Thank you very much.
As you probably see on your screen, I'm Natasha Crowcroft, and I work at the provincial level in Canada, although I have international experience. As an aside, I have been through the immigration experience myself, so I have direct experience of some of the processes we're going to discuss.
Thank you very much for inviting us to speak. We're going to share the time. Dr. de Villa's going to take the second half, and I'm going to kick off.
The reason I talk about working at the provincial level is that there are different issues at the federal level, possibly. We will be speaking from our own perspective and from some international experience as well. I shall speak from a provincial level and Dr. de Villa from a local public health perspective. We agree that these are very complementary, but I will flag that the Public Health Agency of Canada may have additional views to contribute to this conversation.
The scope of what we can speak to is within public heath, which is dealt with in section 38 of the Immigration and Refugee Protection Act, specifically the part of it that says the applicant's health condition “is likely to be a danger to public health”. We can't really speak to “public safety” or “excessive demand on health or social services”, because they are not really in our area of expertise. I wanted to make that clear.
But there is a part that is relevant, though not to health services. Here I don't want to get into too much jargon. In our minds—I speak for both of us, probably—we think of public health as being distinct from health services, and that may not be true for members of the committee. With the term “health services” I think of hospitals, primary care doctors, and that kind of context. Public health, which in Ontario is based in municipalities, is another service to the public that relates to health, but it's not acute health care. So there is an element to what we are talking about that concerns the impact on public health services, which are in a different place in many provinces and are funded in different ways.
I hope that's clear, but we will obviously have an opportunity to take questions, if any of it isn't clear.
I'm going to start off with one of the questions that seem to come out clearly from the audit, about why Citizenship and Immigration Canada does not consider the 56 diseases that are currently reportable because of their risk to public health.
The important consideration here is that immigration is a slow process. I would distinguish here between immigrants and refugees; there are separate issues for refugees. For most of the immigrants who arrive in Canada, it's a slow process. In contrast, the 56 diseases that are reportable because of their risk to public health are generally, for the most part, diseases of short duration. The process will not really capture them. Screening in that context is not the appropriate tool. The appropriate place to take action to protect Canadians is at the point of travel, at which somebody who has any of these diseases might present a risk both to fellow travellers and also on arrival in Canada.
If you think about SARS, which presented a considerable risk to public health, the immigrant screening process would have been irrelevant to protecting Canadians from that disease. There were many other measures that were more important to have in place.
So most reportable diseases are of short duration, and the medical screening process is really not relevant. The danger to public health is from travellers who are ill at the point of travel, become ill just before, or are incubating a disease just before and immediately afterwards.
Another thing is about proportionality. The number of travellers into and out of Canada each year far exceeds the number of people who arrive through immigration. If you want to protect Canadians, it is disproportionate to focus on the point of immigration. It's the travel backwards and forwards, sometimes involving the same communities, to countries where diseases occur more frequently than within Canada. That is really the issue that would be most important to focus on to protect the health of Canadians.
Another idea I think important to emphasize, but is not really the focus of the order, is the idea of screening as a health benefit for immigrants. It's worth considering that most immigrants who come to Canada are healthier than people living in Canada, the Canadian-born. They start out healthier and they become less healthy.
There's an element to which we are putting immigrants’ health at risk by their coming to Canada. So consideration from a public health perspective could easily be given to protecting the health of immigrants, through screening for measures we know are effective and will protect them from becoming ill while they're here.
Some of the diseases I think reasonable to screen for are really for the benefit of the immigrant rather than to protect public health.
