Citizenship and Immigration Committee on Nov. 20th, 2017

[The Chair (Mr. Robert Oliphant (Don Valley West, Lib.)), Liberal, Rob Oliphant]

Good evening, ladies and gentlemen. Welcome to the 84th meeting of the Standing Committee on Citizenship and Immigration, which I'm happy to call to order today. We are beginning a new study tonight. We're studying the federal government policies and guidelines regarding medical inadmissibility of immigrants.

It's a new study, and the committee is gathering information from witnesses as we begin this process. I'm very pleased that we have such a good variety of witnesses tonight coming to help us with this really interesting topic. From the Council of Canadians with Disabilities, we have John Rae and James Hicks. From the Canadian Institute for Health Information, we have Brent Diverty and Chris Kuchciak. We also have Lorne Waldman.

Welcome, Mr. Waldman, via video conference. We're going to begin with Mr. Waldman as our first witness just because, with the technical aspects, things sometimes go wrong. If we begin with you, then we know we have your testimony for sure, but we'd like you to stay around for questions as well.

We'll begin with an opening statement from Mr. Waldman.

[Lorne Waldman, Barrister and Solicitor, Lorne Waldman and Associates, As an Individual]

Thank you very much.

The issue you're being asked to study is medical inadmissibility, and under the immigration and refugee protection law there are two grounds upon which—

[The Chair, Liberal, Rob Oliphant]

I'll just ask you to wait one second while people put their earphones in because we don't have a lot of volume.

Thanks, Lorne.

[Lorne Waldman]

Okay.

There are two grounds of inadmissibility under the Immigration and Refugee Protection Act. One is danger to the public, which really doesn't arise very often. I see cases of people who have tuberculosis. If it's active, they have to get treated before they come to Canada. If it's not active, then they are put under surveillance and they have to follow treatment once they arrive. It's very infrequent that people are refused on the grounds of danger to the public.

The more common ground is excessive demand on social and/or medical services. It's interesting to note that the law was changed some years ago, because excessive demand used to apply in all cases involving all applicants for permanent residence, but the Parliament of Canada decided to exempt spouses, dependent children, and protected persons from the excessive demand criteria, a reflection of the fact that the government thought that it was important that those people be allowed to come in and be reunited with their families. Excessive demand now is a ground applied mostly in the case of parents and grandparents, and also in the case of independent or economic migrants who seek to come to Canada.

Several issues have arisen in relation to this process. The first was exposed recently by a reporter for one of the news networks, who discovered that the calculation of average and excessive demand—excessive demand means you cost more than the average amount of money that a regular Canadian would cost—were based on fictitious information. There was no actual true calculation of the cost for the average person, so one issue that needs to be carefully studied by the committee is how authorities come to the number they apply in all of the cases. The reporter discovered that there was absolutely no factual basis for it.

There are other important issues that need to be considered when one considers excessive demand, and those deal with the hardship that often results from the indiscriminate application of these criteria. For example, one of the most common types of cases I see in my office involves people who are trying to bring their parents into the country, and they have medical issues, and they're unable to bring them. This creates huge problems. It creates emotional issues, because people feel that as their parents get older, they have to care for them. The application of the excessive demand criteria, in this context, creates a huge amount of emotional hardship.

The second thing we need to consider when we consider the excessive demand criteria is the fact that they are also applied in the case of economic immigrants. One of the things we need to consider is that, as the demographics of the world change, Canada is a country that needs immigrants in order to meet our demographic needs over the next 40 or 50 years, and we are competing with other countries that find themselves in the same situation. Canada needs to understand that putting up barriers that make it more difficult for the more attractive immigrants to come to the country may have a negative impact on our ability to attract the most qualified immigrants.

From the point of view of an excessive demand analysis, one also has to engage in a cost-benefit analysis. This requires us to consider the emotional hardship that occurs when people are separated from their families, and also requires us to consider the impact of a strict application of the excessive demand criteria on our ability to attract the most desirable immigrants as we move forward.

