In 2011, Su-Yun Kim and her husband arrived in Canada hoping for a better life, as many refugee claimants do. In North Korea where they were born and raised, Su-Yun’s husband was involved in political activity, necessitating that they flee from their loved ones and their home for safety. With difficulty, they managed to escape through China and arrived in Canada, a foreign land with unfamiliar faces, new customs and a different language. We met this couple not long after these events at a refugee shelter which houses and supports refugee claimants. Su-Yun was pregnant when she arrived and required initial prenatal care, which we provided her through the help of an interpreter. Although we could never directly communicate in the same language, the gratitude in this young couple’s eyes and gestures was clearly evident. After fearing for their lives and traveling halfway around the world, they were overwhelmed to find a team of health professionals who cared about their total well-being. No matter where people have come from, the stories of refugees and refugee claimants are often remarkably similar. These are people who have traveled long and far, often to escape war and persecution. They are here not to scam a system, but because they had no choice but to leave their homes. Unfortunately, this is not the picture that has been painted by Jason Kenney, Canada’s Federal Minister of Citizenship, Immigration and Multiculturalism.
Recently, Minister Kenney has proposed drastic changes to the Interim Federal Health Program (IFHP), the very program that allowed us to provide Su-Yun with her prenatal care. This program provides healthcare services for refugees who have been accepted by Canada through refugee camps, as well as those who arrive at our doors for asylum, like Su-Yun and her husband. These cuts would deny all refugees and refugee claimants access to essential medicines. It would also deny regular healthcare services to refugee claimants deemed to come from ‘safe countries’, a questionable classification given the unique situation of each refugee claimant. Understandably, healthcare providers and the public have been outraged over these cuts by staging demonstrations across the country and even a public letter signed by major health provider organizations such as the Canadian Medical Association. Here, we seek to systematically highlight ten reasons why the proposed cuts to the IFHP are a poor policy decision.
1. Worse health outcomes for refugees.
Numerous health organizations and health professionals have expressed their concern over the impact of proposed cuts on the health status of refugees. A Wellesley Institute Health Equity Impact Assessment conducted on the policy change noted that it will likely create more barriers for refugees to receive basic care. The report notes that women and children will be at particular risk, especially if they are victims of physical and emotional abuse. It further states that decreasing access to prenatal care and early childhood interventions could lead to developmental problems for children of refugees, many of whom will be born as or eventually become Canadian citizens. Finally, it predicts that the prevalence of chronic conditions, both physical (e.g. diabetes) and mental (e.g. depression), will increase due to inadequate primary care and monitoring. A particularly striking example of the health effects of this policy is that refugees from countries labeled as ‘safe’, would not even be treated for heart attacks! Among public health experts, there is little doubt that these policy changes will increase the health disparity gap in an already vulnerable subset of the population and worsen the health of refugees in Canada.
2. A threat to the health and safety of Canadians.
Many healthcare professionals believe that the IFHP cuts are not in the best interests of Canadian safety. Without ongoing care from primary care providers, dangerous conditions can go undiagnosed for long periods of time. While the policy purports to provide care for conditions threatening public health, these conditions, such as the highly contagious and deadly tuberculosis, are likely to remain undiagnosed until it is too late. How are refugee claimants to know that they can see a doctor because they now have a disease of concern to public health? Such a disease is often diagnosed in primary care via screening chest x-rays and dealt with before it becomes a threat to public health. By not providing basic care, we are only increasing the health and safety risk posed not just to refugees themselves, but also to the Canadian public.
3. Refugees are not here to abuse Canada’s healthcare system.
The government has attempted to justify the IFHP cuts by painting a very misleading image of refugees and refugee claimants as people who aim to abuse Canada’s generosity via our healthcare system. Not only is it unfair to imply that refugee claimants come to Canada simply to gain access to healthcare services, but this also ignores the fact that individuals selected by our very own government for immigration (government-assisted refugees), are also having benefits cut under these changes. If anything, given the cultural and language barriers, healthcare professionals are often unable to reach refugees and refugee claimants as much as they would like, to provide the kinds of services that they need. As Dr. Meb Rashid of the Crossroads Clinic said, “I’ve seen over 2000 refugee claimants and I can’t recall more than a handful who strike me as being wealthy or here for adventure. The government is painting them to be bogus and cheating the system. That really hasn’t been my experience.”
4. Costs will increase and burden provinces and community groups.
While the primary stated motive behind the government’s proposed cutbacks to the IFHP is to save taxpayer dollars (approximately $20 million annually), this argument doesn’t really hold much weight. A robust body of research supports the notion that timely, organized and prevention-focused primary care, can significantly decrease healthcare costs. Without ongoing treatment of diabetes, hypertension, mental illness and access to prenatal care, refugees who have already endured great personal strife will only get sicker and present to emergency rooms with expensive complications. This will increase wait times at Emergency Departments and some also believe that these associated costs will be shifted to the provinces. Numerous preventative cost-saving measures that occur in primary care will no longer be available and as a result, taxpayers will conversely pay more for hospitalizations due to preventable complications.
