Citizenship and Immigration Committee on March 15th, 2012

[Dr. Natasha Crowcroft]

I would not use hepatitis B and C as admissibility criteria at all. I would screen in Canada, and then what we do is we treat in Canada. So if somebody's a carrier of hepatitis B, we now have effective treatments. If they're not a carrier, if they're negative, then we can offer immunization, which, again, is a very effective way of making sure they don't become positive. Hepatitis C, again, there are treatments available in Canada that will prevent them from getting the other diseases you mentioned like hepatoma and cirrhosis—things that will make them become excessive burdens.

[Chungsen Leung, Conservative, Willowdale, ON]

But doesn't that put a tremendous burden on our medical system to be the world centre for screening for these diseases? Everybody who wants to come in here will take advantage of that and abuse our immigration system as well as our health system.

[Dr. Natasha Crowcroft]

I don't think people are going to immigrate to Canada in order to get screened for hepatitis B or C. I'm not sure I understand the question.

[Chungsen Leung, Conservative, Willowdale, ON]

If you're suggesting that we screen them once they're here, and we are prepared to treat them for it, then that means that they can come in and get screened for these factors, and still have the benefit of our health system.

My line of thought is that we should protect our health system and Canadians by having these immigrants pre-screened before they arrive on our shores.

[Dr. Natasha Crowcroft]

We were not proposing that no pre-screening happens at all. Assuming that these people are screened to the extent that they are healthy individuals when they arrive here, they can still be healthy, for all intents and purposes, but some of them, and it's going to be a minority, may carry hepatitis B or hepatitis C viruses by virtue of the fact they come from countries of the world—East Asia and Southeast Asia being very prevalent places for hepatitis B, and other parts of the world having more hepatitis C than is found in Canada. Now, that's not going to be most people, it's going to be a few, but it's a higher rate than is found in Canada.

So it is worth screening them just for those few viruses, and then you can treat them. But it's not going to be a huge burden, I will put it that way.

[The Chair, Conservative, David Tilson]

Thank you.

Mr. Opitz.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

I'm going to pass my time to Mr. Dykstra.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thanks.

I'd like to pursue this matter a little bit further.

Part of what we're trying to do in this study is respond to the Attorney General's concerns with respect to security. Also, he brought up the issue with respect to how few diseases we actually test for, and you've identified those again for us today. But I do have difficulty understanding how you would actually work through a process that allows for a second screening here to take place. I think I understand the principles upon which you outline that. The difficulty I have with it is that it would lead to abuse in the system, or it could lead to abuse in the system. If you were to be tested in your country of origin, you would try to seek a test that would indicate negative, and then, knowing full well that you could actually get to Canada, be screened again, and then get full treatment.

So what type of rule would we put into place, or what type of defence to this would we put in place? Are you suggesting that before someone were to come to Canada with a negative test back home but a positive test when they come to Canada, that they, in fact, would have to purchase their own health insurance in order to be treated here?

What I'm trying to get at is that this could lead to quite an expense. For one thing, we'd have folks on Canadian soil who, once they are here, are very difficult to remove; and the second is that treatment is obviously going to cost the Canadian taxpayer a lot of money. I think with our health care system, regardless of which province or territory you're in, there are arguments to be made that the provinces and territories are not delivering the type of health care that Canadians find acceptable, at least from a minimum threshold. So I'm trying to make a determination here as to how we would do this.

I understand your recommendation and suggestion, and I think it has some credibility. I'm just trying to determine and would like to get from you some recommendations as to how we would alleviate the cost concern and the bogus testing concern.

[Dr. Natasha Crowcroft]

Just to reinforce what I said, at the moment we don't screen for these conditions at all, so nobody gets screened. I don't propose that would change. At the moment, the inadmissibility on health grounds is about 0.3%. So at the moment we don't screen and we don't have people coming here. Right now, the people abroad could be saying, I know I've got hepatitis B—no question of faking results—I know I've got it, and I could go to Canada and get treated. But, actually, that's not happening.

I don't propose that it gets added to the screening outside the country at all. The screening that happens inside the country, the way I would frame it, is that everybody here's supposed to have an annual health check, and this is just an annual health check that happens when people arrive. When you do an annual health check, you can be screened for hepatitis B. One of the reasons for screening is that if you haven't been immunized in the past, you could be screened to make sure that you need immunizing.

I don't want this to get out of proportion because it's really feasible, and I don't think it's going to present a huge burden.

[Dr. Eileen de Villa]

We're given to understand that these issues, running into persons who actually would be seen as presenting an excessive demand on health or social services, are extremely infrequent. I don't think the concerns you're suggesting are likely to manifest themselves. I don't think it's an issue at all, otherwise we would have seen it already.

I think the other point is that presumably the individuals who are chosen for immigration to Canada are chosen for a number of other reasons, and health is only one element of the whole picture. Presumably, there's actually a whole admissibility procedure that takes into consideration other elements. I think those are important as well. It's all a balance.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

How much time do I have?

[The Chair, Conservative, David Tilson]

About 30 seconds.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Just on that line of questioning, Dr. Crowcroft, I'm going to give you an opportunity here to make a recommendation on what guidelines and what path you'd suggest we follow.

[Dr. Natasha Crowcroft]

In respect to screening on arrival, do you mean?

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Correct, yes, screening on arrival. I'm sorry.

[Dr. Natasha Crowcroft]

We have evidence-based guidelines that were published just in 2011, and I would recommend that those were followed—that is, when immigrants arrive, they'd undergo a health screening as per the guidelines, which I can share with the committee if you want to see them. The work has been done, so that would be the easiest thing to do.

[The Chair, Conservative, David Tilson]

You have less than four minutes, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chairman, and thank you, doctors, again.

I want to make sure I understand your proposal for a more effective and efficient screening process. I can tell you anecdotally in my office, for people waiting overseas to come to Canada, particularly when there are wait times of three, four, five, six, seven and 10 years, we're requiring them to get medicals that they have to renew every year. Many of those people come from second- or third-world countries, and it's expensive for them. It appears to me that it's not very effective either, if I understand your testimony.

What's going through my mind is that we should do one initial screening at the time of application, and then simply wait until close to the time they're going to come to Canada, say within three months of them being issued their visa. Or, if I understand your proposal, perhaps they would be tested when they arrive as well. Would that be a more intelligent and effective way to approach health screening, in your view?

[Dr. Eileen de Villa]

I think that's reasonable. I understand that, again, if you're looking for major issues then, yes, those will presumably present themselves on a health screen at the time of application. If you're looking for issues that present a risk at the time of travel, then clearly that medical examination would have to occur closer to the moment of travel, particularly if you're looking at things like acute infectious diseases, because, again, an exam from a year ago is not relevant.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. In terms of that very small number of people who have been deemed inadmissible, I think it's under 1%...was it 0.6%? I don't know if I caught the number.

[Dr. Eileen de Villa]

We see 0.3%.

[Don Davies, NDP, Vancouver Kingsway, BC]

It's 0.3%. Can you give us some idea of who that 0.3% is made up of?

[Dr. Eileen de Villa]

Unfortunately, we can't. This is a presentation that I was able to attend back in June 2010. It was given by a staff member from Citizenship and Immigration Canada. These are their statistics.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'd like to give you a little more time to tell us about the health outcomes of immigrants when they come here. I know it's a complex issue. You started to get into it, and I realize there is certainly not enough time to even scratch the surface.

Would either of you care to tell us a little more about the health outcomes of immigrants once they're here?