Status and health security: an exploratory study of irregular immigrants in Toronto

Policy Change, Threat Perception, and Mobility Catalysts: The Trump Administration as Driver of Asylum Migration to Canada

Almost 60,000 people claimed asylum at Canada's border with the United States between 2017 and 2020, marking Canada's first sustained cross-border asylum migration since the 1990s. Virtually, all entered irregularly via a rural road on the New York/Québec border. The “Roxham Road route” was partly owing to the 2004 Canada/US Safe Third Country Agreement (STCA), which allows both states to refuse asylum-seekers on the grounds that the other offers commensurate protection standards yet only applies to official ports of entry. Roughly, 40 percent of the 60,000 who claimed asylum were US residents with precarious immigration status. This article examines the route's emergence and contributes a novel case on decision-making and destination choices for asylum migration. Data are derived from interviews with over 300 asylum-seekers, two dozen experts, and monthly asylum statistics. The central finding is that Trump-administration immigration policies were the major driver for asylum migration yet do not entirely explain the new route, since a relatively small number of US residents departed for Canada. Interviews revealed that while Trump-era policies fostered a climate of fear, individual experiences with immigration enforcement, loss of temporary protected status, or deferred asylum cases were catalysts for migration. Welcoming Canadian rhetoric and liberal asylum policies were only considered in light of risk in the United States, challenging research findings that asylum-seekers are primarily motivated by destination-state policies. The article also offers qualitative methods for connecting asylum data with migrant decision-making and problematizes the STCA's ethics and effectiveness for managing asylum.

Irregular Migrant Workers and Health: A Qualitative Study of Health Status and Access to Healthcare of the Filipino Domestic Workers in Mainland China

In public health research, the health issues of irregular and vulnerable migrant populations remain under-explored. In particular, while mainland China has become a new and popular job-seeking destination for Filipino domestic workers (FDWs), the health status of FDWs and their access to healthcare have been invisible to public and academic concerns. This paper fills this lacuna by conducting a qualitative study that investigates FDWs’ self-reported health status and their healthcare-seeking behaviors. The results show that: (1) respondents do not report significant abusive and exploitative experience because the scarcity of FDWs in China in relation to the high demand enables them a certain degree of agency in labour market; (2) while FDWs do report some health problems, they tend to resort to self-medication and food-healing; (3) the main factors influencing health-seeking behavior include the fear of deportation, language gaps, the lack of knowledge of the local healthcare system and dependence on co-ethnic networks which serves as a double-edged sword; (4) these factors also lead to hesitation in health-seeking choice between public and private hospitals, which sometimes result in delayed treatment. This paper contributes to revealing the health conditions of FDWs in mainland China and calls for more inclusive health policy to enroll foreign domestic workers into the local health system in China.

Comparison of End-of-Life Care Between Recent Immigrants and Long-standing Residents in Ontario, Canada

IMPORTANCE

Recent immigrants face unique cultural and logistical challenges that differ from those of long-standing residents, which may influence the type of care they receive at the end of life.

OBJECTIVE

To compare places of care among recent immigrants and long-standing residents in Canada in the last 90 days of life.

DESIGN, SETTING, AND PARTICIPANTS

This population-based retrospective cohort study used linked health administrative data on individuals from Ontario, Canada, who died between January 1, 2013, and December 31, 2016, extracted on February 26, 2020. Individuals were categorized by immigration status: recent immigrants (since 1985) and long-standing residents. Data were analyzed from December 27, 2019, to February 26, 2020.

EXPOSURES

All decedents who immigrated to Canada between 1985 and 2016 were classified as recent immigrants. Subgroup analyses assessed the association of region of origin.

MAIN OUTCOMES AND MEASURES

The main outcome was place of care, including institutional and noninstitutional settings, in the last 90 days of life. Descriptive statistics were used to compare characteristics and health service utilization among recent immigrants and long-standing residents. Negative binomial regression models estimated the rate ratios (RR) of using acute care and long-term care in the last 90 days of life.