5. Inconsistent with Canadian values.
Not only will these cuts be bad for the health and wallets of refugees and Canadians, they are inconsistent with Canadian values. The Canada Health Act, our federal legislation that enacted Canada’s cherished universal public healthcare system states “the primary objective of Canadian health care 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.” The Act clearly exemplifies how Canadians have chosen to protect the health of all those within our borders, and not just its citizens. As Dr. Philip Berger stated, “Canadians are fair-minded people that would never accept turning anybody down, whether refugee or tourist or citizen, when they’re suffering from a heart attack.”
6. Inhumane, unjust and in contravention of human rights.
What has struck many who have denounced these cuts is the mean-spirited nature of the proposed changes. Refugees and refugee claimants are among the most vulnerable members of our society. Given the frequently urgent reasons for their departure, often refugees and refugee claimants arrive with few belongings to a country with no friends and family and a head full of traumatic memories. To then deny this population access to essential medicines, or even basic healthcare services, is simply cruel. The Universal Declaration of Human Rights, adopted by the UN General Assembly in 1948, clearly states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
7. Perpetuating the cycle of poverty.
Many refugees come to Canada for a better life for their families after fleeing war and/or persecution. As part of this process, refugees are statistically much more likely to live in poverty than non-immigrant Canadians. Income level is the most important determinant of one’s health, and on top of acclimatizing to a new culture and society, the stress of living in poverty can be very detrimental to the health of this population. In turn, it is crucial to ensure that access to healthcare services is available for this marginalized group rather than exacerbating their challenges. Furthermore, without primary healthcare, refugees will not receive the kind of support, counseling and connection to social services that has shown to benefit successful incorporation into Canadian society. How can we reasonably expect refugees to productively contribute to society if they are living in poverty and not able to receive treatment for their medical conditions?
8. Canada’s international reputation is at stake.
In the grand scheme, the proposed cuts reflect a change in the way Canada is being viewed internationally. In 2010, for the first time in history, Canada lost its bid for a seat on the UN Security Council. This was largely believed to be the result of a shift in Canada’s foreign policy and a lack of action on climate change. At such a sensitive time on the world stage, it is not in our nation’s best interest to be seen as unsupportive of our most vulnerable populations and accusing them of abusing our services. Dr. Mark Tyndall, a physician in Ottawa, also felt these “unfair and unethical” cuts would reflect poorly on Canada, by “taking the most disadvantaged and traumatized human beings on Earth and telling them we have been too generous for too long.”
9. Unsustainable for our healthcare system.
Canadians cherish their universal public healthcare system, and yet, the proposed cuts are threatening its sustainability. There is no doubt that chronic medical conditions are best managed in primary healthcare settings. Not only are diseases more easily diagnosed in primary care but this model has been shown to be cheaper for taxpayers. As Rachel Bard, CEO of the Canadian Nurses Association, has stated, “A system based on acute care and emergency treatments cannot work. Preventive approaches are critical to the sustainability of the system and the health of our population.” Cuts to refugee health benefits will only decrease the amount of preventative care available and will lead to increased usage of our hospitals and emergency rooms. We must all work together to ensure our healthcare system is sustainable, for everyone.
10. Refugees are not currently getting MORE than most Canadians.
Recently, Minister Kenney has widely promoted the notion that the IFHP provides services beyond what is available to Canadian citizens in order to justify the proposed cuts. The services he is referring to (coverage for essential medicines and minimal coverage for urgent dental care & eyeglasses) are similar to what is covered under provincial public plans for those living in poverty. The refugee and refugee claimant population frequently arrive in Canada with little to no money and would only be accessing the same benefits available to Canadians in the same financial bracket. Furthermore, the IFHP actually denies some preventative services (such as stool testing for colon cancer) and has extra paperwork that makes care cumbersome for clinicians.
Ironically, these changes will take effect on our nation’s anniversary, Canada Day (July 1, 2012). For Su-Yun, her husband and her newborn baby, this Canada Day will forever signify a change in attitude towards her family and people like her. A change away from the Canada that accepted her with open arms and cared for her throughout her pregnancy, to one that will now take away her essential medications and her access to health care. This is not the Canada she came to for a better life and this is not the Canada we want.
Naheed Dosani is a Family Medicine Resident with the Department of Community and Family Medicine at the University of Toronto and is training at St. Michael’s Hospital in Toronto.
Ritika Goel is a Family Physician in Toronto who cares for refugees and refugee claimants and is a Public Health Professional.