Research Library

What can be learned about the healthcare access of undocumented workers? How can health equity be advanced through sensitivity to the process of precaritization and the precarities informing their lives? Thailand and Spain are the only countries in the world that offer the same healthcare access to undocumented migrants as citizens. Most European countries only offer emergency services: France, the Netherlands, Portugal, Spain, and Switzerland allow undocumented migrants to access similar services to citizens if they meet conditions (proof of identity; length of residence in the country). European cities such as Ghent, Frankfurt, and Dusseldorf, offer barrier-free healthcare. Throughout the USA, Federally Qualified Health Centers support care to the uninsured regardless of immigration status. In Canada, Ontario and Quebec, provide a base level of healthcare access to undocumented migrants, and a small number of stand-alone community-based clinics offer additional care and specialized services. To promote healthcare for undocumented migrants in Alberta, barrier-free access to vaccination, COVID-19 treatment, and proof of vaccinations are essential, but an equity lens to healthcare service— informed by analytic understanding and robust approach to precaritization as a social determinant, is most needed. What can be learned about the healthcare access of undocumented workers? How can health equity be advanced through sensitivity to the process of precaritization and the precarities informing their lives? Thailand and Spain are the only countries in the world that offer the same healthcare access to undocumented migrants as citizens. Most European countries only offer emergency services: France, the Netherlands, Portugal, Spain, and Switzerland allow undocumented migrants to access similar services to citizens if they meet conditions (proof of identity; length of residence in the country). European cities such as Ghent, Frankfurt, and Dusseldorf, offer barrier-free healthcare. Throughout the USA, Federally Qualified Health Centers support care to the uninsured regardless of immigration status. In Canada, Ontario and Quebec, provide a base level of healthcare access to undocumented migrants, and a small number of stand-alone community-based clinics offer additional care and specialized services. To promote healthcare for undocumented migrants in Alberta, barrier-free access to vaccination, COVID-19 treatment, and proof of vaccinations are essential, but an equity lens to healthcare service— informed by analytic understanding and robust approach to precaritization as a social determinant, is most needed.
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Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals will have undoubtedly led to changes in clinic use, shifts in clinic demographics, or clinic policy. Refugees are a vulnerable population with specific physical health, mental health, and social needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical for future planning. We studied a specialized refugee health clinic in Calgary, AB from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts (January 2011 – June 2012), IFHP Cuts (July 2012 – October 2015), Syrian Surge (November 2015- January 2017), Yazidi Period (February 2017 – February 2020), and COVID-19 (March 2020 – December 2020). We analyzed quantitative changes as well as conducted semi-structured interviews with clinic leadership. Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. The stress of these upheavals negatively impacted staff wellness and patient care. Understanding how health and immigration policy changes affect care, especially at specialized refugee clinics, is critical for being able to anticipate and thrive through future upheavals as turmoil globally seems to continue. Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals will have undoubtedly led to changes in clinic use, shifts in clinic demographics, or clinic policy. Refugees are a vulnerable population with specific physical health, mental health, and social needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical for future planning. We studied a specialized refugee health clinic in Calgary, AB from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts (January 2011 – June 2012), IFHP Cuts (July 2012 – October 2015), Syrian Surge (November 2015- January 2017), Yazidi Period (February 2017 – February 2020), and COVID-19 (March 2020 – December 2020). We analyzed quantitative changes as well as conducted semi-structured interviews with clinic leadership. Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. The stress of these upheavals negatively impacted staff wellness and patient care. Understanding how health and immigration policy changes affect care, especially at specialized refugee clinics, is critical for being able to anticipate and thrive through future upheavals as turmoil globally seems to continue.
This publication has no Abstract to dispaly

Two studies were completed as a part of this Master’s thesis. Study 1: Human papillomavirus vaccine coverage among immigrant children in Alberta: a population-based cohort study concluded that overall, immigrant children in Alberta had higher HPV vaccination coverage in comparison to non-immigrants, which is encouraging given some previous literature has suggested the opposite. This implies that efforts to increase vaccination rates among immigrant children may be having a positive impact. Among immigrants, routine immunization promotion strategies should be targeted to those living in rural residences and from North America, Oceania, and South America, in order to improve HPV vaccination coverage in this group even further. Study 2: Study 2: COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study concluded that high COVID-19 vaccination coverage among immigrant populations in Alberta is an encouraging outcome. However, continued efforts are needed to target public health interventions towards older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage. Two studies were completed as a part of this Master’s thesis. Study 1: Human papillomavirus vaccine coverage among immigrant children in Alberta: a population-based cohort study concluded that overall, immigrant children in Alberta had higher HPV vaccination coverage in comparison to non-immigrants, which is encouraging given some previous literature has suggested the opposite. This implies that efforts to increase vaccination rates among immigrant children may be having a positive impact. Among immigrants, routine immunization promotion strategies should be targeted to those living in rural residences and from North America, Oceania, and South America, in order to improve HPV vaccination coverage in this group even further. Study 2: Study 2: COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study concluded that high COVID-19 vaccination coverage among immigrant populations in Alberta is an encouraging outcome. However, continued efforts are needed to target public health interventions towards older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage.
This publication has no Abstract to dispaly

