Citizenship and Immigration Committee on March 15th, 2012

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you very much, Mr. Chair.

To our doctors today, thank you very much for coming. You're really introducing this issue of health screening to us. We haven't had witnesses under this study yet who have talked about this, so there are a lot of concepts you're putting in front of us, and big words like “epidemiology” that we'll have to wrestle with and wrestle down.

Let me start with what seems to be the most fundamental question here. In the presentation you talked about the need for a system review, and something as fundamental as the objectives of screening as the subject of that review. Could you elaborate on that? I presume there's some implicit criticism of the objectives as they exist now. I'd like to hear, from either or both of you, what you feel the objectives should be.

[Dr. Eileen de Villa]

I'll start off with that.

On public health, if the system is meant to protect the safety of travellers and Canadians, it isn't so much that there's a problem with that objective; the question is whether the current process actually facilitates meeting that objective.

As Dr. Crowcroft suggested, I'm not sure we're the right people to speak to public danger, or placing excessive demand on the health care system. But when it comes to matters of public health, I think the question I was trying to raise was: does the current process and the current medical screening process actually address the objective of protecting public health? I suggest to you there are elements of it that do not.

[Matthew Kellway, NDP, Beaches—East York, ON]

Where do we need to start? Is it with the traveller issue? Is that where the greater risk comes from for public health here in Canada?

[Dr. Natasha Crowcroft]

I think there is a very good system for trying to pick up people who are sick when they're travelling. That's not really the job of CIC. Our discussion of that was in response to the comment in the report about the 56 reportable diseases that the Public Health Agency of Canada requires. I wouldn't hand that responsibility to CIC, because I think that it's handled through other measures.

There are things like the syphilis screening, for example, which really serves, as far as we're concerned, no real purpose, because it comes from 50 years ago and now we have very good treatments for syphilis. It probably causes more problems than it solves, and we have ways of treating people in Canada. So there are some historical elements that could easily be discarded.

Going back to objectives, if the objective was to protect the health of the immigrant as well as the health of other Canadians, that would be a new objective that would bring a whole lot of other potential activities that I think would be of benefit in protecting Canadians as well as protecting the health of the immigrants. The inefficiencies in the current system could be mitigated to a certain extent by a system that picks people up when they arrive here and investigates them very thoroughly and treats diseases much sooner after someone's arrival. That would really be a new objective for health screening.

[Matthew Kellway, NDP, Beaches—East York, ON]

Is there a list of diseases that should be subject to screening, on which there's some consensus in the public health field?

[Dr. Natasha Crowcroft]

I don't know if you can see this, but in the Canadian Medication Association Journal from last September, there was a paper with information, which I can send to the committee. It describes how we would like immigrants to be screened on arrival in Canada. That work has been done by a multidisciplinary committee with the objective of protecting the health of immigrants. So again, it wouldn't currently fall within the legislation. That's not part of section 38. It's not in there, so it would be something new.

[Matthew Kellway, NDP, Beaches—East York, ON]

Most of us—those of us from Toronto anyway—remember the SARS issue. Is there a way to capture events like that, prior to an epidemic outbreak in a city such as Toronto, or is it just that these things will come through and there's no way to stop them, and it's about mitigation on this end?

[Dr. Natasha Crowcroft]

We do our absolute best to try to know what's going on. There is a worldwide network of people who are examining data every single day. The World Health Organization picks up information from all around the world and relays it to the Public Health Agency of Canada, and there is a cascade system within Canada that goes through the provincial and territorial governments and into agencies such as the one I work in, and we work very closely to keep a constant watch for new emerging issues around the world.

The international regulations, which you may or may not be aware of, require every country to report to the World Health Organization anything of public health significance and to do that immediately, and there's a set of criteria. There are some specific diseases that are reportable, but there is also, I think most importantly, a generic one that says anything that is regarded as being unusual and of public health significance must be reported immediately. That's important, because of course with SARS we didn't know what it was until it was here.

The World Health Organization, recognizing the impact that SARS had, knew it had to change its regulations. So Canada has signed up to that and participates in that and we benefit from it. That's a very well-rehearsed system.

[The Chair, Conservative, David Tilson]

Thank you.

Mr. Lamoureux.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

I thank you and appreciate your presentation.