RESULTS

A total of 376 617 deceased individuals (median [IQR] age, 80 [68-88] years; 187 439 [49.8%] women and 189 178 [50.2%] men) were identified, among whom 22 423 (6.0%) were recent immigrants; recent immigrants were younger than long-standing residents (median [IQR] age, 76 [60-85] years vs 81 [69-88] years; P < .001), more likely to be living in lower income neighborhoods (12 357 immigrants [55.1%] vs 166 017 long-standing residents [46.9%] in the lower 2 income quintiles; P < .001), and had a higher Charlson Index score (score ≥5, 6294 immigrants [28.1%] vs 74 809 long-standing residents [21.1%]; P < .001). In the last 90 days of life, recent immigrants spent more days in intensive care units than long-standing residents (mean [SD], 2.64 [8.73] days vs 1.47 [5.70] days; P < .001), while long-standing residents spent more days using long-term care than recent immigrants (mean [SD], 19.49 [35.81] days vs 10.45 [27.42] days; P < .001). Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates.

CONCLUSIONS AND RELEVANCE

These findings suggest that at the end of life, recent immigrants were significantly more likely to receive inpatient and intensive care unit services and die in acute care settings compared with long-standing residents. Further research is needed to examine differences in care preference and disparities for immigrant groups of different origins.

Interview survey of physical and mental changes and coping strategies among 13 Vietnamese female technical interns living in Japan

We conducted a case study to assess 1) physical and mental changes; 2) self-assessments of symptoms; 3) coping strategies; and 4) adaptation to physical and mental changes by semi-structured interview survey among Vietnamese female migrant workers working in Japan under the Technical Intern Training Program. We found they experienced female-specific physical changes, and some interns' symptoms worsened because they did not consult anyone about their symptoms. We propose increasing opportunities to learn about possible physical and mental changes caused by migration and to improve health literacy, including prevention, coping, help-seeking, and consultations about health concerns among female technical interns.

Are the Undocumented Deserving? Health Workers' Views of Immigrants in Alabama

Undocumented immigrants are ineligible for many public benefits and often rely on safety-net clinics, such as community health centers, for health care. Using in-depth interviews, we explored attitudes about undocumented immigrants' deservingness of health care among staff and professional health workers (n=31) at two safety-net clinics in Alabama, which passed a restrictive immigration law in 2011. We used content analysis to examine frequently used frames to describe health deservingness. Overall, a total of 27 frames were used by health workers. They most frequently justified their views using frames of medical humanitarianism (i.e., health workers should care for those in need) and equality (i.e., people should not be treated differently from one another). Several respondents used multiple, conflicting frames that simultaneously supported and questioned immigrants' deservingness of care. The diverse ways in which health workers in this sample framed undocumented immigrants' health deservingness may affect provider-patient interactions.

Undocumented adult migrants in Sweden: mental health and associated factors

Background

Undocumented migrants (UMs) in Europe constitute a heterogeneous group. They are typically in a vulnerable and marginalised situation, since most of them have exhausted their options for gaining asylum and protection from war and persecution, many are traumatised and fear disclosure and deportation, and they typically lack basic social security. The present study investigates living conditions, access to human rights and mental health of UMs living in Sweden.

Methods

A cross-sectional study with adult UMs was performed in the three largest cities in Sweden in 2014–2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed, and psychiatric symptoms were screened for using Beck’s Depression Inventory II, Beck’s Anxiety Inventory and the PTSD Checklist (PCL) for civilians. Trained field workers conducted the interviews. Descriptive statistics, chi-square tests and logistic regression models were used.

Results

A total number of 104 individuals participated. Preliminary findings show that 68% of respondents were suffering from either moderate or severe anxiety, 71% from either moderate or severe depression and 58% from PTSD. No statistically significant gender differences occurred, but age was statistically significant in relation to anxiety and depression. The majority feared returning to their country of origin, for political reasons, due to war in progress there and/or because they belonged to a minority and feared harassment. Almost all had an unstable housing situation and were often forced to move. Fifty-seven percent experienced food insecurity.

