HLTH - Week 4: Geography, Migration, & Health

What is Migration how can it affect the SDOH?

Migration refers to the movement of people from one place to another. Migration is shaped by social, political, economic, and historical conditions. Government policies and discrimination determine who can enter Canada, who receives protection and resources, and who becomes marginalized — all of which can affect health.

what are the Health Threats upon arrival to host-country?

Material conditions: poverty or near-poverty, unemployment, underemployment, housing and food insecurity, and barriers to receiving/ completing education

Social condition: Racism and discrimination, lack of housing, employment discrimination, language barriers, detention upon arrival of asylum seekers

What are environmental refugees and climate refugees?

Environmental refugee - A person forced to leave their home community because of environmental changes or disasters (not crossing international boarders)

Climate refugee - A person displaced due to climate-related events, such as extreme weather, rising sea levels, or prolonged droughts, (crossing international borders.)

People immigrating to Canada follow one of 4 processes allotted under the Canadian Immigration Categories:

Economic: People come to Canada because of their skills, education, work experience, or ability to contribute to the economy.

Family: Someone can immigrate to Canada because they have a qualifying family relationship with a Canadian citizen or permanent resident.

Refugee: he person is seeking protection, rather than primarily coming for work or family reunification. they cannot safely return to their home country due to things such as persecution, armed conflict, or serious human-rights violations.

Humanitarian :Canada has some immigration pathways for people in exceptional or crisis situations who may not fit the normal economic, family, or refugee pathways.

Political refugees vs. economic migrants

Political refugee: Leaves because they cannot safely remain in their country, often because of persecution or serious threats connected to their political opinion or other protected grounds.

(forced migration)

Economic migrant: Leaves primarily to improve their economic situation, such as finding a job, earning more money, or having better economic opportunities.

(usually voluntary migration)

What was the 1976 Immigration Act?

A Canadian law that defined who qualified as a refugee and created two main ways refugees could come to Canada: claim asylum after arriving or be sponsored by the government or private groups before arrival.

How can foreign workers be more affected by SDOH?

employment may improve income, housing, food, and access to resources, but workers may also face low wages, poor working conditions, low access to health care, housing challenges, discrimination, and limited social support, which can negatively affect health. especially if they don’t have proper refugee status the employer has more control over them, because they wont be reported with the fear of being deported.

How can governments improve healthcare access in rural/remote areas?

by using financial incentives for healthcare providers, telehealth/virtual care, home-monitoring equipment, and rural training pathways to bring healthcare closer to remote communities.

Explain the differences between rural, remote, and urban health concerns

Urban	Rural	Remote
More healthcare services, but overcrowding, pollution, and higher living costs can affect health.	Fewer healthcare providers and services, with longer travel distances to care.	Very limited healthcare access, extreme travel distances, transportation barriers, and difficulty accessing specialized care.

What are urban heat islands, how can they affect SDOH

Urban heat islands (UHIs) occur when cities are significantly warmer than surrounding rural areas because buildings, pavement, and roads absorb and retain heat.

Urban heat islands are relevant to SDOH because cities can have higher temperatures, and people with lower incomes or poor housing may have less protection from extreme heat, increasing their risk of health problems.

what is a economic migrant?

someone who moves mainly for better economic opportunities.

Environmental migrant

someone who moves because environmental conditions make living somewhere difficult or unsafe

What is Nonrefoulement

a principle in which you cannot send a refugee back to a place where they face serious danger/persecution.

UNHCR - United Nations High Commissioner for Refugees

UN organization that protects/supports refugees.

Multiculturalism

Canada officially recognizes and supports cultural diversity.

What is health geography?

Health geography is the study of how health and healthcare are affected by where people live.

It looks at how factors such as location, environment, access to healthcare, income, transportation, and population characteristics create differences in health between places.

Explain briefly Canada’s shift in immigration

Canada’s immigration shifted from mainly European immigration after WWII to a much more diverse population from Asia, Africa, the Caribbean, and Latin America. This change was influenced by the removal of racial and national-origin preferences and the introduction of a points-based system in 1967, which focused more on skills, education, and other qualifications.

Give a general understanding of the nature of refugee migration.

Refugee migration is forced migration where people leave their country because of persecution, danger, or conditions that make staying unsafe. Refugees may flee because of race, religion, nationality, political opinion, or membership in a social group.  

Asylum seekers are waiting for their refugee claim to be decided, while 

IDPs are displaced but remain within their own country. Most refugees stay in nearby countries, which can put pressure on housing, food, water, healthcare, and other resources. 

how the physical and social conditions of pre-migration and the migratory process itself may have an impact on short-term and long-term health outcomes of refugees.  

Refugees can experience trauma, violence, poverty, unsafe conditions, and lack of healthcare before and during migration. Refugee camps may have overcrowding, poor sanitation, unsafe water, and malnutrition. After migration, poverty, unemployment, language barriers, discrimination, and difficulty accessing healthcare can continue to affect health. Long-term fear and stress can keep cortisol and adrenaline elevated, contributing to cardiovascular and immune system problems.

Describe the living conditions in refugee camps from a social determinants of health perspective.  

Refugee camps are supposed to be temporary but can become long-term and overcrowded. Limited food, clean water, sanitation, housing, and healthcare create poor material conditions and increase the risk of malnutrition and disease outbreaks. From an SDOH perspective, these living conditions directly affect physical and mental health.

describe how post-migration factors at several levels have an impact on the health and well-being of resettled refugees in Canada. 

After arriving in Canada, refugees can face poverty, unemployment, housing problems, language barriers, education barriers, transportation costs, and complicated healthcare systems. The “Canadian experience” barrier can prevent skilled refugees from finding professional jobs. Legal status also affects access to work, healthcare, and support. On the other hand, stable employment and strong community connections can improve well-being and integration.