I think that when you consider the medical inadmissibility over the next weeks, you need to consider these issues, and consider whether or not, in fact, we need to reconsider the inflexible approach we've seen applied by the officials to excessive demand over the course of the last many years, and either get rid of the whole notion of medical inadmissibility—because from a cost-benefit point of view, it doesn't make any sense—or at least guarantee that there's a much more flexible approach that will take into account the hardship that arises as a result of an inflexible approach; and also the fact that we may be harming ourselves by making it more difficult to attract the types of immigrants that we will need in the years ahead.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

For the Council of Canadians with Disabilities, are you going to speak first, Mr. Rae?

[John Rae, First Vice-Chair, Council of Canadians with Disabilities]

Yes. Thank you, Mr. Chair and honoured members of the committee.

We are really pleased to be here tonight, and are delighted that you are taking up this important issue. We are here to recommend in the strongest possible terms that the excessive demand clause in the immigration act be repealed, and having made that comment, I'm tempted to rest my case right there, but of course I'm not going to.

Let's look at it from a number of perspectives, first of all, philosophical. The existing provision, in our minds, is mired in outdated ableist, offensive, and stereotypical notions about disability, in which it seems that we are considered automatically to be a burden upon society. Needless to say, as an organization of persons with disabilities, we reject, out of hand, that notion. However, the continuation of that phrase in the act is demeaning, and if you think about it from where we sit, basically that phrase is saying that we aren't wanted in Canada. That's not the Canada that I understand that I live in, nor the Canada that I want, nor do I believe it is the Canada that you and your fellow members want either. So, this provision must go.

When the Canadian Human Rights Act was proclaimed, we hoped that would signal a new era; it did not. When the Charter of Rights came into force, again we were hopeful but again disappointed. When Canada signed and later ratified the UN Convention on the Rights of Persons with Disabilities, again we were hopeful, because prior to ratifying it, the Government of Canada consulted its provincial counterparts. But again, we've seen no movement.

Today we are on the verge of a promised national accessibility act. We suggest to you that this repeal is long overdue and very timely, and can be done either through legislation proposed by you or as part of the national act. In order to make the kinds of tangible differences in our lives that we want, and that you folks have led us to expect, that bill needs to include the amendment of a number of pieces of legislation.

In practice we have an immigration system that runs several different ways. If you're a refugee, the excessive demand clause doesn't apply. If you are rich and have lots of resources, you can argue that you can cover whatever excessive demand costs may exist. If you are neither, you are often forced to almost beg the minister, on compassionate grounds, to let you stay in Canada. It seems that in that case, the squeaky wheel gets the minister's permit. If a person raises enough trouble and threatens to go to court a lot of times, the permit is issued.

We don't think Canada should have a “several streams” kind of process. We do support the need for refugees to be fast-tracked. We understand where they're coming from.

With regard to the numbers game, we suspect some people are concerned that if we repeal this offensive section, Canada will be flooded with applicants for landed status. We see no evidence to support that idea, so we consider this an outdated provision whose time to end has come.

I want to leave you with one final thought. Consider this list of Canadians; it's not exhaustive. You will know many of these names.

There's the Honourable Carla Qualtrough and the Honourable Kent Hehr. Catherine Frazee is the former chairperson of the Ontario Human Rights Commission. Yvonne Peters, I think, is the current chair of the Manitoba Human Rights Commission, and Jim Derksen was formerly with Disabled Peoples' International. Sandra Carpenter is the leading spokesperson in the independent living movement in Canada and around the world.

That's not an exhaustive list by any means, members.

Consider this though. We in Canada have benefited from their work and their expertise partly because through good luck they were born in Canada. What would have been the result had they not been? One thing that is common with those individuals and others such as Rick Hansen is that they all have an ongoing permanent disability. If they had lived outside of Canada and had applied to immigrate to Canada, how would their applications have been viewed and dealt with by immigration officials? How would they have been?

I ask you to ponder that question tonight and as you go forward, and I submit that Canada would not have been able to benefit from at least some if not all of the work of those important and significant Canadians, because a lot of them would have been denied the opportunity to come to Canada.

That's not the kind of Canada I want. We need to be able to benefit from the interest, the aspirations, and the contributions of everyone, and we reject any notion that disabled people are automatically a burden. The work and contributions of those individuals put the big lie to any such contention. I invite you to ponder that point if not others.

Thank you for the opportunity to be here.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

Mr. Diverty, go ahead, please.

