Maintaining health

Good physical and emotional health is important and may impact how new immigrants handle the many challenges of moving to a new country, such as looking for a job, finding a place to live, etc. Conversely, the settlement process is stressful and may affect the health of new immigrants and thus their integration into Canadian society.

In this chapter, different aspects of health will be examined, such as health status, prevalence of health problems, use of health care and access to health care services.

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Health status

New immigrants are generally in good health

After six months in Canada , new immigrants appear to be experiencing good health. More than three quarters of them reported to be in excellent or very good health condition while only 3% reported a fair or poor health status.

According to research, recent immigrants report a better health status than immigrants who have been in Canada for a longer period of time or native-born Canadians¹. The Longitudinal Survey of Immigrants to Canada (LSIC) data support this finding in all age groups, the LSIC immigrant population consistently report better health status than the Canadian population.

A low proportion of new immigrants report health problems since their arrival

In LSIC, 16% of new immigrants reported physical health problems, 11% dental problems and 5% emotional or mental problems. Overall, 43,000 immigrants (26%) declared a health problem of some kind.

Even under the most favourable conditions, leaving behind a familiar environment for a new country with perhaps a different culture and a different way of doing things can be stressful. This transition can be a source of increased susceptibility to risks of anxiety or physical hardship. Many immigrants may postpone receipt of health care for minor concerns until they are settled. This may be the case for example, with refugees whose migration is often caused by unfavourable circumstances such as war, famine or human rights violations which also adds to other risk factors affecting physical and emotional health.

Older immigrants are more likely to report physical health problems

Age may also influence the health status of immigrants. The proportion of immigrants in the family category who reported health problems is similar to that of refugees (20% and 23% respectively), and higher than the incidence reported by skilled worker principal applicants (12%). However, it should be noted that immigrants admitted in the family category are also on average, older than immigrants in other immigration classes. Nine in 10 of the immigrants aged 55 years and older were admitted under the family category.

Age is, in fact, an important determinant of health, and new immigrants are no exception to this rule. The proportion reporting physical health problems increases by age category. For example, 15% of immigrants between 15 and 54 years reported physical health problems, while 28% of those 55 years and older reported physical health problems.

The relationship between age and mental or emotional health shows a different dynamic. A higher proportion of immigrants aged 25 to 44 (6%) suffered from these problems when compared to the 15 to 24 age group (4%) or to the 55 and over age group (3%).

Finally, age did not have a noticeable impact on the prevalence of dental problems, the proportion of immigrants having suffered from such problems varied between 11% and 12% in all age groups.

Access to health services

Nearly all recent immigrants have a health insurance card

In Canada, only permanent residents have access to health cards which provide no fee access to a broad range of health services. Although health insurance is universal in Canada each province and territory administers an independent program. In Ontario, Quebec, British Columbia and New Brunswick , new permanent residents must wait three months before being eligible for a health card, while in Alberta for a cost, residents can apply immediately. Immigrants who do not have immediate access to provincial health insurance may purchase private insurance. Refugees are eligible for the Interim Federal Health Program, which guarantees essential medical services and emergency services.

The LSIC data show that at the time of the interview, almost all immigrants (97%) had obtained their health card. The most often cited reasons for not obtaining a health card were: delays in applying for a card (56%) and waiting to receive their health card (18%).

One in five accessed health care services

The LSIC data show that approximately six months after their arrival in Canada, nearly 32,000 or 19% of new immigrants had accessed health services for a health problem. Among these immigrants (72%) visited the office of a physician or a dentist, 13% went to a walk-in clinic, 10% to a hospital emergency department, 5% to a clinic by appointment or hospital outpatient clinic and 3% to a local community services centre².

The majority of immigrants who reported physical, dental or emotional problems received care. Two thirds received care for all of their problems, while a smaller proportion received care for only some of their problems (6%).

The degree to which immigrants receive help for health problems varies by category, ethnicity and province. Individuals in the family category were more inclined to get help for health problems while skilled worker spouse and dependents were less inclined to do so.

