Citizenship and Immigration Committee on Nov. 21st, 2017

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

Good morning. Welcome to our guest witnesses today, and also to committee members, for this 85th meeting of the Standing Committee on Citizenship and Immigration. We're continuing our study on the policies and guidelines regarding medical inadmissibility of immigrants to Canada.

We thank our witnesses for coming today. We have two panels. We are really hopeful that you will shed light on this important topic in a variety of ways, so that we will know more, and know it from different angles, by the time we finish.

We're going to begin with Professor Hanes, who is at Carleton, and then we will go to Ms. Bennett and Mr. Sweetman.

[Roy Hanes, Associate Professor, School of Social Work, Carleton University, Council of Canadians with Disabilities]

Good morning.

First of all, I'd like to thank members of the committee for inviting me to speak about the excessive demand clause of the Immigration and Refugee Protection Act. I am particularly grateful that members of Parliament are examining this clause, and I congratulate all political parties for their concern about the plight of people with disabilities and their families who wish to immigrate to Canada.

One of the things I'll be focusing on primarily is disability as a minority group status, as opposed to illness or anything along those lines. I begin with this concept of disability as a human variation, as depicted by Higgins in 1992, when he talked about disability intersecting all racial, gender, religious, class, cultural, and ethnic divides. According to recent United Nations reports, there are over one billion people with disabilities worldwide, making the disability community one of the largest minority populations in the world.

The United Nations Convention on the Rights of Persons with Disabilities incorporates what we refer to as a social model of disability, and defines disability as follows:

...disability is an evolving concept...that...results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others....

The United Nations Convention on the Rights of Persons with Disabilities asserts quite unequivocally that yes, people with impairments are very much part of humankind, always have been, and always will be. It is the social interaction process and the creation and maintenance of structural and attitudinal barriers that stigmatize, exclude, oppress, and minimize opportunities for education, employment, relationships, and indeed immigration and mobility. Members of the Council of Canadians with Disabilities assert that in short, it is societies that disable people with impairments.

While it is true that the Immigration and Refugee Protection Act does not categorically state that people with disabilities need not apply, contemporary immigration policies and practices depicted in the excessive demand clause and the inadmissible category make it very difficult for foreign nationals with disabilities and their families to be citizens of Canada. It is my opinion, and it is shared again by the Council of Canadians with Disabilities, that the excessive demand clause stigmatizes, excludes, and creates barriers. In the end, it prevents and disables people from attempting to become citizens.

Terms such as “disabled persons” and “persons with disabilities” are not merely adjectives and nouns. Indeed, they were actually created as socio-legal terms to separate the deserving from the non-deserving, and are rooted in legislation dating as far back as the English Poor Laws of 1601. I find it interesting that we are meeting here today, some 416 years later, to discuss legislation created as a legal category of disability and intended, by the way, to prevent movement of populations in the United Kingdom at that time.

I would like to add that it's also 170 years since legislation pertaining to the early roots of the excessive demand clause and concerns about disabled people becoming an expense on the public purse was introduced by the colonial governments of Upper and Lower Canada in 1848. Terms such as lunatic, idiotic, deaf and dumb, blind or infirm persons were the targets at that time.

Not to get into a long history, but Canada's first immigration act in 1869 itself talks about disability dependence, and legislation on who should and who shouldn't become citizens. I'm not going to get into all of the legislation, but suffice it to say that the immigration acts of 1869, 1906, 1910, and onward until the present time, all have concern about disabled people becoming burdens on the state.

It is interesting, too, that there's another element that is part of the excessive demand clause and also the inadmissible act. It has to do with violent psychosis and contagious diseases. In fact, these are rooted in legislation going back over a hundred years as well. I find it quite interesting that we still talk about contagious diseases such as syphilis, and other contagions such as tuberculosis and cholera, and in some capacities about psychosis and mental health, yet, considering the advances in medical science and pharmaceuticals, these issues can be addressed quite safely in the modern era.

