Alberta’s government wants to ask voters in a referendum this fall whether newcomers should face new barriers to health care and education. In her Feb. 19 address, Premier Danielle Smith argued that federal immigration levels contribute to unsustainable pressure on provincial systems. Yet, she also acknowledged the province cannot estimate the proposal’s savings because it does not track costs attributable to newcomers. Alberta should not pursue sweeping health policy changes that are both uncosted and unsupported by clear evidence.
As physicians and migration health researchers, we have spent years studying how immigration policies affect health systems. Our work, including the recently published Halifax Declaration in The Lancet Regional Health – Europe, summarizes the collective voice of more than 600 clinicians, experts, refugees and migrants and affirms a core principle: health is a fundamental right, regardless of legal status. The Declaration calls on governments and health systems to dismantle structural inequities and remove barriers to care – precisely the opposite of what Alberta is proposing.
This matters because the people being targeted are not peripheral to Alberta’s economy or its health system. They are part of its foundation.
In 2021, Statistics Canada estimated temporary foreign workers were 4.1 per cent of all paid workers in Canada. These workers pay income and consumption taxes that help fund health care for older Canadians. International students contributed an estimated $37.3 billion to the Canadian economy in 2022. Both groups tend to be younger and healthier than the general population.
Across Canada, newcomers now comprise 25 per cent of registered nurses, 42 per cent of nurse aides and 37 per cent of physicians. These are core pillars of care delivery. Without them, our health-care systems could not function. Alberta cannot rely on internationally trained migrant workers to staff hospitals, clinics and long-term care homes while simultaneously proposing new barriers to health care and education for some of them.
That is not fiscal prudence. It is economic self-sabotage.
It is also bad health policy. Fees and waiting periods do not create efficiency or reduce costs; they create delay. When access is restricted, patients defer care and present later with more advanced and costly conditions. A systematic review of uninsured migrant populations found lack of coverage is associated with delayed care and preventable health consequences.
That is not fiscal prudence. It is economic self-sabotage.
The evidence on this point is consistent. Migrants in high-income countries are, on average, healthier than host populations and contribute more economically than they consume in services. This is known as the “healthy immigrant effect.” Moreover, a 2025 Canadian national linkage study showed all-cause hospitalization rates were lower among temporary residents than the general population.
Blaming newcomers for system strain without clear evidence does not solve structural problems. It scapegoats them and distracts from the policy failures that are actually driving current strain.
Alberta’s real health system pressures are not hard to identify. Across Canada, emergency departments are overcrowded and primary care access is strained. Health workers are increasingly burned out. The dominant causes are well documented: workforce shortages, an aging population, lagging infrastructure and capacity planning failures that have not kept up with population growth.
These structural issues long predate recent increases in immigration. International comparisons confirm this: Spain’s migrant-inclusive health coverage has supported an expanded labour force and strong economic growth, while Japan’s decades of restriction have produced severe health workforce shortages and forced policy reversals.
Newcomers are not the cause of those failures. In many cases, they help hold the system together.
Canada’s demographic reality makes this more, not less, important. With fertility at a record low of approximately 1.25 children per woman and the population aging rapidly, the country is increasingly dependent on younger workers to sustain social programs.
Health care is especially vulnerable. If Alberta develops a reputation for recruiting international talent while erecting new care barriers, it risks losing precisely the young, skilled workers its economy and health system require. Competing provinces and countries will gladly welcome them.
There is a better path forward. To address the real drivers of health system strain, Alberta should start by publishing migration-disaggregated health utilization and costing data (the data it admitted it lacks) and accelerate credential recognition for internationally educated health professionals already in the province but unable to practice. Concurrently, it should expand and invest in community-engaged team-based primary care, disease prevention and public health capacity to reduce downstream system demand. Finally, it should invest in health workforce retention, improve working conditions and ensure safer workloads across the health-care workforce.
This is not a debate between compassion and restraint. It is a debate between evidence-informed policy and scapegoating as political distraction.
Alberta cannot build a functioning health system by recruiting newcomers to sustain it while denying some of them the care and education that allow them to live, work and stay. The erosion of evidence-based discourse and policy around migration threatens not just newcomers but the integrity of the systems that serve us all.
Inclusion is not charity. It is sound health policy, smart economics and a basic condition for a functioning province.