By ethnic origin, 61% of immigrants having declared their ethnic origin to be Eastern or South Eastern Asian and having reported health problems obtained care for all or some of their problems. In comparison, higher proportions were observed for other ethnic origin groups. These differences may reflect the diversity of newcomers to Canada with regard to culture, traditions and experience with health care services. Consulting health professionals may not be customary for immigrants from countries where religious or traditional healers are common providers of such services.

By province, 84% of immigrants from Alberta received care for all or some of their health problems, which is noticeably higher than the proportion found for all immigrants (74%). The difference between Alberta and the other provinces may reflect the three month waiting period for a health card in Ontario , Quebec and British Columbia , whereas in Alberta immigrants can obtain a health card immediately for a fee.

Lack of seriousness and high cost of care, reasons cited for not accessing health care

Just over one quarter of immigrants did not access health services for their problems. When asked why, 44% reported that the problem was not serious, 31% reported the cost of care was too high and 15% reported not being eligible for insurance or that the problem was not covered by insurance.

The high cost of some health services was the second most commonly cited reason for not accessing health care and highest for residents in Quebec. This may suggest that some immigrants may not be obtaining the health care they need due to a lack of financial resources. It is hard to determine the relationship between income and those who cited lack of financial resources because the data only represent the initial transition period. By separating immigrants into four groups based on quartiles of monthly family income – less than $485, $485 but less than $1,350, $1,350 to less than $2,700, and $2,700 or more – it appears that for respondents whose monthly family income was less than $1,350, one in three immigrants (34%) did not receive care for their health problems, while 25% of immigrants with a family income between $1,350 and $2,700 and 14% of immigrants with a family income great than $2700 did not receive care for their problem.

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Health care providers

When describing concerns to a health care professional and when receiving medical advice or treatment, being able to communicate effectively is important. Nearly six in 10 immigrants (57%) said it was important or very important that the person providing them with health care speak their language. This proportion is consistent for both immigrants who had accessed health care since their arrival, and those who had not. However, this proportion varies slightly by gender: more females (60%) than males (54%) attached importance to this factor.

Language barriers become more problematic when the patient does not speak either English or French well. Proportionally more individuals who reported not being able to speak either English or French "fairly well", "well" or "very well" thought that it was "important" or "very important" that health care providers speak their language (81%).

Gender differences were most notable when it came to having the same gender of the health care professional. Nearly one in three females (31%) reported that it was "very important" or "important" that the physician be a female, while only 11% of males preferred having a male doctor.

Just over one third (36%) of immigrants reported that it was "very important" or "important" that the health care provider is of the same ethnic background as they are. Mo re females than males reported this (38% and 33% respectively). However, those who had received health care in Canada for medical, dental and/or emotional problems attached slightly less importance to having the medical care provider share their ethnic background (31%), compared with 40% who had not received health care.

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Health of children of LSIC immigrants

Among the LSIC immigrants, 71,900 had at least one child living in the same household. Among them, 19% reported at least one child had physical health problems, 13% dental problems and 2% had emotional problems during their first six months in Canada.

In families where at least one child had health problems, 82% of respondents received health care for all of these problems, and 4% for only some problems. This proportion is higher than for immigrants receiving help for their own health problems (74%). Two thirds of the immigrants went to a doctor's office to obtain care for their children's health problems, 17% went to an emergency department and 14% went to a walk-in clinic.

The most frequently cited reason for not consulting health services for children's problems were the same as for the respondent: the problem was not serious enough (47%), the cost of care was too high (30%), or the individual was not eligible for insurance or the treatment was not covered by insurance (15%).

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Problems or difficulties accessing health services³

Immigrants from the family category encountered less difficulties accessing health care

Problems or difficulties accessing health care are not concerns specific to immigrants, but to all Canadians. In a 2001 study on access to health care, it was estimated that 18% of Canadians experienced difficulties in obtaining first-contact services such as routine or follow-up care, health-related information or advice, or immediate care for a minor health problem⁴. In the LSIC, 23% of the immigrants who tried to access health care reported problems or difficulties.