As I indicated earlier, I find that disabled people are one of the largest minority populations in the world. Can you imagine the outcry here if legislation had changed as slowly for other minority populations, such as people of Chinese origin, LGBTQ persons, Jews, or Muslims, and they were still being denied permission to immigrate to Canada? For people with disabilities, there doesn't seem to be the same potential for outrage.

I did an exercise in my class not long ago and asked students to raise their hands if they represented any one of the minority populations. At the end of the class, almost 70% of the class wouldn't have been there, because their families or they themselves wouldn't have been allowed to come to Canada.

One of the things that is linked to the excessive demand clause and which I hope the committee will address is that people are being turned away for infractions, and they're deemed to be part of the inadmissible category. Who else is part of the inadmissible category? How is it that people with disabilities are associated with this group?

Besides people with disabilities, other constituents of the inadmissible class include persons involved in subversion, terrorism, violence, and espionage, and persons who have been involved in crimes and crimes against humanity, persons who have been convicted of a crime, and persons involved in organized crime. Last but not least are people who are likely to cause an excessive demand on public health and public services and likely endanger the public good. By association and extension, family members of people with disabilities become part of the inadmissible population. I am not sure if this applies to any other group.

In short, over the years, reforms have put an end to immigration policies and practices rooted in racism, sexism, xenophobia, and homophobia, but no similar reforms have put an end to practices rooted in ableism.

Some recent presenters have indicated that the IRP Act provides opportunities for people with disabilities and their families to immigrate to Canada if the family is willing to—or can provide evidence that they're willing to—cover the costs of long-term possible medical, social, and educational services.

[The Chair, Liberal, Rob Oliphant]

I'm going to need you to draw to a close, Mr. Hanes.

[Roy Hanes]

Okay.

This may seem to be the policy, but it's not the practice. I'm presently working with a young man from the Middle East who was willing to pay for everything for his family to come here, but they're being denied. Not only that, but some families here also risk deportation, and some have been deported. I'm referring to cases such as those of Chris Mason, the Montoya family, Jon and Karissa Warkentin and their daughter Karalynn, and others.

One question I would like to leave you with before I wrap up is in terms of thinking about disability as a problematic category. Can you imagine what our country would be like if people like Terry Fox and Rick Hansen were applying for citizenship here? There's a last question I would like to ask: would Stephen Hawking be granted citizenship?

I'll leave it there for now and respond to questions.

[The Chair, Liberal, Rob Oliphant]

Thank you, Mr. Hanes.

Ms. Bennett.

[Sheila Bennett, Faculty of Education, Brock University, As an Individual]

Thank you for this opportunity to speak today. It is a real honour. As an aside, having grown up in 1960s Newfoundland with Joey Smallwood, when I tell you it's a real honour, I mean it's a real honour. The fact that we as a country can speak to each other and make decisions that are this important is the essential cornerstone of who we are as Canadians, so I very much appreciate the time you are taking to listen.

I come here as a lifelong educator, administrator, faculty member, and researcher. My choice to share the information with you today has been shaped by my experience and my learning. My career has as its focus the inclusion of students with special needs in the regular classroom.

The purpose of my testimony is to highlight the importance of diversity and inclusive practice as essential components of our national and international identity. I have been fortunate to work and develop relationships with researchers, educators, and organizations across Canada. Through these experiences, I have had the privilege of engaging in ongoing research and discussion about diversity and inclusion. My pan-Canadian experience has provided me with multiple opportunities to engage in this field at the international level. It is clear from my work that across Canada and across the globe discussions of equity and diversity framed within an inclusive perspective are at the forefront of critical thought and active change.

I am proud to be a Canadian. Born in Newfoundland and Labrador to pre-Confederation parents, I learned the lessons of what it meant to be Canadian. I began my education in a two-room school, where segregation was not an option. Everyone belonged. This allowed inclusion to be woven into the pattern of my experience. When I graduated as a teacher in 1982, the Charter of Rights and Freedoms freshly minted, I looked forward to seeing the leadership standard set by our federal government enacted through the lives and the futures of all the students I would meet.

