Advancing Multicultural Health Research in Ontario and Canada:

The Challenge for Older Arrivals

Kenise Murphy Kilbride, Ph.D.Adjunct Professor and Professor Emerita

School of Early Childhood EducationYeates School of Graduate Studies

Ryerson University

March 17, 2012

The study, funded by Citizenship and Immigration Canada (2009-2011), was entitled “Listening to Seniors”.

Research base: • 13 key informant service providers in individual interviews• 120+ senior immigrant women over 50 (arrived in past 10

years) in focus groups• 72 immigrant men over 55 (arrived in past 10 years) in

individual interviews• 157 family members (sponsored a senior in past 10 years) in

focus groups

Languages and Locations

12 languages (based on Ontario migration data 1996-2006)• Arabic, Cantonese, Farsi, Gujarati, Korean, Mandarin, Punjabi,

Russian, Spanish, Tagalog, Tamil, and Urdu Locations• 10 larger cities: Windsor, London, Kitchener, Niagara/St.

Catharines, Ottawa, Hamilton, Brampton, Richmond Hill, Markham, and Toronto

• 3 smaller cities: Thunder Bay, Chatham/Kent, and Brantford.

Principal findings relating to health

1. Like other immigrants, older immigrants had first passed a physical examination; they were healthy when they arrived.

2. Like many other immigrants, the health of many deteriorated after arrival.

3. They do not attribute this decline to old age but rather to the challenges they associate with settlement, particularly but not exclusively to isolation which leads to loneliness and finally depression.

4. Women are more outspoken about this than men but they are more concerned about their husband’s depression, rather than their own.

5. While the women are most concerned about depression itself, they claim it is also the principal cause of the physical ailments that both men and women suffer from.

6. An almost equally important cause of any ill health is the financial stress they find themselves under here, and their loss of status through unemployment, as opposed to the financial security and status most had “back home.”

BUT: They had strong recommendations as to how to prevent this decline in health.

The absence of doctors and nurses who speak their language? --Make it easier for the doctors from their home countries to practice here.

Implications for OMHARN research?•Identify best practices in medical credential recognition and residency, and make a very strong, evidence-based case for implementing them throughout the province.•Identify and evaluate cases of foreign-trained doctors who work as assistants with Canadian physicians as soon as their language skills permit good communication with the physician.

Isolation and depression? –Programs designed (and run) by seniors for seniors.

Implications for OMHARN research?• Identify and evaluate excellent programs (for seniors designed and

run by seniors) for their contribution to seniors’ mental health• Identify other programs and determine how they could become

excellent programs for seniors designed and run by seniors• Conduct focus groups with seniors to determine what programs

could and should be implemented to improve their mental health• Identify ways to fund such programs

Isolation and depression? –Provide genuinely accessible transportation

Implications for OMHARN research?• Identify and evaluate existing transportation programs for seniors,

how they are funded, what the impacts are on their health, and what it would take to replicate them

• Conduct focus groups with seniors to determine what is needed to make transportation genuinely accessible for them, and how they think this would affect their health

• Identify ways to fund such programs• Study alternative ways to locate such programs, to reduce the need

for transportation

Besides ending their isolation, what else is needed to prevent their depression?--The bare minimum for successful settlement and integration, and for the good health that must underlie a successful integration, is: English language proficiency for virtually all Employment for those who seek it Adequate financial support

Good English is needed for good health? --Provide genuine access to language classes that are appropriate for seniors:

• in local schools that are within walking distance, and during the day when their grandchildren are in class

• in the high-rises where so many of them live• with bilingual teachers or teachers’ aides so someone can tell them what

the teacher is saying• in conversational style for those who need a more informal approach;

with formal grammar and syntax for those seeking professional English

Implications for OMHARN research?• Conduct studies to compare the mental and physical health of seniors

before and after they acquire English• Conduct focus groups with seniors to identify their conclusions as to the

links between their health and their English proficiency

No access to employment? --Provide employment agencies that specialize in placing older workers; Canadians need them too! And, given the ageism in Canadian society, make age one of the “equity categories”, along with the statuses of female, disabled, visible minority, and First Nations people.

Implications for OMHARN research?

• Identify and evaluate the work of agencies which, if they don’t specialize in serving older workers, at least have an articulated program for serving them as opposed to younger workers

• Identify what could be replicated more broadly from such programs, and what the consequences are likely to be

• Conduct economic modeling to determine the impacts of making age a fifth equity category

• Measure health differences between employed and unemployed immigrant senior cohorts who are matched in other ways

Insufficient finances? –Do away with artificial barriers: Do away with the two classes of citizenship for seniors, one for senior immigrants from countries with an agreement with Canada so that their citizens receive the OAS immediately, and one for those from other countries, who must wait 10 years for the OAS. If Canada wants to classify sponsored immigrants as “dependents”, then they should stop waving a magic wand on income tax day, which makes these dependents “INDEPENDENTS FOR A DAY” so that the children who sponsored them cannot claim any of their living or medical expenses, etc.

Implications for OMHARN research? Conduct comparative health studies of arrival cohorts from countries with

and without OAS agreements Conduct comparative health studies of arrival cohorts who have and don’t

have dependent status Conduct FGs with those in independent and multigenerational housing

Thank you!