Abstract
Migration flux is being transformed by globalization, and the number of people with either undocumented or with a precarious status is growing in Canada. There are no epidemiological data on the health and social consequences of this situation, but clinicians working in primary care with migrants and refugees are increasingly worried about the associated morbidity. This commentary summarizes findings from a pilot study with health professionals in the Montreal area and suggests that the uninsured population predicament is a national problem. Although ethical and legal issues associated with data collection by clinicians, institutions and governments need to be examined, estimating the public health consequences and long-term cost associated with problems in access to health care due to migratory status should be a priority. Current regulations and administrative policies appear to be at odds with the principles of equal rights set out by the Canadian Charter of Rights and Freedoms and the UN Convention on the Rights of the Child. Beyond the commitment of individual clinicians, Canadian medical associations should take an advocacy role and scrutinize the ethical and medical implications of the present system.
Résumé
La mondialisation transforme les mouvements migratoires et le nombre de personnes sans papiers ou ayant un statut précaire augmente progressivement au Canada. Il n’y a pas de données épidémiologiques au sujet des conséquences sociales et de santé de cette situation, mais les cliniciens qui travaillent au niveau des soins de première ligne auprès des immigrants et des réfugiés sont de plus en plus préoccupés par la morbidité associée. Ce commentaire résume les résultats d’un projet pilote examinant les perceptions de professionnels de la santé de la région Montréalaise. Les résultats suggèrent que les soins de santé aux personnes non assurées sont un problème d’envergure nationale et qu’il est urgent d’estimer, en termes de santé publique, les conséquences d’un accès restreint aux soins à cause du statut migratoire, même si cette documentation soulève en elle-même des questions éthiques et légales qui doivent préalablement être examinées. Les politiques et procédures actuelles semblent être en contradiction avec certains des principes d’équité mis de l’avant par la Charte canadienne des droits et libertés et avec la Convention des Nations Unies sur les Droits de l’Enfant. Au-delà de l’engagement de cliniciens individuels, les associations médicales canadiennes doivent assumer un rôle de protection des populations vulnérables et examiner de façon attentive les questions éthiques et médicales posées par le système de soins de santé actuel.
Similar content being viewed by others
References
Foreign Affairs and International Trade Canada. Canada’s Immigration Policies — Misperception vs. reality. 2007; Available online at: https://doi.org/geo.international.gc.ca/can-am/main/defence/misperceptions-en.asp (Accessed June 12, 2008).
Jiminez M. Ottawa rules out amnesty for 200,000 illegal workers. The underground economy: Construction industry hit hard by decision. Globe and Mail October, 27, 2006.
Andrulis DP. Access to care is the centerpiece in the elimination of socioeconomic disparities in health. Ann Intern Med 1998;129(5):412–16.
Fry-Johnson YW, Daniels EC, Levine R, Rust G. Being uninsured: Impact on children’s healthcare and health. Current Opinion in Pediatrics 2005;17(6):753–58.
Fuentes-Afflick E, Hessol NA, Bauer T, O’Sullivan MJ, Gomez-Lobo V, Holman S, et al. Use of prenatal care by Hispanic women after welfare reform. Obstetrics & Gynecology 2006;107(1):151–60.
Hadley J. Sicker and poorer—The consequences of being uninsured - A review of the research on the relationship between health insurance, medical care use, health, work, and income. Med Care Res Rev 2003;60(2 Suppl):3S–75S.
Kuiper H, Richwald GA, Rotblatt H, Asch S. The communicable disease impact of eliminating publicly funded prenatal care for undocumented immigrants. Maternal Child Health J 1999;3(1):39–52.
Lu MC, Lin YG, Prietto NM, Garite TJ. Elimination of public funding of prenatal care for undocumented immigrants in California: A cost/benefit analysis. Am J Obstet Gynecol 2000;182(1 Pt 1):233–39.
Marshall KJ, Urrutia-Rojas X, Soto Mas F, Coggin C. Health status and access to health care of documented and undocumented immigrant Latino women. Health Care Women Int 2005;26(10):916–36.
Caulford P, Vali Y. Providing health care to medically uninsured immigrants and refugees. CMAJ 2006;174(9):1253–54.
Lewandowski R. Ils ont fui sans payer… L’Actualité 2006.
ter Kuile S, Rousseau C, Munoz M, Nadeau L, Ouimet MJ. The universality of the Canadian health care system in question: Barriers to services for immigrants and refugees. Int J Migration, Health Social Care 2007;3(1):15–26.
Trotignon M. Intervenir auprès des immigrants en situation illégale, du soutien discret à la désobéissance civile. Montréal: Université de Montréal, 2007.
Croteau M. Mourir d’incompréhension. La Presse 11 décembre 2007.
Haines R. Access to protection: Latest European developments. Asylum-seekers in the legal system: Refugees’ rights to protection. Montréal, 2006.
Cunliffe HD. Humanitarian action to protect public health. 2006. Available online at: https://doi.org/www.beehive.govt.nz (Accessed August 30, 2006).
Bicocchi L, LeVoy M. Undocumented migrants have rights! An overview of the international human rights framework. Belgium: PICUM -Platform for International Cooperation on Undocumented Migrants, March 2007.
Davenport-Perth Neighbourhood Centre. Available online at: https://doi.org/www.dpnc.ca/mainframeset.htm (Accessed June 23, 2008).
Muennig P, Franks P, Gold M. The cost effectiveness of health insurance. Am J Prev Med 2005;28(1):59–64.
Lansdown G. Implementing children’s rights and health. Arch Dis Child 2000;83:286–88.
Hjern A, Bouvier P. Migrant children: A challenge for European paediatricians. Acta Paediatr 2004;93:1535–39.
Author information
Authors and Affiliations
Corresponding author
Additional information
Acknowledgement: Dr. Lawrence Kirmayer received funding through a CIHR Training Grant.
Rights and permissions
About this article
Cite this article
Rousseau, C., ter Kuile, S., Muňoz, M. et al. Health Care Access for Refugees and Immigrants with Precarious Status. Can J Public Health 99, 290–292 (2008). https://doi.org/10.1007/BF03403757
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03403757