We need to ensure universal health care includes migrant workers during and beyond COVID-19

July 5, 2020   |   CGSHE

This op-ed co-authored by Dr. Shira Goldenberg, Dr. Mei-ling Wiedmeyer, Ingrid Mendez and Byron Cruz first appeared in the The Province on July 5, 2020.

Tragically, a third temporary foreign worker (TFW) from Mexico has died in Ontario from COVID-19.

Migrants, regardless of immigration status, in Canada are overrepresented in “essential” roles during the COVID-19 pandemic, including agriculture, food processing, retail and care work. Early in the pandemic response, Canada closed its border to non-essential migration, making exemptions for those whose labour ensures the stability of these essential industries, like migrant farm workers. The federal government has further begun fast-tracking approvals for temporary foreign workers already in Canada to support essential industries.

In May, the Healthcare for All National Coalition of over 200 civil society organizations published an open letter calling for the federal government to work with provincial and territorial governments to ensure access to healthcare for all people living in Canada, regardless of immigration status.

This movement is supported by leading global human rights and healthcare organizations, including the UN Human Rights Committee and Amnesty International. Canada is also signatory to the UN’s Global Compact on Migration, which reaffirms that migrants deserve human rights independently of their immigration status, including the right to healthcare.

Yet, Canada is failing to protect the health and safety of migrants.

In North America, the U.K., and elsewhere, marginalized and racialized communities are disproportionately impacted by COVID-19, yet face immense barriers to critical services and supports. In migration destinations such as Canada, migrants in front line jobs face higher chances of COVID-19 exposure and transmission. The reasons for this include crowded workplaces, pressure to come to work, lack of sick pay, and crowded housing.

Many migrant workers — such as temporary foreign workers — hold visas linked to their employer, rendering them vulnerable to unsafe or exploitative working conditions. Perhaps unsurprisingly, meat and poultry processing plants where migrants are overrepresented have been sites of the largest known COVID-19 outbreaks in North America, including a large outbreak in Alberta. Recent media reports spotlight farms in British Columbia and Ontario, which have become an important driver for new cases.

These inequities are exacerbated by the fact that many immigrants in Canada face severe barriers to healthcare, which is highly dangerous and potentially life-threatening, particularly in a pandemic.

In contrast to claims of Canada’s healthcare system as “universal,” people with precarious immigration status — including migrant workers, people without status, and refused refugee claimants — often lack health insurance coverage in our country.

While Canadians may think of the lack of health insurance as an American issue, the right to health is not a reality for many people residing here. Research shows that lacking healthcare coverage results in high out-of-pocket costs, delays in receiving needed medical attention, and worse health outcomes.

Furthermore, migrants face other barriers to needed healthcare, including language barriers and fear of “status-checking” in healthcare settings and the sharing of information with Canada Border Services Agency, contrary to patient privacy obligations. In the context of COVID-19, it is also possible that the rapid transition to virtual healthcare delivery has worsened barriers, especially related to language and the effects of social isolation for marginalized individuals.

Statistics Canada data suggest that immigrants report higher levels of concern about negative impacts of the COVID-19 pandemic on their health and financial situation than Canadian-born individuals. Immigrants in Toronto face disproportionately high rates of COVID-19 infection and hospitalization, and Black and immigrant communities are at higher risk for COVID-19.

We need research in other provinces that disaggregates our understanding of COVID-19 for migrant communities. However, that research requires community leadership to ensure that it brings equitable resources rather than fuelling racism or xenophobia.

To address pre-pandemic gaps in the province’s Medical Service Plan (MSP) coverage, B.C. eliminated its three-month wait period for new/returning residents and introduced coverage for COVID-19-related care for uninsured people. However, migrants still report charges for COVID-19 testing and must pay for non-COVID care if they test negative. As temporary changes, with no indication these improvements will be extended beyond the end of July, migrants are left in limbo.

The continued gaps in health access faced by migrants in Canada represent an urgent public health and human rights concern that must be addressed immediately. While these are long-standing concerns, the COVID-19 pandemic has put a spotlight on these inequities, poignantly illustrating the need for immediate actions to save lives and protect communities. Canada and its provinces and territories must leave no one behind in the COVID-19 response and beyond. We must make our health care system truly universal, so that migrants in our communities can survive this pandemic and thrive beyond it.

Dr. Shira Goldenberg is an Assistant Professor of Health Sciences at Simon Fraser University and Director of Research Education with the Centre for Gender & Sexual Health Equity. Dr. Mei-ling Wiedmeyer is a family physician and clinician-researcher, and Ingrid Mendez and Byron Cruz support the migrant community through Watari Counselling and Support Services, all located in British Columbia.