Citizenship and Immigration committee  I would suggest that we look at timing and the validity of the medical examination. Right now it's valid for a year. If we're concerned about health during travel and the journey to Canada, it makes more sense to have that medical examination closer to the moment of travel. The other thing is that there are elements of the medical screening process that are onerous, heavy, and very paper-intensive for local public health, and for minimal benefit.

Citizenship and Immigration committee  What do you think, Natasha? It's hard to say, with this one. Some people have bandied about the time of three months, or six months. I think those are more reasonable, particularly for certain diseases.

Citizenship and Immigration committee  We have a similar function with quarantine health officers.

Citizenship and Immigration committee  We're in public health.

Citizenship and Immigration committee  That's a difficult question. I don't know that we can speak to the frequency with which one runs into fraud in the system. But I think we can speak to the fact that not all labs are created equal, and there must be reasonable quality assurance measures. Even if you have the right person and the sample is appropriately identified, if the test is not done under appropriate conditions, the result of the test will be questionable.

Citizenship and Immigration committee  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.

Citizenship and Immigration committee  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.

Citizenship and Immigration committee  Again, it depends on which country we're speaking of, but certainly there are countries in the world where TB is much more common and where infectious TB is much more common. As a result, in those countries of the world, the likelihood that one actually becomes infected is much, much higher.

Citizenship and Immigration committee  It is included. It has been included since 2002.

Citizenship and Immigration committee  I think what we would suggest is, again, a review of the objectives of medical screening should be undertaken, and then we should be looking at what tests are actually done in order to achieve those objectives and understanding whether, in fact, there is evidence to support those tests in terms of achieving those objectives.

Citizenship and Immigration committee  Oh, you should wear that pin with pride.

Citizenship and Immigration committee  If I suggested to you that it wasn't a concern, that's not what I intended. I would suggest, though, that the medical screening process for tuberculosis actually takes too much effort for the benefit that's derived. Tuberculosis is an important health problem. I believe—and Natasha can correct me—that it's the most common infectious disease in the world.

Citizenship and Immigration committee  No, not at all. I will pick up from here. In our next slide, we note with interest that in paragraph 2.77 of the report of the Auditor General calls for a better definition of applicants who present a danger to public health. I would suggest that, from many of the tables and committees on public health that I've participated in over the years, I've heard that Citizenship and Immigration Canada has expressed interest in reviewing the medical screening process.