Describe the difference between Forced vs. voluntary migration 

• Forced migration: migration because of fear of persecution and conditions that make staying unsafe.  

• Voluntary migrants: officially includes people who migrate because of things like extreme poverty, natural disasters, or environmental degradation.  

• BUT → the line between forced and voluntary migration is not always clear. Someone may technically be classified as a voluntary migrant even when their circumstances leave them with very little real choice. 

What is a refugee?

A refugee is someone who is forced to leave their country because they have a well-founded fear of persecution and their own government cannot or will not protect them. (Race, Religion, Sexual orientation, Political opinions, membership in a social group, home country cannot protect them) 

Countries that signed the UN Refugee Convention agree to what criteria?

• Provide temporary sanctuary/protection  

• Not return refugees to the country they are fleeing (the principle of non-refoulement). 

 

What is a Asylum Seeker? 

An asylum seeker is someone who has left their country and is asking to be recognized as a refugee, but their claim has not been decided yet. they have crossed the boarder but they must prove they are fleeing persecution to receive refugee status, decision can take years in some countries, If their claim is rejected, they are generally required to leave the country, If they do not leave voluntarily, they can be deported to the country they fled.

What is a resettled refugee?

a person who is officially recognized as a refugee and who has been offered permanent residency in another third country. 

 

What is a internally displaced person (IDP)

a person who is forcibly displaced from their home for the same reasons as refugees but has not crossed international borders yet. Most of those displaced by violence and persecution are displaced in their own countries.

What is a migrant?

A migrant is someone who crosses an international border but does not meet the legal (UN Convention) definition of a refugee. (their migration may or may not be voluntary) 

How can large refugee populations affect health?

Large refugee populations can strain a country’s infrastructure and resources. Overcrowded camps may have unsafe water, poor sanitation, and limited food/healthcare, increasing disease and malnutrition. Refugees living outside camps may lack legal status, face unsafe informal work and exploitation, and live below the poverty line.

How can refugee experiences affect the body through SDOH?

Poor living conditions, unsafe work, and constant fear cause long-term stress. This keeps cortisol and adrenaline high, which can raise heart rate and blood pressure and harm the immune and cardiovascular systems.

What are the three durable solutions for refugees?

• Voluntary perpetration back home where its safe 

• Integration into the neighboring country that they fled to  

• Or resettlement in a third country like Canada (Permeant resettlement in a safe third country is extremely rare so the process for most refugees is never truly over.)  

 

What are the options for entering canada as a refugee?

• Government assisted refugees– federal gov provides about a year of financial support  

• Privately sponsored refugees  - community groups or faith based organizations pool their own money to support a family for year 1. these are said to initially have better integration because they already have connections in the community. 

• Blended visa office referral program – mix of both 

 

What are the five other main barriers that refugees face after entering canada?

Canadian experience" barrier – highly skilled fully degreed refugees can't find a job because they have no previous experience in Canada.  

Transportation law – after just fleeing their country they are hit with a massive bill from the Canadian government for flight and medical exams. Imagine the cascading of that debt immediately puts on a social stress. 

Education barrier – youth are chronologically much older in schooling but sometimes they can age out and may not get youth and free education. Creates a structural trap.  

Medical bureaucracy -  form of social exclusion, refugees aren't handed healthcare just immediately they are placed on intern federal health program(IFHP) (so complicated that it makes healthcare difficult or impossible) IFHP patients were often discriminated and received different care.  

Language barriers – leads to medial barriers, 

What is the Designated Countries of Origin (DCOs)

Designated Countries of Origin (DCOs) were countries that Canada considered “safe” for refugee claimants. The policy was intended to fast-track refugee claims from these countries.

People from DCOs generally could not get a work permit until their claim was accepted or they had been in Canada for 180 days.

What is Bill C-4

Applied to people who arrived in Canada as part of a group classified as an “irregular arrival.” These people could be detained for long periods, and designated foreign nationals were not allowed their first detention review until 12 months after being detained. This meant that families could potentially be held in detention for up to a year before their detention was reviewed. 

Healthy immigrant effect

whereby immigrants arrive in Canada healthier than the average Canadian and then show decreases in perceived and observed measures of health over time because of the SDOH that being a refugee causes

What are push and pull factors?

Push = reasons people are leaving the location they are in.

Ex. discrimination, family rejection, lack of safety, violence

Pull = reasons people are attracted to a new location.

Ex. freedom, safety, acceptance, opportunity, better living conditions.

Connect migration to health

Migration is not just about physically moving from one country to another. The experience of migration can change a person's social environment, which can strongly affect their health.

However: A person may leave an unhealthy or unsafe environment, but then face new social determinants of health in their destination country.

Why is food insecurity a major issue in Northern Canada?

Food is much more expensive in the North, while many Inuit families have low incomes, making it difficult to afford enough healthy food.

Northern communities are isolated, so much of their food must be flown or shipped in, making transportation expensive.

What is Nutrition North Canada?

A federal program that subsidizes shipping costs to lower the price of perishable foods like meat, milk, fruits, and vegetables.

How can food insecurity affect health?

Not having enough food can cause hunger and malnutrition, making it harder to get the nutrients the body needs. This can lead to poor physical health, lower energy, and increased risk of illness, especially in children.

How does limited access to clean water affect health?

Contaminated water can cause rashes, sores, diarrhea, headaches, and other health problems, while too little water makes basic hygiene difficult.

How does the water crisis affect daily life?

Water must be strictly rationed, bottled water is extremely expensive, and residents have limited water for drinking, cooking, bathing, and cleaning. Which is also not good for health.

How is the water crisis connected to SDOH?

ack of safe water is a material condition that affects physical health, mental health, hygiene, finances, and overall quality of life.