I feel as though I am preaching to people who know this, but just in case, section 15 of the Charter of Rights and Freedoms states:

Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

In reviewing this committee's October 24 meeting, I was reassured to see that the charter mandate as it relates to the deliberations of this committee was discussed. As noted during the October meeting, thus far the charter challenges with regard to immigration policies have been unsuccessful. Despite these unsuccessful attempts, it is clear that a relationship exists between our rights as delineated by the charter and the recommendations that will be made by this committee.

Canada is a diverse country. Prime Minister Trudeau, in his 2016 presentation to the World Economic Forum in Switzerland, said, “We need societies that recognize diversity as a source of strength, not a source of weakness.”

From my perspective, diversity, as it relates to individuals with disability, needs to be brought to the forefront. One of many research projects focusing on students with intellectual disabilities, and I've been engaged in a number of them, highlights for me the gap between what inclusion means when we speak about larger populations and what inclusion means when we speak about people with disabilities. The tag line for this project has become: if inclusion means everyone, then what about me? Pictured below it is a school-aged child with Down syndrome sitting alone in a classroom.

The chronic undervaluing of persons with disabilities in our society speaks to a much larger and more insidious pattern of discrimination. Low expectations and unexamined predisposition, veiled under the auspices of charity and benevolence, have kept many individuals in positions of power in stasis, unwilling or unable to make decisions and take action. If we are to live up to the expectations that Canada is a country in which diversity is valued, we must not set limits on what it means to be diverse. School systems pride themselves on inclusivity, but the inclusion of students with special needs continues to be debated.

A 2009 publication that I wrote and which was used by Immigration Canada discusses this debate:

Some researchers still argue vehemently that the segregation of students into specialized learning environments is essential in order to provide them with the type of individualized instruction that their learning profile suggests would be beneficial. Other researchers argue that to separate students on the basis of ability or other characteristics represents a form of “colonization” that blocks access to a larger learning environment. Many see the segregation of students with exceptionalities as a human rights issue....

Hand in hand with this debate, of course, is the question of cost. Having spent 18 months as co-chair on a government working table of special education funding, I know only too well that there exists a desire to quantify disability. For the purposes of this committee's deliberations, it's important to differentiate service delivery in the context of cost.

For a shrinking number of school boards across the country, the delivery of services to students with special education needs is a separate service. The budgeting for these services and service delivery models is differentiated from what you might refer to as the “regular” class. Interestingly, school boards are transitioning to a system of service delivery for learners that includes universal design for learning and differentiation of planning and curriculum delivery. For those school systems, all students belong. The emphasis is on creating supported communities of learners where all students can access learning, as well as social opportunities is their age-appropriate peer group.

Inclusive settings have been shown to decrease bullying, enhance learning and social engagement for students with special needs, and improve the attitudes and interactions of the larger class group. In essence, all students benefit. They learn to be more tolerant of difference and are able to access learning in multiple ways. For systems that use inclusive models, the question of cost is still a real one. To provide those types of professional learning, educator support, paraprofessional engagement, and auxiliary services, it requires funding. The difference in that funding is that funding dollars are spent on the entire school community to raise the expectation for all.

School systems are a reflection of societal values and norms. School systems are also a projection of societal possibility. Inclusive schools have been shown to have a positive effect not just on academic and social learning of the students with special needs. They also, more importantly, have a positive effect in terms of tolerance and acceptance of difference among all members of a school community. Schools are a microcosm of society. They tell us that cognitive and physical diversity add value.

[The Chair, Liberal, Rob Oliphant]

I'll need you to wrap it fairly quickly.

[Sheila Bennett]

Any society that seeks to differentiate those whom they deem as prohibitively expensive in terms of service provisions fail to equate the value added of what it means to be truly diverse.

