Responding to the WHO CSDH Report: Considerations for Improving Health Equity among Migrant Farm Workers in Canada

Transcription

1 1 Responding to the WHO CSDH Report: Considerations for Improving Health Equity among Migrant Farm Workers in Canada Janet McLaughlin, Beth Jackson, Donald Cole, Willem van Heiningen

2 Responding to the WHO Commission SDH Report: Considerations for Improving Health Equity among Migrant Farm Workers in Canada Janet McLaughlin, PhD - International Migration Research Centre, Wilfrid Laurier University Beth Jackson, PhD - Public Health Agency of Canada Donald Cole, PhD Institute for Work & Health, University of Toronto Willem van Heiningen, MD McMaster University CPHA Annual Conference Toronto, ON June 15, 2010

3 3 Overview of Presentation Background: WHO Commission on Social Determinants of Health (CSDH) & Canada s contribution WHO CSDH key areas of recommendations What some of these mean for MFWs Promising directions for future research, policy & practice

4 WHO CSDH & Canada s Role 4 Canada s Contribution to the work of the Commission: Provided funding assistance to Knowledge Networks: Early Childhood Development and Education Globalization and Health Health Systems Conducted global review of intersectoral action for health equity (with WHO) Provided support for Commissioner Monique Bégin Collaborated with Country Partners Supported development of input on Indigenous Peoples health determinants Established multi-sector Canadian Reference Group to inform action in Canada

5 5 Canada s Outputs Global review of intersectoral action Consortium to study health costs of poverty Engagement of civil society & private sector (in Canada) Key reports on SDH and health inequalities: CPHO (PHAC) Reports on the State of Public Health in Canada 2008, 2009 A Healthy, Productive Canada: A Determinant of Health Approach - Final report of the Senate Subcommittee on Population Health (2009) In from the Margins: A Call to Action On Poverty, Housing and Homelessness - Senate Committee on Social Affairs report (2009)

6 6 WHO CSDH Final Report: Key Recommendations Improve Living and Working Conditions: Early Childhood Development Urban & Rural Environments Employment & Working Conditions Social Protection Systems Universal Health Care Tackle Inequitable Distribution of Power, Money and Resources Measure and Understand the Problem and Assess the Impact of Action

7 Early Childhood Development Children need safe, healthy, supporting, nurturing, caring, and responsive living environments (CSDH) 7 Three main areas critical to healthy child development (CPHO 2008): adequate income effective parenting & family functioning supportive community environments Lack of an independent means of transportation, lack of knowledge of where to go for needed care, and very high caretaker pressure to work contribute to unmet medical need among migrant children. [ ] These findings likely reflect the employment-related vulnerability of migrant workers (Weathers et al 2004:e281)

8 8 ECD: Promising Practices 1. Community Action Program for Children provides funding to community groups & coalitions to address health & development of children living in conditions of risk benefits for participant families include: lower rates of maternal depression & sense of isolation fewer emotional & behavioural issues reported among children (CPHO Report 2009) 2. Family reunification & access to permanent residency or citizenship available to other classes of TFWs (e.g. live-in caregivers) supports parent-child relations

9 9 Employment & Working Conditions Stress from job strain (high demand, low control), (dis)satisfaction, perception of physical risk and issues of job security are a significant health concern for both Canadian-born and migrant workers (CPHO 2008). - MFWs employment is generally low-paid, low status and precarious; evidence indicates MFWs are at higher risk for work-related illness & injury. Full and fair employment and decent work be made a shared objective of international institutions and a central part of national policy agendas and development strategies, with strengthened representation of workers in the creation of policy, legislation, and programmes relating to employment and work (WHO CSDH 2008, Rec.7.1) Strengthened representation of migrant farm workers in the development of employment-related policy & legislation may help ensure health-supporting conditions of work

10 10 Promising Practices: Manitoba & Maple Leaf Foods Industry, community & provincial govt support permanent settlement: MB allows all TFWs, regardless of skill level, to apply under the Employer Direct stream of the Provincial Nominee Program (PNP) as long as they have worked in MB for six months and have a full-time job offer In 2007, over 90% of Maple Leaf TFWs applying to PNP were successful Upon receiving PN status, TFWs can initiate family reunification In 2008, over 2100 family members were expected to arrive in Brandon as applications for PN status were approved It is estimated that approx family members (children & spouses) will arrive in Brandon by 2011

11 Manitoba & Maple Leaf Foods Collaborative Service Delivery 11 TFW Dialogue Group (Rural Development Inst, Brandon U): Brandon Regional Health Authority, Citizenship and Immigration Canada, City of Brandon, Westman Immigrant Services, Manitoba Labour & Immigration, Manitoba Agriculture, Food & Rural Initiatives, Maple Leaf Foods, Rural Secretariat, Service Canada City of Brandon: community orientation & settlement strategy; strategic cultural plan Maple Leaf Foods: In 2007, partnered with International Organization for Migration (IOM) to facilitate the fair, transparent and safe migration of TFWs settlement team that assists newcomers with pre- & post-arrival needs, including language training, housing, school readiness for children, public transit, SIN and MB health card applications human resource workers fluent in Spanish and Mandarin human resources coordinator to help workers apply for provincial nominee status

12 12 Universal Health Care WHO CSDH Recommendation: National governments, with civil society and donors, build health-care services on the principle of universal coverage of quality services, focusing on Primary Health Care ; National governments ensure public sector leadership in health-care systems financing, focusing on tax-/insurance-based funding, ensuring universal coverage of health care regardless of ability to pay, and minimizing out-ofpocket health spending Canada meets this recommendation; nevertheless, many MFWs experience barriers to access: delayed health card access low levels of cultural competence among health care providers lack of interpreters low levels of health literacy difficulty taking time off work fear of losing employment lack of transportation

13 13 Access to Care: Promising Practices Farm Worker Family Health Program (southern US) improves MFWs access to health care via a community partnership model Justicia for Migrant Workers engages in advocacy, outreach & support for health care access. Occupational Health Clinics for Ontario Workers (OHCOW*) offers outreach occupational health services with interpreters and advocates to MFWs in rural Ontario OHCOW s Key Strategic Directions includes: Strengthen capacity and accessibility to deal with vulnerable worker populations, including a specific focus on immigrant, migrant and first nations workers * established in 1989 by the Ontario Federation of Labour (OFL); funded by the Workplace Safety and Insurance Board (WSIB)

14 A bounty of promising practices, or a harvest yet to reap? Intersectoral, interjurisdictional collaboration on interventions at multiple levels to address determinants of health for MFWs 14