I was speaking at a fascinating conference in Montreal. The seminar was reporting on the final stages of a comprehensive multi-site research project on the factors that shape the health of refugee and immigrant children and families, their access to health care and overall health status. The research is making a major contribution in documenting and understanding the ways that broader patterns of social and economic inequality affect immigrant health; the language, discrimination, organizational and other barriers to equitable access to care; and the program and policy changes needed to enhance the opportunities for good health for all refugees and immigrants.
The conference heard of many innovative community and front-line initiatives – community health centres, volunteer clinics, partnerships with immigrant communities – addressing access barriers and providing comprehensive support to vulnerable and marginalized people. What was striking was the tremendous enthusiasm of front-liners to find really inventive ways to work around policy and ‘official’ barriers and provide the best care and support possible for these groups.
My talk was on where we go from here – on the policy changes needed to enhance health equity for refugee and immigrant communities. I emphasized:
- always starting by analyzing the factors that underlie inequitable access – whether the federal cuts to the Interim Federal Health program that provides care for refugees or hospitals seeing people without insurance as a revenue generating pool rather than as particularly vulnerable populations – in other words, identifying the specific problems to be solved;
- then drilling down to analyze how these particular access barriers, inequitable treatment or other problems are based in specific policy frameworks – again, whether overall federal immigration policy or provincial primary care programs, accountability regimes or funding incentives;
- identifying the policy mechanisms or levers that can be changed to address the particular problems and improve refugee and immigrant access to care and overall health;
- and developing concrete policy options and alternatives to accomplish the necessary changes;
- understanding the different levels of government and decision making that can make these changes – and crafting effective cases for each; and
- how all of this can be pulled together into a coherent political and policy strategy to drive the changes needed.
A copy of my presentation can be found here.