To date, very little is known about intimate partner violence (IPV) service providers’ experiences serving trans and immigrant women (IPV) survivors and their barriers in reporting and/or accessing formal services. Employing constructivist grounded theory, two vignettes were constructed – one featuring a trans woman and the other an immigrant woman, both seeking IPV services. American and Canadian IPV service providers responded to open-ended survey questions about both scenarios, resulting in several emergent themes including, but not limited to: service provider biases, shelter conflicts, and distrust of systems. Policy implications and future research are also addressed. To date, very little is known about intimate partner violence (IPV) service providers’ experiences serving trans and immigrant women (IPV) survivors and their barriers in reporting and/or accessing formal services. Employing constructivist grounded theory, two vignettes were constructed – one featuring a trans woman and the other an immigrant woman, both seeking IPV services. American and Canadian IPV service providers responded to open-ended survey questions about both scenarios, resulting in several emergent themes including, but not limited to: service provider biases, shelter conflicts, and distrust of systems. Policy implications and future research are also addressed.
This publication has no Abstract to dispaly

Racialized, low-income, and migrant communities in East and Northeast Calgary were disproportionately impacted by COVID-19, yet faced vaccine access barriers. This article is a formative evaluation of a low-barrier, community-engaged vaccine outreach clinic in Calgary, Alberta, Canada, on June 5–6, 2021. Stakeholder respondents felt the clinic was effective (99.2%), efficient (96.9%), patient-centered (92.3%), and safe (90.8%), and that the outreach model was scalable 94.6% (123/130). Suggested improvements include increased time for clinic planning and promotion, more multilingual staff, and further efforts to reduce accessibility barriers, such as priority check-in for people with disabilities. These findings support the value of community-engaged outreach to improve vaccine equity among other marginalized newcomer communities. Racialized, low-income, and migrant communities in East and Northeast Calgary were disproportionately impacted by COVID-19, yet faced vaccine access barriers. This article is a formative evaluation of a low-barrier, community-engaged vaccine outreach clinic in Calgary, Alberta, Canada, on June 5–6, 2021. Stakeholder respondents felt the clinic was effective (99.2%), efficient (96.9%), patient-centered (92.3%), and safe (90.8%), and that the outreach model was scalable 94.6% (123/130). Suggested improvements include increased time for clinic planning and promotion, more multilingual staff, and further efforts to reduce accessibility barriers, such as priority check-in for people with disabilities. These findings support the value of community-engaged outreach to improve vaccine equity among other marginalized newcomer communities.
This publication has no Abstract to dispaly

Administrative data was used to study COVID-19 vaccine coverage in immigrants and refugees compared to the Canadian-born population. Broadly, immigrants and refugees (78.2%) had comparable vaccine coverage to Canadian-born individuals (76%). However, initiatives to improve vaccine coverage is needed for older immigrants, immigrants in rural areas, and immigrants from certain ethnicities. Administrative data was used to study COVID-19 vaccine coverage in immigrants and refugees compared to the Canadian-born population. Broadly, immigrants and refugees (78.2%) had comparable vaccine coverage to Canadian-born individuals (76%). However, initiatives to improve vaccine coverage is needed for older immigrants, immigrants in rural areas, and immigrants from certain ethnicities.
This publication has no Abstract to dispaly

The Rainbow Refuge Program (through the Edmonton Newcomer Centre, formerly called the Edmonton Mennonite Centre for Newcomers) provides settlement services, housing support, settlement support and community building for 2SLGBTQ+ newcomers in Edmonton. Since the start of the program, the acceptance rate of 2SLGBTQ+ refugee claims in Edmonton has increased exponentially. The Rainbow Refuge Program (through the Edmonton Newcomer Centre, formerly called the Edmonton Mennonite Centre for Newcomers) provides settlement services, housing support, settlement support and community building for 2SLGBTQ+ newcomers in Edmonton. Since the start of the program, the acceptance rate of 2SLGBTQ+ refugee claims in Edmonton has increased exponentially.
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Canada’s National Housing Strategy (2017) identifies LGBTQ2 people and newcomers (including refugees) as vulnerable groups within Canada’s housing system. Members of each group are known to experience significant barriers to housing in Canada. However, the unique experiences of LGBTQ refugees—who fall into both groups—have yet to be investigated. This thesis asks: To what extent are LGBTQ refugees able to access safe, stable and affordable housing in Alberta, Canada? Interviews and policy analysis found that LGBTQ refugees do not have adequate access to safe, stable and affordable housing in the province. They continue to experience significant barriers related to affordability, social housing supply, and discrimination, among other factors. Policy recommendations are also included in this thesis. Canada’s National Housing Strategy (2017) identifies LGBTQ2 people and newcomers (including refugees) as vulnerable groups within Canada’s housing system. Members of each group are known to experience significant barriers to housing in Canada. However, the unique experiences of LGBTQ refugees—who fall into both groups—have yet to be investigated. This thesis asks: To what extent are LGBTQ refugees able to access safe, stable and affordable housing in Alberta, Canada? Interviews and policy analysis found that LGBTQ refugees do not have adequate access to safe, stable and affordable housing in the province. They continue to experience significant barriers related to affordability, social housing supply, and discrimination, among other factors. Policy recommendations are also included in this thesis.
This publication has no Abstract to dispaly

