beyond ten years. This fact signifies that over time, these people tend to exhaust their previously perfect health conditions. (Chen, et al,1996) On the other hand, Dunn and Dyck (2000) contrasted the findings of Chen (1996). They initiated that migrants usually declare low levels of health conditions, but do not frequently report problems of inadequate health care. The results may have been validated by the actuality of age being related to lower health status among the migrants, same with the majority of the geriatric population in Canada. The new immigrants, who are mostly non-European, report a higher level of health status as opposed to the migrants from Europe and immigrants who have lived for more than ten years in the country; the latter say that they are experiencing lower levels of health status. Longitudinal data from the National Population Health Survey (NPHS) (2005) show that the migrants coming from the Non-European countries report health decline two times more over the period of eight years compared with the natural-born citizen Canadians report lower levels of health conditions than the immigrants who are in far better health upon entering the country. In researches done earlier, it was indicated that 97% of the immigrant population reported health levels that were excellent, very good or good within half a year of their residence. But with the adaptation of the new immigrants to the general culture and population, the “healthy immigrant effect” loses over time. A study observed primarily healthy people transversely among the five wages of longitudinal data provided by the National Population Health Survey. In the years of 1994-95 and 2002-03 most of the migrants show an inclination to having satisfactory to poor levels of health. In addition, migrants who entered Canada between 1984 and 1994 tend to report a drop in health levels two times as likely compared with the natural citizens within the duration of the study. The fact may imply that new migrants who originate from non-European nations that were reported to be in excellent health may have taken some of the unhealthy lifestyles brought by the need to adjust in their new way of life (NPHS,2005). According to Cairney & Ostbye (1999) observation data, reveal that being overweight is boosted as the immigrant stays longer. The observation that the prevalence of overweight seems to increase with increasing length of stay in Canada .(Cairney J, Ostbye T,1999) A limitation that possibly rules out comprehensive analyses is the fact that migrants are not fully represented. Factors such as ethnicity, age, gender, and health habits were most likely overlooked. Also, problems of being overweight are usually related to Type 2 Diabetes. Immigrants with no signs of Diabetes incur the disease upon settling. The rate of the disease cannot be closely related with the population standard, as it usually exceeds the normal occurrence in Canada (Weijers RNM et al ,1998). Immigrants from South Asia seem to exude higher occurrence of the disease than Canada’s citizens. Also, compared with their natural-born counterparts, the new migrants tend to do less physical activity, cancer screening and other health-enhancing behaviors. (Beiser et al., 1997) A dose-response report also indicate that color cancer becomes more common with the migrants as they stay longer in the country (Balzi et al., 1995). The studies must focus on determining the risk factors which might shed light on issues that are helpful to the migrants and the citizens of the country; wherein the after effects may be heightened by the process of resettlement. According to a research done to 131,000 Canada immigrants aged 12 years and above, immigrants who lived in the country within 30 years or less tend to exhibit significantly low incidences of alcohol dependency and depression compared to the natural-born Canadians. But the occurrence of acquiring mental diseases seems to be higher than the population sample compared by age. Findings may somehow prove that Immigrants who have lived for more than 30 years will most likely acquire mental diseases. Researchers note that though there is strong evidence of the healthy immigrant effect, it is not convincing enough. They postulate that this might be the effect of the immigration process. As new immigrants come from low-depression and low-alcoholism areas like Asia and Africa, placed side-by-side with the Europeans, who consisted most of the migrant population in the 1900s. The effect may also be originated from the aging process which is vulnerable to such risks for the immigrants that the natural born citizens. Aside from the possible vanishing of the healthy immigrant image, these people may experience worsening of the health condition in general. Owing it to the fact of immigrant issues of poverty, scarcity of health services as well as unemployment, the phenomenon is then referred to as the Immigrant Overshoot. Poverty is more likely to occur among immigrant in the first decade of their settlement than their natural-born counterparts. Poverty may lead to other complications such as being more prone to diseases as well as lesser access to adequate healthcare. In addition, the pessimistic effects of unemployment cause greater impact for the immigrants; that is maybe because of the scarcity of resources available to them compared with the Canadians. This does not only affect their probability of acquiring diseases, but it also impinges on their ability to ethe ndure life-threatening diseases such as cancer. Immigrant women in Ontario were reported to dismiss their doctors’ advice in terms of following the procedures for cancer detection. It was suggested to have more researches undertaken to address the issues. Researches done by Nair and colleagues (1990) suggest that cardiovascuylar health is better among immigrants than natural-born Canadians, but this lead deteriorates as time passes by. But since the immigrants are not of the same kind, their health conditions vary depend on their place of origin. For example, Asians are more likely to have higher rates of heart disease occurrence. Sheth and his collegues (1999) observe that genetically-based insulin conflict, paired with altered dietary patterns tend to result in a high-risk atherogenic profile. Factors affecting immigrants’ health in Canada enumerate the ff: income, educational attainment, marital status, social support and language abilities. These factors are common within their country, culture as well as the socioeconomic situations in Canada. The experience and process of migration and the duration of stay in the Canada are also noted inclusion in the factors. Factors that Affect Health Age Migrants that are in the old age tend to note more health problems Those migrants in the family category are noticeably older than other migrant from other classes. Nine out of ten migrants are in the 55 and above age category. As a determinant of health, not even immigrants are exempted. Health problems usually increase with age. In a study conducted, 15% of the immigrants between the age of 15 and 54 stated health problems that were physical in nature. On the other hand, 28% of the 55 years and above who reported the same problem. Those aged 25-44 showed an increase of 6% on these problems as evaluated against the 15-24 age bracket (with 4%) as well as the 55 and above age group (3%) Stress The paradigm of stress from resettlement explains the framework of the Immigrant Overshoot. The framework shows that problems