Conclusion

The psychosocial situation among UMs in Sweden, in addition to insecure living conditions without a guarantee of basic needs being met is stressful, and many UMs live in constant fear of disclosure and deportation, all of which has a detrimental effect of the mental health. It is important to understand both associated risk factors for ill-health and coping strategies in this vulnerable population in order try to reduce ongoing stress.

Emergency Room Visits by Uninsured Child and Adult Residents in Ontario, Canada: What Diagnoses, Severity and Visit Disposition Reveal About the Impact of Being Uninsured

Canadian immigrants can be without health insurance for many reasons but limited data exists regarding uninsured health outcomes. Uninsured Canadian residents were identified in the National Ambulatory Care Reporting System for all visits to emergency departments in Ontario, Canada between 2002/3 and 2010/11 (N = 44,489,750). Frequencies for main diagnoses, severity (triage), and visit disposition were compared. Ambulatory care sensitive conditions were identified in a 10 % subsample. The uninsured (N = 140,730; 0.32 %) were more likely to be diagnosed with mental health (insured: 3.48 %; uninsured: 10.47 %) or obstetric problems (insured: 2.69 %; uninsured: 5.56 %), be triaged into the two most severe categories (insured: 11.2 %; uninsured 15.6 %), leave untreated (insured: 3.1 %; uninsured: 5.4 %), or die (insured: 2.8 %; uninsured: 3.7 %). More ACSC visits were made by uninsured children and youth. Insurance status is associated with more serious health status on arrival to emergency departments and more negative visit outcomes.

World region of origin and common mental disorders among migrant women in Spain

Migration can affect the mental health of migrants. This cross-sectional study has two objectives: (1) to compare the prevalence of common mental disorder (CMD) between migrants (n = 458) living in Granada (Spain) and Spanish-born women (n = 448); (2) within migrants, to analyse the associations of world region of origin, other sociodemographic factors and post-migration features with the presence of CMD. Participants answered a questionnaire, including sociodemographic characteristics, post-migration features and CMD that was measured by Kessler K6-scale. Logistic regression analyses showed that CMD (K6 ≥ 13) was significantly higher among migrants than Spaniards. Compared with Spaniards, the odds of CMD were 3.6 [95 % confidence intervals (CI) 2.1–6.0] and 2.9 (CI 1.6–5.3), respectively, for Latin Americans and for Moroccan and other African women. Among migrants, Latin Americans as opposed to the reference group (migrants from other countries), had higher probability of CMD (OR 2.3, CI 1.1–4.9). This study supports the hypothesis that migration leads to mental distress. Consideration of world region of origin may clarify the differences observed in mental health across different migrant groups.

Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal

Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

Rejecting and accepting international migrant patients into primary care practices: a mixed method study

Purpose

– International migrants frequently struggle to obtain access to local primary care practices. The purpose of this paper is to explore factors associated with rejecting and accepting migrant patients into Canadian primary care practices.

Design/methodology/approach

– Mixed methods study. Using a modified Delphi consensus approach among a network of experts on migrant health, the authors identified and prioritized factors related to rejecting and accepting migrants into primary care practices. From ten semi-structured interviews with the less-migrant-care experienced practitioners, the authors used qualitative description to further examine nuances of these factors.

Findings

– Consensus was reached on practitioner-level factors associated with a reluctance of practitioners to accept migrants − communication challenges, high-hassle factor, limited availability of clinicians, fear of financial loss, lack of awareness of migrant groups, and limited migrant health knowledge – and on factors associated with accepting migrants − feeling useful, migrant health education, third party support, learning about other cultures, experience working overseas, and enjoying the challenge of treating diseases from around the world. Interviews supported use of interpreters, community resources, alternative payment methods, and migrant health education as strategies to overcome the identified challenges.