This community-based research study provides new data collected from 25 in-depth individual interviews with immigrant women HCAs who were working in LTC in Calgary, Alberta between January 1 and March 30, 2021. The data, analysed through the lens of intersectional exclusion, highlight how the pandemic has impacted the working lives of immigrant women employed in LTC facilities on a daily basis, as well as their suggestions for enhancing their safety and employment conditions. Two key themes emerged during the process of data analysis: (a) HCA experiences of economic exclusion and workplace precarity—many of which pre-dated the pandemic but have been exacerbated by current policies and practices that prioritize profits over quality of community care, and (b) experiences of broader social exclusion, many of which are tied to being considered “just HCAs” who are doing “immigrant’s work”, rather than including HCAs in broader conversations about how to reform and improve the LTC sector for future. Concluding thoughts discuss how to improve policy to support low wage workers within LTC in order to address intersectional inequalities and to better support front-line care workers during current and future health pandemic recovery efforts. This community-based research study provides new data collected from 25 in-depth individual interviews with immigrant women HCAs who were working in LTC in Calgary, Alberta between January 1 and March 30, 2021. The data, analysed through the lens of intersectional exclusion, highlight how the pandemic has impacted the working lives of immigrant women employed in LTC facilities on a daily basis, as well as their suggestions for enhancing their safety and employment conditions. Two key themes emerged during the process of data analysis: (a) HCA experiences of economic exclusion and workplace precarity—many of which pre-dated the pandemic but have been exacerbated by current policies and practices that prioritize profits over quality of community care, and (b) experiences of broader social exclusion, many of which are tied to being considered “just HCAs” who are doing “immigrant’s work”, rather than including HCAs in broader conversations about how to reform and improve the LTC sector for future. Concluding thoughts discuss how to improve policy to support low wage workers within LTC in order to address intersectional inequalities and to better support front-line care workers during current and future health pandemic recovery efforts.
This publication has no Abstract to dispaly

We investigated health risks associated with climate and air pollution hazards and community covariates to generate insights into the resilience of older adults and immigrants at the community level in a northern urban center in the Canadian prairies (i.e. Edmonton, AB). Communities with higher proportions of older adults were associated with increased cardiovascular, injury, mental, and respiratory health event rates. Notably, heat effects on injury rates impacted communities with higher percentages of older adults (Prevalence Rate Ratio (PRR) [95%CI] 1.110 [1.011, 1.219] at 25% ≥65 years). Ozone effects on cardiovascular event rates exhibited similar trends. Areas with higher percentages of immigrants generally had lower rates of health events. However, increasing diurnal temperature range became a risk factor for respiratory health rates where there were higher percentages of refugees (PRR 1.205 [1.004, 1.447] at 20%). Industrial emission effects on injury and respiratory health rates also amplified in areas with higher percentages of refugees (PRR 1.127 [1.058, 1.200]; 1.130 [1.050, 1.216] at 20%). Similar effects were observed for mental health event rates and total immigrants. Greater neighborhood material and social deprivation were significant risk factors for increased health event rates across outcomes. Future work should focus on disproportionately affected vulnerable populations to address community-level resilience. We investigated health risks associated with climate and air pollution hazards and community covariates to generate insights into the resilience of older adults and immigrants at the community level in a northern urban center in the Canadian prairies (i.e. Edmonton, AB). Communities with higher proportions of older adults were associated with increased cardiovascular, injury, mental, and respiratory health event rates. Notably, heat effects on injury rates impacted communities with higher percentages of older adults (Prevalence Rate Ratio (PRR) [95%CI] 1.110 [1.011, 1.219] at 25% ≥65 years). Ozone effects on cardiovascular event rates exhibited similar trends. Areas with higher percentages of immigrants generally had lower rates of health events. However, increasing diurnal temperature range became a risk factor for respiratory health rates where there were higher percentages of refugees (PRR 1.205 [1.004, 1.447] at 20%). Industrial emission effects on injury and respiratory health rates also amplified in areas with higher percentages of refugees (PRR 1.127 [1.058, 1.200]; 1.130 [1.050, 1.216] at 20%). Similar effects were observed for mental health event rates and total immigrants. Greater neighborhood material and social deprivation were significant risk factors for increased health event rates across outcomes. Future work should focus on disproportionately affected vulnerable populations to address community-level resilience.
This publication has no Abstract to dispaly