Immigrants from the family category were less likely to report problems accessing health care services (15%) than refugees (20%), skilled workers – principal applicants (27%), spouse and dependents (28%) and other economic immigrants (25%). This may be because members of their family who were already present in Canada had established access to health care.

Long waits is the most cited problem accessing health care

The most frequently cited problem or difficulty for immigrants trying to access health care services was long waits (48%). This problem is not specific to immigrants: in a health survey of Canadians⁵ long waits was also cited as the most common problem (23%). As show in Table 6.4, the high cost of health care and language problems were also commonly cited problems for the LSIC respondents (29% and 26%).

High cost of health care was a problem for three new immigrants in 10 having declared difficulties accessing health services

In Canada , it is estimated that approximately 70% of health services are subsidized by the government⁶. Canadians must pay for some services, including drugs, dental and vision care and alternative medicine treatments, while some Canadians have private health insurance, most frequently offered by their employer. Others, including those on social assistance, are covered by government insurance plans. Despite subsidized health care, high cost appears to be the second most commonly cited problem when accessing health services, being cited by almost three in 10 who reported problems (29%).

The high cost of health was cited more frequently by refugees: 43% of them said it was a problem in accessing health services. Because refugees also have the lowest monthly average family income by household member among all categories this may not be surprising.

By province, immigrants living in Alberta mentioned high costs of health care in a smaller proportion (16%) than in other provinces. As stated earlier, immigrants in Alberta , for a fee, do not have a three month waiting period in order to obtain a health card and therefore can access health services with no supplementary charges in the first three months.

Language is an important barrier for immigrants trying to access health care

Language barrier was also a commonly cited problem, identified by 26% of immigrants who reported at least one problem when trying to access health care services. By category, immigrants admitted as skilled worker principal applicants were least likely to report the problem of language barrier (17%). This may be because knowledge of either English or French is one of many factors considered in the assessment criteria for skilled worker principal applicants.

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Conclusion

New immigrants are generally in good health. Since their arrival in Canada older immigrants and refugees were most likely to report health problems. Six months after arrival almost all of the LSIC immigrants had a provincial health card, and therefore access to a broad range of health services.

Few immigrants reported difficulties in accessing health services. The most common problems reported by immigrants trying to access health care were long waits, high costs and language barriers. Although provincial health insurance programs cover a wide range of services, many medical and related needs are subject to private expenses that may influence access to some services and represent major draws on many new immigrants' limited financial resources.

While the long waits are a national problem for all Canadians, it is hopeful that financial and linguistic problems will decrease in waves two and three when immigrants will have had two and four years to find employment, and increase their language ability in either of Canada's official languages.

Notes

1. Health Canada. I. Hyman. Immigration and Health, 2001, working paper available at http://dsp-psd.communications.gc.ca/Collection/H13-5-01-5.pdf (accessed October 14, 2003 ).

2. More than one response may be chosen therefore the total does not equal to 100.

3. In the LSIC, respondents are asked to identify problems or difficulties accessing health services. They are then asked to identify which of the reported problems would they consider the most serious. In this section, the analysis is based on all of the problems identified by respondents and are therefore not directly comparable with the analysis in Challenges to integration, where it is based on the most serious problem identified by the respondent.

4. C. Sanmartin, C. Houle, J.-M. Berthelot and K. White. Access to health care services in Canada, Statistics Canada, Catalogue no. 82-575-XWE, Ottawa , 2001.

5. J. Chen and F. Hou. "Unmet Needs for Health Care", Health Reports, Statistics Canada, Catalogue no. 82-003-XIE, vol. 13, no. 2, 2002, p. 23 to 34.

6. Statistics Canada and the Canadian Institute for Health Information. Health Care in Canada– A First Annual Report, Statistics Canada , Catalogue no. 82-222-XIE, Ottawa , 2000.