Research limitations/implications

– This Delphi network represented the views of practitioners who had substantive experience in providing care for migrants. Interviews with less-experienced practitioners were used to mitigate this bias.

Originality/value

– This study identifies the facilitators and challenges of migrants’ access to primary care from the perspective of primary care practitioners, work that complements research from patients’ perspectives. Strategies to address these findings are discussed.

Health workers' perceptions of access to care for children and pregnant women with precarious immigration status: health as a right or a privilege?

The Canadian government's recent cuts to healthcare coverage for refugee claimants has rekindled the debate in Canada about what medical services should be provided to individuals with precarious immigration status, and who should pay for these services. This article further explores this debate, focussing on the perceptions of healthcare workers in Montreal, a large multiethnic Canadian city. In April-June 2010, an online survey was conducted to assess how clinicians, administrators, and support staff in Montreal contend with the ethical and professional dilemmas raised by the issue of access to healthcare services for pregnant women and children who are partially or completely uninsured. Drawing on qualitative analysis of answers (n = 237) to three open-ended survey questions, we identify the discursive frameworks that our respondents mobilized when arguing for, or against, universal access to healthcare for uninsured patients. In doing so, we highlight how their positions relate to their self-evaluations of Canada's socioeconomic situation, as well as their ideological representations of, and sense of social connection to, precarious status immigrants. Interestingly, while abstract values lead some healthcare workers to perceive uninsured immigrants as "deserving" of universal access to healthcare, negative perceptions of these migrants, coupled with pragmatic considerations, pushed most workers to view the uninsured as "underserving" of free care. For a majority of our respondents, the right to healthcare of precarious status immigrants has become a "privilege", that as taxpayers, they are increasingly less willing to contribute to. We conclude by arguing for a reconsideration of access to healthcare as a right, and offer recommendations to move in this direction.

Waiting for care: effects of Ontario's 3-month waiting period for OHIP on landed immigrants

OBJECTIVE

To describe the experiences of a group of new immigrants and caregivers of new immigrants who were subject to the 3-month waiting period for the Ontario Health Insurance Plan and needed to access health care services during that time.

DESIGN

Qualitative study using a phenomenologic framework.

SETTING

Participants were recruited through the Scarborough Community Volunteer Clinic in Toronto, Ont. Interviews were conducted in person at the clinic or by telephone.

PARTICIPANTS

Seven participants were interviewed who themselves needed to access health care during the 3-month waiting period for the Ontario Health Insurance Plan or who were caring for someone who did.

METHODS

Seven semistructured, in-depth interviews were conducted using an interview guide; these were recorded and transcribed verbatim. Data were analyzed for themes to arrive at the essence of the participants' experiences.

MAIN FINDINGS

Participants believed that there was a lack of clear information and a lack of help from officials. Other common themes included poor social situations, financial loss or threat of financial loss related to health care, a choice to delay seeking care owing to cost, difficulty accessing alternative care, and appreciation for those who advocated on their behalf. Other themes that arose included emotional hardship, poor health outcomes or threat of poor health outcomes resulting from not seeking care, the importance and unpredictability of health, as well as negative impressions of Canada as a country as a result of the negative experience of seeking care.

CONCLUSION

New immigrants to Ontario who need to access health care services during the 3-month waiting period for provincial health insurance and the caregivers of such newcomers can have potentially very negative experiences. They might be unable to access care without financial barriers and might, therefore, choose to delay seeking health care until the end of the waiting period; this can lead to emotional hardship for themselves and their caregivers as well as to potentially poor health outcomes. This potential for an overwhelmingly negative experience for some new immigrants to Ontario might lend support to the argument that this policy be eliminated.

Developing population interventions with migrant women for maternal-child health: a focused ethnography

BACKGROUND

Literature describing effective population interventions related to the pregnancy, birth, and post-birth care of international migrants, as defined by them, is scant. Hence, we sought to determine: 1) what processes are used by migrant women to respond to maternal-child health and psychosocial concerns during the early months and years after birth; 2) which of these enhance or impede their resiliency; and 3) which population interventions they suggest best respond to these concerns.