that causes stress such as poverty, lack of adequate healthcare and unemployment seems to have an undesirable effect on people and it is further aggravated by the immigration experience and resettlement. Within the first ten years of living in Canada, the migrant is more likely to be living in poverty as compared with a native-born Canadian (Beiser, 2002) (DeVoretz, 2002). Aside from increasing the probability of disease exposure, it also bars benefits to treatment. (Kinnon, 1999) (Kliewer & Jones, 1997). As some health problems are affected by age, other problems are brought by integration and settlement difficulties. The absence of adequate employment, disillusionment, despair and heightened poverty situations coupled with the lack of ability to pay health insurance which is not accessible to the public. Immigrants do not possess the needed social support networks. Prior studies done in the topic are from the critical mass theory where the premise lies on the fact that migrants settling in areas with established communities of ethnicity get mental health advantage than migrants who do not belong in a similar community. (Murphy, 1973) Aspects on both individual and family health such as education, non-discrimination proper housing and community assimilation may not be considered in the absence of complete socially determinant approach in doing healthcare. As immigrants experience a great deal of adjusting in a new nation with the barriers of race discrimination on issues such as housing and employment, language variation, different social and religious values including the resistance to employ foreign credentials presented by non-Canadians, women experience problems that are distinct to their gender. Decision making still depend on the males, with the women and children required to obey as in the case of doing the migration. Frustrations brought by inability to earn a large income enough to support the family, may cause domestic violence that affect the wives and children. Factors such as skin color, immigrant’s country of origin, age during the migration and experience with the discrimination may affect the person’s identity and may affect the health and well being. Employment & Income According to Dunn and Dyck (1998), socioeconomic factors are vital factors for health outcomes for the immigrants compared with non-immigrants. Employment and income are important influences on the health of a person or a community according to the Region of Waterloo Public Health. This meant that low-income familes or individuals may seem to be unhealthy because they lack the fundamental needs like housing, food, and clothing which are also important for keeping good health. New immigrants who arrived five years before, seems to have lower income and / or no jobs. Culture difference Health care inequalities imposing on cultural behavior aspects has been seen. A researcher who examined health ideas passed along generations includes studies on the following: how people view health and illness and how they see inequalities in terms of the medical care provisions. Like when an immigrant, had two children allowed her to follow the old customs of her country of origin, it would be much easier for her. Especially Chinese women, who strongly adhere to traditions of balancing the Yin and Yang which is believed to be important in the mother and child’s health. This meant shying away from prohibited foods, only giving the mother hot liquids in oder to maintain the balance of energies in her body to avoid making her system weak. When she is admitted in the hospital, her mother would be at her side and the staff would be understanding of her needs (Candaian Press News Wire, 1996). While it is noted that some incorrect information on health, they were ready to address it. It was also observed that poverty was seen by people as a hindrance to their choices and affecting their health. 90% of Asian women report that they did not undergo mammogram testing within the previous year. This is a disturbing fact as the early detection of breast cancer reduces the mortality of the disease, especially among women aged 50-69. (Second Report on the Health of Canadians, 1999. This poses the question why Asian women do not do mammograms. Traditional oriental cultures were attributed to the belief that one should only go to the doctor when sick. (Dinh, et al, 1990) (Lai & Yue, 1990). Also it was noted that cultural unfamiliarity as well as language barriers happen between the physician and the patient the probability of having an old woman visit the doctor for checkup will decrease. Sociologist Alba (1999) noted that multiculturalism is basically speaking of accepting the minority to be of equal standing and worth of its language, religion, traditions, respect, encouragement and recognition. Access to health services According to the Longitudinal Survey of Immigrants to Canada (2001) 23% of the immigrants had a problem with accessing health care. Though there may be programs to cover for health care, a number of unmet needs may cause a dent in the finances of the immigrants. The most common problem was the difficulty in accessing health care was the long waits which resulted to 48% which rung the same for Canadians, this was followed by high health care costs (29%) and language problems (26%). Recommendations : Des Mueles and colleagues (2004) opinion on early detection and the use of cancer screening is urgently required for immigrants. Workshops or educating the immigrants such as competency enhancement training, cultural awareness, training and support should be done through focus groups. Health professionals in Canada should have good training in handling stress and depression that are usually encountered by migrants in diverse society. Inequalities in terms of health between countries of origin and migration could be minimized through developing culturally and linguistically-relevant program to promote particular benefits of preventive health programs. Policies centering on multicultural groups are important as it will give a feeling of belongingness to the immigrant, that they feel welcome. Also, there should be considerations on the socioeconomic / socio-political factors shaping the nlives of the immigrant people. These programs should involve follow-through and talks from the federal and governmental organizations. Health care professionals should be trained for awareness and understanding of important issues in cultural communities. Asian women should be made aware of the importance of examinations such as , mammogram and pap smear and remove the negative attitudes and behaviors toward testing in these communities. The provision of family and individual counseling , transportation and child care should also take place. Cultural sensitivity is an important topic as well as effective and responsible health care. Health professionals should understand and conceptualize health forums where information can be informed in a coordinated and culturally appropriate manner. For starters, federal and provincial governments should fund, prepare, and promote native-language health information for common health conditions, such as diabetes and hypertension. Interpreter services, should also be provided a standard to ensure that, at a minimum, key documents, such as health information and consent forms, are accessible in minority languages, reflecting the growing diversity of the Canadian population beyond that of a traditionally English and French medium “. Read More