[Brent Diverty, Vice-President, Programs, Canadian Institute for Health Information]

Good evening, Mr. Chair and committee members. On behalf of the Canadian Institute for Health Information, I'd like to thank you for the opportunity to appear before the Standing Committee on Citizenship and Immigration.

Since 1994, CIHI, the Canadian Institute for Health Information, has been an important organization in Canada's health sector. We are a not-for-profit independent body funded by the federal government and all provinces and territories. Our board of directors is made up of deputy ministers of health and other health system leaders representing all regions of the country and the federal government.

When we were created over two decades ago, we had three databases. Today we have 28, and we have data-sharing agreements with every province and territory, Health Canada, Statistics Canada, and the Public Health Agency. CIHI is a leader in health data, methodologies, and system performance measurement, and we are recognized internationally for our work. Over 20 years we have become the authoritative source on a range of health system topics, including health expenditures.

Our role in the health system is to make data publicly available for people like you, Canada's policy-makers, as well as for the health system, researchers, and the general public. We are neutral and objective in fulfilling our mandate to deliver comparable and actionable information. Our aim is to give people the tools they need to drive improvements in health care, health system performance, and population health. Ultimately we work to improve the health care system and the health of Canadians across the country.

Earlier this month we released our annual report on health spending in Canada. “National Health Expenditure Trends” examines how much is spent on health care each year, where the money comes from, and how the money is spent. For the past 20 years, we've been responsible for reporting on health spending in Canada, continuing work that began 40 years ago with the purpose of supporting the development and evaluation of health programs in Canada.

Our report is based on a classification system that is consistent with international standards developed by the OECD for reporting health expenditures, so the focus of our work is on health system expenditures. Spending in important areas such as social services, including income support for housing, home supports, and home support services, is not included, even though these areas may impact health. Total health spending in Canada includes both public and private sector expenditures. These are further broken down into broad categories such as hospitals, drugs, physicians, and other institutions such as long-term care, nursing homes, and professional services for things like dental and vision care, and so on. We call it NHEX. This report combines readily available information from public accounts, annual reports, main estimates, Statistics Canada, and private health insurance. This information is used to produce estimates for the current year.

Current year estimates are revised to actual expenditures once they are confirmed, typically with a one- to two-year lag. It's just one example of how publicly available data is used by government officials, provinces, and territories, and other third party organizations, all with the common goal of improving the health of Canadians.

Canada's health spending is forecast to grow almost 4% this year to $242 billion. This is a slight increase in the rate of health spending growth. We've seen an average growth rate of about 3% since 2010. Health spending is forecast to be $6,604 per Canadian. This is almost $200 more than last year.

Total health expenditure per person is expected to vary across the country from $7,378 in Newfoundland and Labrador and $7,329 in Alberta to $6,367 in Ontario and $6,321 in British Columbia. This variation across the country occurs for many reasons, including differences in population demographics and health status, prescribing practices, public program design, and other factors.

The results of this report are also used to compare Canada with other OECD countries. In 2015, which is the latest year for which we have actual expenditure data, Canada's per-person spending was among the highest internationally at $5,782 CAD, which is a figure comparable to those for the Netherlands, France, and Australia, but much lower than that of the U.S. at $11,916.

Hospitals, drugs, and physician services are the categories that continue to use the largest share of health dollars. Over time, the share allocated to hospitals has been decreasing and the share allocated to drug spending has increased. In 2017 spending on drugs is expected to grow at an estimated 5%, spending on hospitals at about 3%, and spending on physicians at about 4%.

We've identified several major cost drivers, including inflation, population growth, and the aging population. Population growth and aging account for 2% of total health spending growth per year. Over the last several years, we have found that population aging, in particular, is a modest but steady cost driver, about 1% per year.

In closing, I'd also note that we have a new strategic plan for the years 2016-21, identifying strategic goals that build on our core strengths as an organization and that focus on priority populations, including seniors, children and youth, indigenous people, and those living with mental illness and addictions. Along with our stakeholders, including the federal government and the provinces and territories, we identified these priority populations.

I thank you for the opportunity to present this information. My colleague Chris Kuchciak and I would be pleased to answer any questions you may have.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

We're going to begin with Mr. Tabbara, for a seven-minute round of questioning.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here today.

I asked this question previously in another meeting, and I want to revisit it.