METHODS

Sixteen international migrant women living in Montreal or Toronto who had been identified in a previous study as having a high psychosocial-risk profile and subsequently classified as vulnerable or resilient based on indicators of mental health were recruited. Focused ethnography including in-depth interviews and participant observations were conducted. Data were analyzed thematically and as an integrated whole.

RESULTS

Migrant women drew on a wide range of coping strategies and resources to respond to maternal-child health and psychosocial concerns. Resilient and vulnerable mothers differed in their use of certain coping strategies. Social inclusion was identified as an overarching factor for enhancing resiliency by all study participants. Social processes and corresponding facilitators relating to social inclusion were identified by participants, with more social processes identified by the vulnerable group. Several interventions related to services were described which varied in type and quality; these were generally found to be effective. Participants identified several categories of interventions which they had used or would have liked to use and recommended improvements for and creation of some programs. The social determinants of health categories within which their suggestions fell included: income and social status, social support network, education, personal health practices and coping skills, healthy child development, and health services. Within each of these, the most common suggestions were related to creating supportive environments and building healthy public policy.

CONCLUSIONS

A wealth of data was provided by participants on factors and processes related to the maternal-child health care of international migrants and associated population interventions. Our results offer a challenge to key stakeholders to improve existing interventions and create new ones based on the experiences and views of international migrant women themselves.

What are the living conditions and health status of those who don't report their migration status? A population-based study in Chile

Background

Undocumented immigrants are likely to be missing from population databases, making it impossible to identify an accurate sampling frame in migration research. No population-based data has been collected in Chile regarding the living conditions and health status of undocumented immigrants. However, the CASEN survey (Caracterizacion Socio- Economica Nacional) asked about migration status in Chile for the first time in 2006 and provides an opportunity to set the base for future analysis of available migration data. We explored the living conditions and health of self-reported immigrants and respondents who preferred not to report their migration status in this survey.

Methods

Cross-sectional secondary analysis of CASEN survey in Chile in 2006. Outcomes: any disability, illness/accident, hospitalization/surgery, cancer/chronic condition (all binary variables); and the number of medical/emergency attentions received (count variables). Covariates: Demographics (age, sex, marital status, urban/rural, ethnicity), socioeconomic status (education level, employment status and household income), and material standard of living (overcrowding, sanitation, housing quality). Weighted regression models were estimated for each health outcome, crude and adjusted by sets of covariates, in STATA 10.0.

Results

About 1% of the total sample reported being immigrants and 0.7% preferred not to report their migration status (Migration Status - Missing Values; MS-MV). The MS-MV lived in more deprived conditions and reported a higher rate of health problems than immigrants. Some gender differences were observed by health status among immigrants and the MS-MV but they were not statistically significant. Regressions indicated that age, sex, SES and material factors consistently affected MS-MVs’ chance of presenting poor health and these patterns were different to those found among immigrants. Great heterogeneity in both the MS-MV and the immigrants, as indicated by wide confidence intervals, prevented the identification of other significantly associated covariates.

Conclusion

This is the first study to look at the living conditions and health of those that preferred not to respond their migration status in Chile. Respondents that do not report their migration status are vulnerable to poor health and may represent undocumented immigrants. Surveys that fail to identify these people are likely to misrepresent the experiences of immigrants and further quantitative and qualitative research is urgently required.

International migration to Canada: the post-birth health of mothers and infants by immigration class

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.

Risk factors and health profiles of recent migrant women who experienced violence associated with pregnancy

BACKGROUND

Violence associated with pregnancy is a major public health concern, but little is known about it in recent migrant women. This study looked at (1) risk factors for violence associated with pregnancy among newly arrived migrant women in Canada and (2) if those who experienced violence associated with pregnancy had a different health profile or use of healthcare services for themselves or their infants during pregnancy and up to 4 months postpartum compared to other childbearing migrant women.