I wanted to make an assertion and you can tell me if it's right, or if I'm off base, maybe where I'm off base.

Is it fair to say that the risk factor is just as high for individuals who are coming to visit Canada or to immigrate to Canada, as it is for the many Canadians we have who travel abroad and then return to Canada, in terms of the potential impact it could have on public health here in Canada?

[Dr. Natasha Crowcroft]

I'm not sure. I think it's the travel. It depends. It's hard to identify whether it is Canadians travelling or immigrants. The risk depends on where they go. The well-known factor is people visiting friends and family. It's people who are Canadians, but who are visiting friends and family in areas of the world where diseases are more common than they are in Canada.

I would like reiterate that this idea that immigrants pose a risk, when they are healthier than Canadians, is a bit of an issue. There are recognized risks. We don't discount them at all. In regard to volume and continued exposure, we have huge communities like Peel, where people go back to India and spend many months there.

[Dr. Eileen de Villa]

One of the members of the committee was discussing risks associated with tuberculosis. Tuberculosis is more common in certain parts of the world, notably parts of Asia, from which we derive many of our immigrants. But if you have active TB disease and you're infectious to others, you are prohibited from travelling. In fact, when we're looking at immigrants who arrive in this country, they're not infectious with tuberculosis.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

When it comes to public health safety here in Canada, we're almost better off to say that it's great that Citizenship and Immigration is looking at it, but maybe it's much bigger than that. Maybe we should be incorporating other departments to deal with this issue. Is that a fair comment?

[Dr. Natasha Crowcroft]

It could be. I'm not sure I know enough about the other departments. We mentioned the Public Health Agency of Canada. They would be a good group to involve, for sure.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Are you familiar with any other jurisdictions? I've travelled abroad. Sometimes there are individuals who look as if they're medical officers of some sort, and you walk by them. You walk through screens. I don't know what it is they see of you. Are you familiar with any other jurisdictions that look at all people who are arriving, whether through an airport or a port?

[Dr. Natasha Crowcroft]

There is a similar system in the U.K. It's called Port Health there. These are portals of entry into the U.K. It's very similar to what is here. There is somebody whose responsibility it is to pick out people who are sick when they're travelling, or who might present a security risk. They are not looking for terrorists, but perhaps people who are psychologically unstable.

They pick up people like that and either treat them or isolate them. Sometimes they actually send them back to where they came from, but it is a health role. They have health associates in the airport or at the port.

[Dr. Eileen de Villa]

We have a similar function with quarantine health officers.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Is there always some sort of local screening taking place in other jurisdictions?

[Dr. Natasha Crowcroft]

There is, but it's not the detailed screening we were talking about, where people arrive and they get fully checked out for things like hepatitis or HIV. You don't see that when you walk through an airport. The airport screening is more about somebody who has one or more of those 56 diseases that are reportable. They go past with a florid rash and a fever, and they look sick. The officials will be wondering whether that person has measles, or something like that.

[The Chair, Conservative, David Tilson]

Thank you,

Mr. Weston.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you, Mr. Chair. And thanks, Dr. Crowcroft and Dr. de Villa, for joining us.

Natasha, you mentioned that immigrants who come here decline in health. As a great fan of our doctors in Canada, I just want to say, it's not your fault.

[Dr. Natasha Crowcroft]

Thank you.

[Dr. Eileen de Villa]

We're in public health.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

I have a quick question on syphilis. I just happened to read an article this week that said syphilis rates were increasing. According to this article, the problem was that women who were infected might not know they were infected. I may have gotten that wrong. But did you catch that? Is that consistent with your statement, that it shouldn't be part of the screening process?

[Dr. Natasha Crowcroft]

The problem is that the women are getting infected in Canada, and there are outbreaks in Canada. It's not something that immigrants are bringing to Canada. We have plenty of our own. The women are screened in pregnancy, but if they get infected afterwards, during pregnancy, they're not going to be re-screened. It can be a silent infection. It's back to the safe-sex messages. There's a huge issue with sexually transmitted infections in Canada, but that's our own problem. We have to try to fix that. Immigration really doesn't bear on it.

Travel does, to a certain extent. We have outbreaks that occur in relation to big international events, like Caribana and things like that, where you have a lot of people arriving, partying, and there's alcohol and everything else. But immigration is not the problem.