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Amri M. Accepting refugees: alternative arguments for Canada. Harvard Public Health Review. Spring 2016;9.
The Canadian federal election came to an end on October 19, 2015, with Prime Minister Justin Trudeau promising to bring in 25,000 Syrian refugees to Canada by the end of 2015. This became a national priority when a photo of Alan Kurdi, a three-year-old boy, dead on a Turkish beach surfaced and knowledge spread of his family’s intention to come to Canada.
While this sad occurrence tugged on Canadian heartstrings, limited government resources to financially support relocation fees and social safety nets for accepted refugees often trump moral arguments to save refugees. Thus, first and foremost, thought must be given to resources required for refugee arrival. The media is doing just that, averring that Canada lacks the resources to handle the 25,000 refugees arriving by January 1st, 2016, an election promise made by the Liberal government in March of 2015 prior to the Federal election, who later won the majority of seats in the October 2015 election and subsequently formed government. The media has raised concerns over security amidst the attacks in Paris, time needed for host communities to receive refugees, public rejection of accepting refugees for reasons of time, too many refugees, and expenses, among other concerns. This is undoubtedly a large feat for such a short time period. While the military and religious community are assisting, Canada has previously evidenced its capacity to provide this degree of aid. In the past, Canada has demonstrated its capacity to accommodate refugees, as one of three main immigrant-accepting countries in the latter half of the 1971 to 1981 decade; including accepting 60,000 refugees of the Vietnam conflict from the late 1970s, when Canada’s population was just shy of 25 million. The argument that Syrian refugees will consume inordinate resources upon arrival is not unfounded. These individuals will inevitably rely on the social safety net to regain their footing in society. But their use of resources can be seen as a small investment for gains both economically, achieved through their daily work, and their contributions to the nation’s “greater good.” Many immigrants are proud to call Canada home and work hard to contribute to Canadian society. Given that English is not the first language of many refugees and their credentials may not be recognized upon entry in Canada, many will work low-wage service jobs. These jobs are essential for the economy, as they are the foundation on which other forms of employment are built and have the potential to boost the economy in have-not regions, with the potential to create wealth, create jobs, and increase tax revenue. Contribution to the greater good is best personified by a previous Governor General of Canada, Adrienne Clarkson, a Chinese refugee herself as well as the many Vietnamese refugees mentioned earlier who are thriving in Canada. These Vietnamese refugees now work as professors, in medical careers, factory workers, and are raising families, among others. A study of 1, 300 Vietnamese boat people found that within ten years of arrival, they had an unemployment rate 2.3% lower than the Canadian average and one in five had started a business.
In one study, a macro-econometric forecasting model was used to simulate the impact on the Canadian economy of a hypothetical increase in immigration. The study yielded only positive impacts on factors such as: real GDP, GDP per capita, aggregate demand, investment, productivity, and government expenditures, taxes, and especially net government balances, with essentially no impact on unemployment. Therefore, it is safe to expect that the work of refugees will push the Canadian economy further, and thus, potentially improving the well-being of all Canadians, as wealth is often spread throughout a nation.
This discussion on well-being may lead us to wonder about refugees’ well-being and the impact of a refugee population on the healthcare system of the host nation. Studies have demonstrated the presence of a “healthy immigrant effect,” in which the health of immigrants is generally higher than those born in the host country. Studies of mortality found that the healthy immigrant effect is stronger for immigrants from poor or culturally distant countries. While the theory is relevant to immigrants in general, it particularly applies to Syrian refugees coming to Canada, given the difference in culture. It can be expected that these refugees will not heavily utilize healthcare services when they arrive. A 2002 study found Canadian immigrants have lower odds of reporting chronic conditions, but these odds increased with time spent in Canada. While this underreporting and potential underutilization of healthcare services may be due in part to barriers faced, such as difficulties with: language, finances, transportation, mistrust of health care workers, perceived lack of access, and lack of familiarity navigating the health system, it inevitably does not result in additional expenditures (unfortunately, there is a lack of longitudinal Canadian data on healthcare service utilization of refugees). This is particularly important when the nation has a largely single-tier healthcare system funded by the state. Regrettably, this can have implications on refugees’ health in the long-term.
Given Canada’s track record of accepting refugees in the past, the nation should continue to embrace Syrian refugees with open arms. There is a high likelihood that the accepted refugees will largely contribute to Canadian society and minimized chance these individuals will be high-end users of healthcare system resources upon arrival. Therefore, accepting refugees into a nation is not as financially burdensome as some may think.
While Alan Kurdi did not make it to Canada, the tragic image of his lifeless body sparked both outrage and action. Accepting refugees speaks directly to what the people of Canada stand for: a fair and just society. He reignited the dormant values of justice and compassion in the hearts of Canadians, with February 27th, 2016 marking the day the 25, 000th Syrian refugee arrived in Canada.
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[1]Unpublished data based on a pilot screening program of all incoming refugee to King County for complex cases.
J. Carey Jackson MD, MPH, MA is a Professor of Medicine in the School of Medicine at the University of Washington in Seattle. He is an Affiliate Investigator at the Fred Hutchison Cancer Research Center and an Adjunct Professor of Global Health at the University of Washington.
Mahri Haider MD, MPH is an attending physician in the International Medicine Clinic at Harborview. She serves as a primary care physician for refugees and immigrants. In addition, she provides medical evaluations for torture victims, in collaboration with the Northwest Health and Human Rights (NWHHR) project.
Christine Wilson Owens BA is Public Information Specialist in the Interpreter Services Department at Harborview Medical Center (HMC) in Seattle, WA. She leads program and content management related activities for EthnoMed.
Nicole Ahrenholz MD is an attending physician at Harborview’s International Medicine Clinic and a clinical assistant professor at the UW School of Medicine.
Alexandra Molnar MD is a primary care provider at Harborview’s International Medicine & Pioneer Square Clinic, as well as, caring for individuals in the Harborview wards. She is also a clinical assistant professor at the University of Washington’s School of Medicine.
Beth Farmer LICSW is a trained clinician and also manages an outpatient mental health clinic for refugees and asylum seekers called International Counseling and Community Services. She has been a social worker for over twenty years, with the past eight years spent in the field of refugee mental health.
Genji Terasaki MD is a board certified physician at the International and Adult Medicine clinics at Harborview and a UW assistant professor of General Internal Medicine.
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