METHODS

Pregnant migrant women in Canada <5 years were recruited in 12 hospitals in 3 large cities between 2006 and 2009 and followed to 4 months postpartum. Data were collected on maternal background, migration history, violence associated with pregnancy, maternal and infant physical and mental health, and services used.

RESULTS

Of a total of 774 pregnant migrant women, 59 (7.6%) women reported violence associated with pregnancy. Migrant women who experienced violence, compared to those who did not, were at increased risk of violence if they lived without a partner, were asylum seekers, migrated <2 years ago, or had less than high school education. Women who reported violence were less likely to have up-to-date vaccinations, take folic acid before pregnancy, more likely to commence prenatal care after 3 months gestation and to not use contraceptives after birth. They were also more likely to have a history of miscarriage and report more postpartum pain and increased bleeding. They were also more likely to have inadequate social support and report more depression, anxiety, somatization, and posttraumatic stress disorder (PTSD) on standardized tests. No differences were found in the health status of the infants of women who experienced violence compared to those who did not.

CONCLUSIONS

Clinicians should sensitively ask recent migrant women (asylum seekers, refugees, and nonrefugee immigrants) about violence associated with pregnancy and appropriately assess, treat, and refer them.

Health situation of migrants with precarious status: review of the literature and implications for the Canadian context--Part A

Migrants with precarious status (MPS) are an understudied population. Yet there are indications that they could be particularly vulnerable and confronted to health inequalities. This review of Canadian and international literature highlights that MPS, like other migrants, are confronted with deleterious living conditions and multiple obstacles to access healthcare. However, their status brings additional challenges and harmful health determinants. The situation of MPS may well be similar in Canada, where they could be numerous. Therefore it is crucial to better document this issue within the Canadian context. Part B of this article, reported elsewhere, further explores this topic.

Health of migrants with precarious status: results of an exploratory study in Montreal--Part B

Increasingly, migrants with precarious status (MPS) are recognized as being particularly vulnerable. This exploratory study assesses whether the health of MPS in Montreal, Canada, is similar to that reported in the international literature (see Health situation of migrants with precarious status: Review of the literature and implications for the Canadian context--Part A, Social Work in Public Health, 27 (4), 330-344). The results of this study show that, as in other parts of the world, MPS in Canada appear to be confronted by multiple obstacles to health, many of which are linked to their precarious migration status and its impact on living conditions and access to health care. To reduce health inequalities, therefore, it is crucial to better understand and address the specific needs of this highly vulnerable population.

Refugee claimant women and barriers to health and social services post-birth

OBJECTIVES

Access to services for international migrants living in Canada is especially important during the postpartum period when additional health services and support are key to maternal and infant health. Recent studies found refugee claimant women to have a high number of postpartum health and social concerns that were not being addressed by the Canadian health care system. The current project aimed to gain greater understanding of the barriers these vulnerable migrant women face in accessing health and social services postpartum.

METHODS

Qualitative text data on services that claimant women received post-birth and notes (recorded by research nurses) about their experiences in accessing and receiving services were examined. Thematic analysis was conducted to identify common themes related to access barriers.

RESULTS

Of particular concern were the refusal of care for infants of mothers covered under IFHP, maternal isolation and difficulty for public health nurses to reach women postpartum. Also problematic was the lack of assessment, support and referrals for psychosocial concerns.

CONCLUSIONS

Better screening and referral for high-risk claimant women and education of health care providers on claimants' coverage and eligibility for services may improve the addressing of health and social concerns. Expansion of claimants' health benefits to include psychotherapy without prior approval by Citizenship and Immigration Canada is also recommended. Interventions aimed at social determinants underlying health care access issues among childbearing refugee claimants should also be explored. These might include providing access to subsidized language courses, social housing and government-sponsored benefits for parents, which currently have restrictive eligibility that limits or excludes claimants' access.

