Newcomer health: Immigrants & Refugees
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Transcript Newcomer health: Immigrants & Refugees
Olive Wahoush
March 7th 2014
IRWHP
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Influence on health
PreMigration
Post
Migration
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Migration
2
Insurance gaps
Health care equity current research shows
healthy immigrant effect with reductions for
newcomers and subsequent generations
Consider Health care Access vs. outcomes
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Most refugee families start their new life in
Canada with a debt of up to $10,000.
They must repay this loan with interest.
Payments start three months after arrival
Loan repayment rate is 91% – an astonishingly
high rate given the sacrifice repayment entails
for many refugees
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CHARSNN 2006 – 2010
Maternal newborn study of health up to 4
months afterbirth (Quebec, Ontario & British
Columbia)
First 18 months in Canada GARs (2010 2012).
(Hamilton & Kitchener/Waterloo, Ontario)
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Cut/skip meals persists and remains most common
for asylum seeking mothers
some increase across groups of women and in each city
except for asylum seekers in Montreal
Developmental delays (2 or more no on Nipissing)
Most commonly reported in Toronto and similar pattern
for Toronto & Vancouver
Highest among refugees (16%) and lowest among
Canadian born (1-2%)
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Figure W1-2: Cut/skip meals (due to lack of money)
by migration status and recruitment city
25
20
Montreal
%
15
Toronto
10
Vancouver
5
0
Refugee
7
Asylumseeker
Non-refugee
Immigrant
Canadian
born
Figure M4-3: Infant developmental delays
(2 or more 'no' responses on Nipissing)
by migration status and recruitment city
20
%
15
Montreal
10
Toronto
Vancouver
5
0
Refugee
8
Asylumseeker
Non-refugee
Immigrant
Canadian
born
Mothers Vaccinations not up to date
Very common among all migrant groups (60-80%)
Toronto > Montreal > Vancouver
Same pattern among Canadian born women (8, 12, 31%)
Physical Abuse in the past year
least reported by Canadian born and non refugee immigrant
women
Most common among Asylum seeker mothers (12-20%)
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%
Figure M4-4: Mother's vaccinations are not up to date
by migration status and recruitment city
90
80
70
60
50
40
30
20
10
0
Montreal
Toronto
Vancouver
Refugee
10
Asylumseeker
Non-refugee
Immigrant
Canadian
born
Risk of Post Partum Depression
Risks may be reduced but still identified in all groups
Refugees & Asylum seekers most often identified
Reported symptoms of Post Traumatic Stress Disorder
Reported in all migrant groups
30% of refugee mothers & 50% of Asylum seekers
Toronto > Montreal
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Figure M4-5: At risk for postpartum depression
(EPDS ≥10)
by migration status and recruitment city
30
%
25
20
Montreal
15
Toronto
10
Vancouver
5
0
Refugee
12
Asylumseeker
Non-refugee
Immigrant
Canadian
born
Figure M4-7: Reports symptoms of Post Traumatic
Stress Disorder (Hopkins)
by migration status and recruitment city
60
%
50
40
Montreal
30
Toronto
20
Vancouver
10
0
Refugee
13
Asylum-seeker
Non-refugee
Immigrant
>3 concerns reported by
50-65% of refugee & asylum seeking mothers
Mothers in Montreal > Toronto or Vancouver
Average unaddressed concerns (40-80%)
Reported by a greater proportion of mothers in all
groups than was reported at the first home visit
60-80% across all migrant groups in each city
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Figure M4-8: ≥ 3 concerns
by migration status and recruitment city
70
60
%
50
Montreal
40
Toronto
30
Vancouver
20
10
0
Refugee
15
Asylumseeker
Non-refugee
Immigrant
Canadian
born
%
Figure M4-9: Average unaddressed concerns
by migration status and recruitment city
90
80
70
60
50
40
30
20
10
0
Montreal
Toronto
Vancouver
Refugee
16
Asylumseeker
Non-refugee
Immigrant
Canadian
born
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Health Insurance
OHIP 46% (6)
IFHP 23% (3)
Both 23% (3)
Income limited >35% spent on housing
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Amount
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<$500
$501- 1000
$1001 – 1500
$1500 – 1640
% (n)
23% (3)
23% (3)
38% (5)
15% (2)
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Family size
2–6
3–6
3–8
5–6
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Racialization
Under or never served
Health insurance gaps
Lack of awareness of issue or services
Transportation
Costs direct and indirect
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Sub-Saharan African, Somali, and South Asian migrants
consistently have higher caesarean rates while EasternEuropean and Vietnamese migrants have lower overall
caesarean rates compared to receiving-country-born
women.
North-African/West Asian and Latin American migrant
women have higher emergency caesarean rates. To date
there is inadequate empirical evidence to explain
observed differences in caesarean rates; more focused
research is urgently needed.
Merry, Lisa, et al. "International migration and caesarean birth: a systematic review and meta-analysis." BMC Pregnancy and
Childbirth 13 (2013): 27. Academic OneFile. Web. 7 Mar. 2014.
Migrant women consistently have different
rates of caesarean compared to receivingcountry-born women,
Non-medical factors such as
communication barriers
support and/or care practices during labour and
delivery
female genital cutting
cultural preference may also be implicated in
caesarean rate differences
http://www.unhcr.ca/
http://www.unhcr.org/4ec262df9.html
www.cic.gc.ca
http://ccrweb.ca/40thanniversary.htm
http://ccrweb.ca/files/whatsnew2013en.pdf
http://www.un.org/en/documents/udhr/
http://www.un.org/en/rights/index.shtml
http://www.cic.gc.ca/english/refugees/outside/sum
mary-ifhp.asp
http://esa.un.org/unmigration/documents/Graphs_a
nd_Maps.pdf
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Gagnon,A.J.; Wahoush,O.; Dougherty,G.; Saucier,J.-F.; Dennis,C.-L.; Merry,L.; Stanger,E.;
Stewart,D.E. (2006). The childbearing health and related service needs of newcomers
(CHARSNN) study protocol. BMC, Pregnancy and Childbirth. Dec 2006 02/2006; 6:31.
DOI:10.1186/1471-2393-6-31
Gagnon,A.J.; Dougherty,G.; Platt,R.W.; Wahoush,O.; George,A.; Stanger,E.; Oxman-Martinez,J.;
Saucier,J.F.; Merry,L.; Stewart,D.E. (2007). Refugee and refugee-claimant women and infants
post-birth: migration histories as a predictor of Canadian health system response to needs.
Can.J.Public Health, 2007, 98, 4, 287-291, Jul-Aug
Stewart,D.E.; Gagnon,A.; Saucier,J.F.; Wahoush,O.; Dougherty,G. (2008). Postpartum depression
symptoms in newcomers. Can.J.Psychiatry, 2008, 53, 2, 121-124.
Ahmed,A.; Stewart,D.E.; Teng,L.; Wahoush,O.; Gagnon,A.J. (2008). Experiences of immigrant
new mothers with symptoms of depression. Arch.Women Ment.Health., 2008, 11, 4, 295-303,
Wahoush,E.O., (2009). Equitable health-care access: the experiences of refugee and refugee
claimant mothers with an ill preschooler. Can.J.Nurs.Res., 2009, 41, 3, 186-206.
Wahoush, O. (2014), Primary Health Care: Provider Perspectives on their Services for Preschool
Children in Refugee & Refugee Claimant Families. Primary Health Care:Open Access 10/2013;
3(140). DOI:10.4172/2167-1079.1000140
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