Thank you.
First off, I'd like to thank the committee for the invitation. It's a new experience for me. Building up to my talk, that's another new experience. Thank you for that.
As a bit of background, I'm a physician at the Ottawa Hospital with expertise in public health and HIV. I completed my medical school and internal medicine specialty training at McMaster University, followed by a fellowship in infectious diseases at the University of Manitoba. I went to the Harvard School of Public Health and completed a doctoral degree in epidemiology, and through this training I spent about four years in Kenya doing HIV research.
I took a job at the University of British Columbia in 1999 and spent about 11 years looking at HIV prevention strategies among marginalized populations, including drug users and refugees.
I moved to the University of Ottawa in 2010 to become the head of infectious diseases, with the goal of expanding the public health mandate of the division.
The clinic I am in charge of at the Ottawa Hospital has a large refugee caseload. As would be expected at an infectious disease clinic, we deal with infections. The biggest threats to refugee health, at least on arrival to Canada, are infections, most notably HIV and tuberculosis. On April 25, when Minister Kenney announced the cutbacks to federal health funding, the clinic physicians were in shock.
Currently, every major health care organization across Canada has spoken out in opposition and rallies against these cuts. Although the government has remained steadfast in its public announcements around the cuts, there have been a number of changes and rollbacks that have just added to the confusion.
We are now anticipating a list of designated countries of origin that will further limit access to health care for some refugee claimants.
There are many reasons that these cuts to IFH are bad for refugees, bad for health care, and bad for Canada. However, today I will focus on public health and why limiting access to health care creates a real threat to our collective public health security.
Of all the issues being considered by this committee, public health and the spread of disease should be recognized as a very serious threat to our security. It has been stated over and over by the Minister of Immigration and his staff that infectious diseases that are considered a threat to public health and safety will continue to be covered under the new IFH plans.
However, for all their resilience and optimism, refugees are generally scared and uncertain about their immediate future when they arrive in Canada. For many refugees, western medicine is foreign and unproven. It is only in the hands of skilled health care workers over multiple visits that trust is built and medical recommendations can be followed.
There is much more to treating HIV than providing pills.
One of the biggest health failures in confronting the global HIV epidemic has been a failure to appreciate the importance of providing a comprehensive set of health care supports for people who are HIV positive. In the United States, a study presented at the world AIDS conference this summer showed that of the estimated one million people infected, only 75% knew they were HIV positive, only 50% were receiving HIV care, and only 28% were successfully taking their HIV medications.
This is exactly what happens when people are not engaged in consistent health care. For the IFH program to continue to pay for the cost of HIV medications but fail to support the very care that makes successful treatment possible undermines the whole program. With these cuts, we are at risk of losing the patients who are currently engaged in comprehensive care, and we are much less likely to engage new patients in HIV treatment. We currently have the tools and expertise to diagnose and treat communicable diseases and limit their spread. However, if the patients are driven away and disengaged from health care, there is no way to identify infections and provide the necessary care, treatment, and education.
Tuberculosis is another serious threat to public health security in Canada. Unlike HIV, which will usually be picked up through mandatory HIV testing prior to arrival in Canada, tuberculosis is often asymptomatic and very difficult to diagnose. In many developing countries, the actual infection is picked up during childhood and lies dormant. The only way to diagnose and treat tuberculosis is to have consistent clinical care and to provide diagnostic testing at the first signs of cough, fever, or other more subtle symptoms.
The continued provision of medications to treat tuberculosis through the IFH is a small part of the necessary tools for early detection and the prevention of spread to others. The cutbacks will have a dramatic impact on the ability of public health to protect Canadians from the spread of imported tuberculosis.
There are certainly other threats to public health beyond HIV and tuberculosis; however, these examples serve to illustrate the very real threat to public health and security resulting from cuts to IFH. It is imperative that refugees are offered comprehensive health care to successfully integrate into Canadian society.
IFH funding provides a critical safety net as refugee claimants await the decision about whether they can stay in Canada or not. For communicable diseases, even a few weeks can be critical, and if the process drags on for years—which has been the case for a number of patients in our clinic—then the threat of spreading infectious diseases to others, both inside and outside their immediate community, is very real.
It is very predictable that we will start to see people defaulting on their HIV treatment and presenting with advanced HIV, and we will see women giving birth to HIV-positive babies. In addition, we will see people presenting to emergency departments with advanced tuberculosis, and there will be cases of tuberculosis transmitted within Canada from refugees. These are not far-fetched scenarios. In fact, they were happening before any cutbacks to IFH.
I feel that the cuts to refugee health care are short-sighted and will directly erode the public health care system that we have in Canada. In my view, this has a direct impact upon Canadian security.
Thank you.