Contacts between general practitioners and migrants without a residence permit and the use of ‘‘urgent’’ medical care

Aims: To examine the extent to which general practitioners (GPs) are consulted by migrants without a residence permit (MRP), their use of the government sponsored reimbursement system and the difficulties encountered therewith. To study what hurdles the care recipients (MRP) experience in using healthcare and the reimbursement system. Methods: A written survey of GPs in the Brussels Capital region and semi-structured interviews with MRP in the same area. Bivariate analysis of the GP data (two-sided independent t-test, two-sided Fisher’s exact test). Recording, transcription, coding and categorizing of MRP interviews. Results: Overall GP response rate was 71%. The average number of MRP contacts per month was 1.1 for all, representing 0.26% of all GP contacts. GPs working in community health centres (CHC) 4.4 MRP per month (p = 0.042). The mean probability that the GP will not use the reimbursement programme is 0.66 — there is less non-use in CHC (p = 0.042). The main barrier for GPs is insufficient knowledge of the system, followed by its complex and time consuming paperwork. Barriers experienced by MRP include fear of deportation, lack of funds, insufficient healthcare-related knowledge and communication barriers. Conclusions: Primary care is an active channel in healthcare for MRP, with CHC taking the lead. With the reimbursement system, there should hardly be financial barriers to access the healthcare system. However, due to the high probability of non-use (0.66), this system cannot substantially contribute to lowering financial barriers. The complexity of the system prevents it from being used properly and leads to undesirable alternatives.

Examining alternative measures of social disadvantage among Asian Americans: the relevance of economic opportunity, subjective social status, and financial strain for health

Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.

Immigration, work and health in Spain: the influence of legal status and employment contract on reported health indicators

OBJECTIVE

To analyze the relationship of legal status and employment conditions with health indicators in foreign-born and Spanish-born workers in Spain.

METHODS

Cross-sectional study of 1,849 foreign-born and 509 Spanish-born workers (2008-2009, ITSAL Project). Considered employment conditions: permanent, temporary and no contract (foreign-born and Spanish-born); considered legal statuses: documented and undocumented (foreign-born). Joint relationships with self-rated health (SRH) and mental health (MH) were analyzed via logistical regression.

RESULTS

When compared with male permanently contracted Spanish-born workers, worse health is seen in undocumented foreign-born, time in Spain ≤3 years (SRH aOR 2.68, 95% CI 1.09-6.56; MH aOR 2.26, 95% CI 1.15-4.42); in Spanish-born, temporary contracts (SRH aOR 2.40, 95% CI 1.04-5.53); and in foreign-born, temporary contracts, time in Spain >3 years (MH: aOR 1.96, 95% CI 1.13-3.38). In females, highest self-rated health risks are in foreign-born, temporary contracts (aOR 2.36, 95% CI 1.13-4.91) and without contracts, time in Spain >3 years (aOR 4.63, 95% CI 1.95-10.97).

CONCLUSIONS

Contract type is a health determinant in both foreign-born and Spanish-born workers. This study offers an uncommon exploration of undocumented migration and raises methodological issues to consider in future research.

Undocumented migrants in Canada: a scope literature review on health, access to services, and working conditions

It is estimated that there are 30-40 million undocumented workers worldwide. Although undocumented migration has become an issue of high international relevance, it has been strikingly understudied in Canada, especially with respect to its impact on health. The purpose of this study is to explore the concept of undocumentedness in Canada through a scoping review of peer-reviewed and grey literature written in English, French, Portuguese and Spanish between 2002 and 2008. The specific aims are to: (i) summarize and disseminate current academic and community-based findings on the health, service access and working conditions of undocumented migrants in Canada; (ii) examine the sources and use of evidence; (iii) identify significant gaps in existing knowledge; (iv) set recommendations for policy and research, including considerations on transnationalism, ethics, interdisciplinary approaches, gender differences, resilience, and impact on the children of non-status parents.