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Priority directions to address hepatitis C amongst immigrants and newcomers to Canada from high-prevalence countries

While immigrants and newcomers to Canada are healthier than their Canadian counterparts when they arrive (the healthy immigrant effect,1) some research has shown that the longer a person resides in Canada, the more their health status declines. Studies have found that immigrants and newcomers to Canada report poorer health outcomes over time because of many factors, including poverty, stress, and structural barriers to accessing health services and receiving culturally appropriate care. Immigrants and newcomers access healthcare services less than people born in Canada, and this is especially true of refugees and individuals who do not have status or proper immigration documents. Medical education often cannot keep pace with the changing population demographics of the country. These factors create unique challenges that must be addressed.

Stigma associated with hepatitis is not as prevalent among many immigrant and newcomer population groups as it is among people born in Canada because hepatitis C and hepatitis B are primarily transmitted through medical systems in many immigrant and newcomer countries of origin. In many immigrant communities, hepatitis C is considered a chronic disease.

Vision for an integrated model of care for immigrants and newcomers to Canada

Local and cultural contextualization of any model is critical, but the following elements support a common vision for an effective and relevant hepatitis C model of care for immigrants and newcomers to Canada.

  • Immigrant community hubs should serve as focal points for hepatitis C programming and services. These hubs include agencies specialized in settlement, social and primary health services for newcomers, including refugees and individuals without the proper immigration documents. They can be integrated into a one-stop-shop model and can make more formalized connections to specialist services beyond their immediate scopes.
  • Multidisciplinary and family-based models of immigrant health should be founded upon:
    • family-centred health care that wraps around the service user’s’ needs in an integrated and comprehensive way;
    • the availability of staff and services that can address accessibility issues of treatment affordability, as well as provide on-site interpretation and translation services; and
    • partnerships with programs and services for related supports such as settlement, language, child care, literacy, and employment training that address broader social conditions and needs of newcomers in a comprehensive manner.
  • Cross-cultural/cultural safety capabilities and interpretation services should be improved in hospitals and other mainstream health centres and speciality clinics. This includes appreciating non-Western models of healthcare, and communicating on the basis of values and beliefs of clients. It is also important to employ a workforce that represents the diversity within the newcomer populations.
  • Alternative funding models should be instituted for specialist services, including salaried compensation rather than fee-for-service compensation, which gives healthcare providers the flexibility to take the time to provide culturally appropriate care.
  • Strategies should be established for non-insured service users, including refugees and individuals without proper immigration documents. This could involve sector-wide arrangements with hospitals, common data collection, and resource-sharing mechanisms.

Recommendations to address hepatitis C amongst immigrants and newcomers to Canada: tools, resources and supports

  • Prioritize investment in community hubs in large urban centres with significant newcomer populations.
  • Include hepatitis C information referrals and testing as part of standard newcomer settlement and orientation packages offered at settlement agencies.
  • Prioritize immigrants and newcomers to Canada within provincial/territorial and national hepatitis C strategies (move beyond a focus on the incidence of the disease). Train healthcare providers in cultural safety, cross-cultural communication and non-Western care paradigms.
  • Employ a diverse workforce that is representative of diversity in Canadian communities.

Notes

  1. Gushulak B, Pottie K, Roberts J, et al. Migration and health in Canada: Health in the global village. CMAJ. 2011 Sep;183(12):E952-E958.