I understand that if one member of a migrant family is considered medically inadmissible, then the whole application is denied, even if the rest of the family do not have any pressing health concerns. We've seen examples of this previously. I think the first question will go to Mr. Waldman.

Have you had any cases in which the whole family has been denied and rejected because one individual was looked at as being medically inadmissible?

[Lorne Waldman]

Under the current Immigration and Refugee Protection Act, if one of the members of the family is inadmissible, then the entire family is inadmissible. This happens all the time.

The most frequent scenario we see is somebody sponsoring their parents and a younger brother, and the younger brother might have some medical issues. As a result, neither the parents nor the younger brother can come. That often creates a lot of hardship. There doesn't seem to be any rationale behind it. I think the committee could at least look at a compromise in those types of situations.

I agree with the person from the Council of Canadians with Disabilities. I think you have to look deeply at all of the medical inadmissibility issues. When you're focusing on this particular question, there is not a lot of common sense behind not allowing parents to come if the child is inadmissible, but that happens all the time.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

If we're looking at migrants coming in, economic migrants to fill a certain sector in our region, such as engineers or doctors, for example, in the Waterloo region for the high-tech sector, and we find really great candidates from around the world who have exceptional skills and qualifications.... These are the types of individuals we want to attract.

You mentioned in your statement that there's no measure of economic benefit. Is there something the government can look at in terms of economic benefit when it is looking at individuals who have these qualities and skills that we need here in Canada? Can we can look past an individual who has medical inadmissibility if it's just an individual in the family?

[Lorne Waldman]

That's what I was trying to say. A lot of times we find highly skilled people who are going to make an important contribution, but because one of the members of their family is medically inadmissible, they're not allowed to come into the country at all. We're competing with a lot of other countries for the same skilled workers. If we put up these impediments, we're going to lose the battle of attracting the best.

There is no flexibility in the system now. If one of the children is inadmissible, the immigrant's application is refused. This creates serious problems. I think we need to look at this whole question and at finding ways to be more flexible in the application of medical inadmissibility.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Perhaps I could get Mr. Diverty to expand on that, as well.

[Brent Diverty]

Actually, I think it's important for me to state that our organization takes no positions on policy. We're here and happy to speak to the data and the information that we produce. Really, our remit on this issue is around the health expenditure numbers and report that I mentioned in my opening statement.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Okay.

Can I get something from Mr. Rae?

[John Rae]

Some of the cases that come to us involve families in which the son or daughter has a disability and that person is deemed ineligible, so the family has a heartbreaking decision to make. Do they come to Canada and leave their son or daughter behind, or do they not come when they want to try to make a new life for themselves?

Despite what may be in the legislation, the way it applies seems to be quite different to us. That, of course, is why we are recommending strongly that the whole notion of excessive demand be repealed altogether.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

We want to take in suggestions from all the witnesses who are here today.

Could you give suggestions for the government that will help to get the balance right between protecting publicly funded health and social services and welcoming new members into Canadian society? I'm just wondering if we can strike a balance.

You look as though you want to comment on that, Mr. Rae.

[John Rae]

I do.

When you think about some of the other groups that are allowed in—people who are heavy smokers, people who are at risk because of a potential accident or whatever—those people are allowed in. They may be non-disabled now. We sometimes use the term “TAB”—temporarily able-bodied—but there is no guarantee that tomorrow those persons won't suffer an accident or sometime shortly down the road develop an illness because of their lifestyle. Yet questions about supposed excessive demands do not appear to be asked of them.

Again, that's why we consider this provision so inequitable and in need of repeal.

[The Chair, Liberal, Rob Oliphant]

You have 30 seconds. Are you okay?

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Yes.

[The Chair, Liberal, Rob Oliphant]

I'm going to take your 30 seconds, then.

I just want to ask the folks from CIHI about that averaging function. How is it actually done? Is it just total cost divided by population?

[Brent Diverty]

That's absolutely correct.

[The Chair, Liberal, Rob Oliphant]

There is no statistical analysis in that in terms of regression or any kind of sophisticated system. It's simply an aggregate amount divided by the number of people.

[Brent Diverty]

Starting from that $242 billion that I quoted to get to the roughly $6,600 per person, there is some estimation within the methodology for some small parts of the overall cost, but most of them are coming straight out of provincial budgets.