Evidence of meeting #28 for Citizenship and Immigration in the 41st Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was diseases.
A recording is available from Parliament.
Director, Surveillance and epidemiology, Public Health Ontario
Yes. That would be an ideal time to screen.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay.
Another thing I notice you recommend in your report is that it would be a good idea if people immigrating to Canada brought with them their immunization records.
I'm just wondering, is that feasible? Is that something that a lot of countries require? Is that something that we could realistically require?
Director, Surveillance and epidemiology, Public Health Ontario
I think it would be hard to require, because they may not exist. And it's not a requirement in the sense that you can't come here without them; it's more that if they're requested, people will do their best to bring them. Then, when they arrive, especially with kids, they can be caught up.
So you wouldn't stop anyone coming here, but knowing what they have received allows us here to make sure they get any immunizations they've missed, which, again, protects Canadians, because then they're not going to put other people at risk.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay.
Now, I'd like to be clear on this, if I can, and get down to simple basics. What do we test for now? When a medical is done before someone comes to Canada as an immigrant, do you know what communicable diseases we test for currently?
Director, Surveillance and epidemiology, Public Health Ontario
TB, HIV, and syphilis are the three infectious diseases.
NDP
Don Davies NDP Vancouver Kingsway, BC
So there are only three that Canada requires testing for now.
It's your testimony that syphilis is something that you actually think is not necessarily something that we need to be testing for, is that right?
Associate Medical Officer of Health, Peel Public Health, Region of Peel
Yes.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay. I have your list, in your notes, of what you think we should....
I want to shift gears a bit to something else that I don't think you've talked about as much, and that's the immigration test of denying entry to someone who may cause excessive demands on Canada's health or social services system.
I notice that you actually say—this is from page 6 of your slides—that our system, through our testing, may actually be creating the circumstances by which we're placing an excessive demand; it's not the actual condition itself.
There was a relatively famous case in the last year about a family in New Brunswick whose child had autism, and the immigration system determined that would present an excessive demand on our medical system.
Do you feel that the medical community and doctors are being consulted well enough by CIC before that decision is made to deny someone entry into Canada?
Associate Medical Officer of Health, Peel Public Health, Region of Peel
Oh, goodness.
Director, Surveillance and epidemiology, Public Health Ontario
I don't think we're able to answer that question.
Associate Medical Officer of Health, Peel Public Health, Region of Peel
Director, Surveillance and epidemiology, Public Health Ontario
I'm sorry, that's outside our....
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay.
Do you know if the medical profession is consulted at all before that decision is made by an immigration official?
Director, Surveillance and epidemiology, Public Health Ontario
I don't know.
Associate Medical Officer of Health, Peel Public Health, Region of Peel
I don't know. I personally have not heard of that, but that doesn't mean it doesn't happen.
NDP
Don Davies NDP Vancouver Kingsway, BC
I'm running out of time.
You commented that the health of immigrants generally declines after arrival. I'd like you to expand on that, and tell us why, and how, and if you have any proposals to address that.
Director, Surveillance and epidemiology, Public Health Ontario
That's a huge topic. It might be something you might like to ask colleagues at the Centre for Addiction and Mental Health to talk about because there are specialists there. Some of it is their loss of status because Canada accepts people on the basis of being highly qualified, but when they get here, they often can't work in the fields in which they've qualified. So they go down the social scale. A lot of immigrants are willing to accept that in exchange for the benefits of coming to Canada, but it is also a big change. So psychologically there are some issues.
Then, of course, there's the lifestyle and dietary changes that occur, which can also have their toll. It's quite a complex question. For my part, it was an observation that this is the case, and that we were getting healthy people coming here. We shouldn't be thinking of immigrants as being unhealthy people. If you want an in-depth account of why that's the case, I would refer you to colleagues at CAMH.
Associate Medical Officer of Health, Peel Public Health, Region of Peel
If I can, from the perspective of Peel Region where we get a significant number of south Asian new immigrants to Canada, they have a particular predisposition—particularly when exposed to western diet and lifestyle—towards obesity, diabetes, and cardiovascular disease. So, in fact, our environment tips them over the balance on obesity, diabetes and cardiovascular disease, and they start off healthier and get sicker.
Conservative
Chungsen Leung Conservative Willowdale, ON
Thank you, Mr. Chair.
I wish to go down a different area of medical science. We talk about the medical screening being a system to pre-screen the immigrant, to protect Canadians from communicable diseases, and also to protect our very generous health system. What I need to know is, do you also recommend the testing of some latent diseases such as hepatitis B; hepatitis C, which could lead to hepatoma; type 2 diabetes; non-specific types of STDs; genetic screening for DNA disorders; post-traumatic stress syndromes; or other psychiatric factors that need to be addressed?
Should that also be on our list for pre-screening before we determine admissibility?
Director, Surveillance and epidemiology, Public Health Ontario
In my view, I would just focus on the infectious diseases, hepatitis B and C. While I think they're important, I would think it was more efficient to screen people when they arrive. If somebody is just hepatitis B positive or hepatitis C positive on screening, I would not exclude them, unless they had serious liver disease in the country of origin. To ensure that they get treated so that they don't become an excessive burden on the health care system, my view is that the best way to do that would be to screen them on arrival in Canada.
If you screen them outside, and you don't exclude them when they arrive here, that test result—which might be done in a non-accredited lab, as we were talking about earlier—has to find its way all the way through the system to Canada, and then find its way to whichever primary care doctor that person ends up with. To my mind, those are very good reasons for having screening in Canada, and they're really important diseases. We did a burden of disease study in Ontario, and hepatitis B and C are right at the top of the list of things that are going to be a burden on public health.
I absolutely agree with you that they're vital, but I would do the screening in Canada.
Conservative
Associate Medical Officer of Health, Peel Public Health, Region of Peel
I agree entirely with Dr. Crowcroft.
Conservative
Chungsen Leung Conservative Willowdale, ON
Then this leads me to the next question, which is more of an administrative and ethical one. If we pre-screen the immigrant before arrival in Canada, and then we screen them again in Canada for these diseases, then what we do? Do we kick them out of this country, or do we admit them as immigrants, because if you use the health issue—their medical issue—as a condition for admissibility, screening them in Canada causes us a large administrative and ethical issue.