As noted at the beginning, the purpose of my testimony today is to highlight the importance of diversity and inclusive practice as essential components to our national and international identity. As an educator, as a member of the public, and as a Canadian, I would ask this committee to imagine what is possible when we open ourselves to difference. When we look at ourselves as a country and when others look at us from the global stage, we see not only who we are but who we want to be.

Thank you.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

Professor Sweetman.

[Professor Arthur Sweetman, Professor, Department of Economics, McMaster University, As an Individual]

Good morning. I would also like to thank you for the invitation to appear today.

Decisions regarding the federal government's policies and guidelines on the medical inadmissibility of immigrants are based on many factors: moral, legal, economic, etc. I'd like to focus my remarks on economic issues.

While the government's current goal is to mitigate excessive demand on health and social services, as far as I'm aware, we—and I use “we” to refer to all of us who make up the Canadian community—have no good measures of actual demand or costs for such services by the subset of potential immigrants who are at risk of being adjudicated as excessive cost or risk. Although there would be some challenges, it would not be extremely difficult to produce such estimates using mostly provincial health and social service administrative data, although it would need to be done province by province. If a complete picture for all provinces were required, the task would take a little bit of time. Overall, while some bits and pieces of evidence do exist, as far as I'm aware, we do not know how well we, at the time of screening new immigrants, are able to predict who will be high cost.

I encourage you, as part of your deliberations, to go beyond simply listening to those who appear before you and what they happen to say and, rather, to produce any evidence you need for good decision-making yourselves. Moreover, I encourage you to take full responsibility for any costs of decisions you recommend. One of the oddities of our Constitution is that the decisions and costs of decisions are not always borne by the same level of government. This can sometimes lead to poor decisions. I encourage you, therefore, to not only figure out what the costs of your decisions are, but if there are increases in costs by provincial governments, that those increases are funded by the decision-maker. Having pointed out our lack of knowledge on the topic, I can point to a few things that we do know.

First, health care costs are extremely unevenly distributed among the population. For example, a group inside the Ontario Ministry of Health and Long-Term Care recently calculated that about 1.5% of Ontario's population represents about 5% of those with the highest costs, and they incur about 61% of total hospital and home care costs. Put another way, of Ontario's population, about 3.9 million people incurred hospital and home care costs in 2009-10 and the total cost was just over $14.2 billion. Of this group, the top 1% in terms of costs, which is just under 200,000 residents, incurred costs that made up $8.6 billion out of that $14.2 billion. A small number of users can make a great deal of difference to total costs. As an aside, these dollar values are limited and do not include, for example, physician billings, which are not normally part of hospital and home care budgets.

An important follow-on to this question has to do with the persistence of costs. It turns out that high-cost use is quite persistent, though clearly there is some turnover. Looking at physician billings, which are less persistent than, say, residential care, one of my students calculated that over 40% of those in the top 5% of costs in 2004-05 were still in the top 10% of costs in 2008-09. A group in the Ontario Ministry of Health also found high levels of year-over-year persistence looking at a broader cost base.

Another important issue for this committee is whether the immigration system as it works at the moment introduces immigrants to Canada who are more or less likely to be high-cost users of health care than people who are Canadian born. As far as I can tell, based mostly on work by researchers at the University of Toronto and Ontario's Institute for Clinical Evaluative Sciences, there is absolutely no difference. In Ontario, immigrants and Canadians by birth are exactly equally likely to be high-cost users of health care. Overall, the cost implications for health and social services resulting from a small and somewhat persistent set of so-called high-cost users, in Ontario at least and probably more broadly in the Canadian health payment system, are substantial. However, none of this evidence speaks to the anticipated costs of those affected by the current operation of our immigration system's effort to mitigate excessive demand on health and social services. Figuring out costs for that group would take more work and, of course, deciding if our society wishes to bear those costs is another issue altogether.

Thank you.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

We begin our questioning with Mr. Whalen, who has a seven-minute round.

[Nick Whalen, Liberal, St. John's East, NL]

Thank you very much, Mr. Chair.

Thank you all for coming today. We've heard some great testimony and yours is following along similar lines we've heard from almost everyone who has appeared before us, which is that with respect to excessive demand, you're suggesting that we should repeal paragraph 38(1)(c). Is that what I understand? I see some nods, but maybe people could verbalize that.

[Prof. Arthur Sweetman]

I'm taking a slightly different tack in saying that we don't know the cost of doing that yet and that you should figure it out.

[Nick Whalen, Liberal, St. John's East, NL]

Then maybe I'll move to that. There is a bit of agreement here anyway on paragraph 38(1)(c) .

The federal government transfers $36 billion a year. Even at the high estimates of what we've heard from people from the various government departments, it's about $135 million a year. That's the ballpark on what it would cost to provide medical services to the people who have been rejected under this provision, on an annual basis over the last five years.

It seems like a drop in the bucket. Why should we care about the cost of this at all? Human rights can cost money. It's part of living in a free and democratic society. Why are we quantifying this at all, Mr. Sweetman? Why is that even part of our discussion?

[Prof. Arthur Sweetman]

I don't think that the costs should cause the decision of whether you do it or not. However, if we admit people who have medical needs and other social service needs, we need to fund those needs adequately.

I'm making no statement about whether we should or should not do it. I'm saying that if we admit people who have needs, we need to pay for those needs. In particular, I argue that the decision-maker for the admission should pay for those needs. I suspect that the number you provided a second ago is a bit of an underestimate of all health and social service costs.

[Nick Whalen, Liberal, St. John's East, NL]

As compared to a $36-billion transfer, it's de minimis. It wouldn't even register. It would be insignificant.

[Prof. Arthur Sweetman]

I agree.

[Nick Whalen, Liberal, St. John's East, NL]

Then why bother to take the time and effort to measure something that is statistically insignificant when it really goes to a basic human rights need? Why are we even engaging in that analysis at all? Why are we forcing the medical officers to make this initial determination? You're proposing that we maintain the system through which we measure and quantify and further—I wouldn't say insult, but maybe—denigrate people with disabilities by quantifying their future medical costs within Canada. Then we're placing a burden on the government to both evaluate that and then to hand over money.

Doesn't that in itself discriminate and marginalize the very people we are trying to help through this debate?

[Prof. Arthur Sweetman]

No, I take exactly the opposite opinion to you.

I think the way we help people is to fund adequate services for those people. If it's a trivial amount, then you should have no trouble paying it.

[Nick Whalen, Liberal, St. John's East, NL]

If it's a trivial amount, why should we even measure it? It may cost more to measure it. It may cause more unseemliness in the whole process than simply saying, “Here, provincial governments, is a transfer of $36 billion.” Notionally, $135 million of that is going to be associated with paying for the health care costs of about 5,000 immigrants over a five-year period, among almost 1.5 million immigrants, who are also going to be users of the health care system but paying taxes, but it all comes out in the wash.

Part of my problem with this whole exercise is that by forcing the government to quantify someone's medical costs to society, it is inherently dehumanizing. You're suggesting that we do it, but it is already fully funded.

[Prof. Arthur Sweetman]

Every single person in society is already dehumanized in that case. In fact, the budgeting process—

[Nick Whalen, Liberal, St. John's East, NL]

I would disagree. I do not see any documents purporting to say exactly how much my medical costs as a human being, as an individual Canadian, are or requiring any particular individual transfer of money on my behalf.

[Prof. Arthur Sweetman]

We're talking about averages across groups, not individuals, so, yes, I think there are estimates. I don't know what province you reside in, but there are estimates on average for males in certain age groups and the health care costs. So, yes, you are in a group and your health care costs have been estimated.

[Nick Whalen, Liberal, St. John's East, NL]

Are you saying that we should estimate this over the broad frame of immigration as a whole?

[Prof. Arthur Sweetman]

Yes, or on the margin for changes.