From Strangers to Neighbors: Fostering Inclusivity in New Brunswick

Immigration has been and remains an important force in beautifully shaping Canadian demography and identity (Gushulak, 2011). Unfortunately, immigrants, refugees, and newcomers often face discrimination and barriers to accessing resources and opportunities due to their ethnicity, nationality, or immigration status (GNB, 2022).

The same applies here in my home province in New Brunswick, Canada. The New Brunswick government and the communities often speak about “welcoming newcomers “and “being a welcoming community” but many newcomers talked about “feeling unwelcomed” and being seen as “foreign,” “stranger” and “threatening” in their workplaces, schools, and communities, as noted in the Systemic Racism Commissioner’s Final Report (GNB, 2022). In the report, one British White newcomer noted, “there is a real reluctance to do things differently here. And if you suggest doing something differently and you are from away, you are told right away, that you are from away and don’t understand how people do things here" (GNB, 2022). Unfortunately, it’s not just the welcoming piece that fails newcomers, health care and medicine usually fail marginalized people (Smith, 1999). New immigrants are twice as likely to have difficulties in accessing immediate care as those born in Canada (Gushulak, 2011). There are other marginalized groups who have high rates of health problems and poor services. These include homeless people, refugees, and travelers. With all marginalized groups the poorer standard of care seems to stem from a combination of ignorance, fear, and prejudice plus a feeling that they should adapt to the services rather than the other way around (Smith, 1999). I found this so heartbreaking that flexibility was seriously lacking.

Research shows building an inclusive society that empowers marginalized groups and individuals supports sustainable development. Unfortunately, marginalized groups are frequently excluded from decision-making, public institutions, basic services, and even citizenship. They are more vulnerable to poverty and are more likely to be afflicted by life-threatening diseases (like HIV/AIDS, malaria, tuberculosis, or mental health disorders). The concerns get even worse, during my research, marginalized groups are also more likely to be victims of violence and exploitation (Government of Canada, 2017).

Below highlights two heart wrenching narratives captured in the Systemic Racism Commissioner’s Final Report 2022. One narrative around a woman seeking help after domestic abuse and another individual unable to access basic health care:

1. “A woman on a tourism visa went to a police station to report domestic abuse. The police told her that they could not help her because she did not have a status here in Canada. She recalled, “the police officer said, ‘you are not an immigrant or a citizen, you are not even a student. You are nothing.’ He told me I was nothing.”

2. "Despite being sick, a young newcomer avoids going to the hospital because she has yet to receive her Medicare card. Although the expected service standard is three months, her coverage takes seven months to arrive. She then goes to the hospital and is so sick, she is put in an induced coma, leaving her student husband to care for their three-year-old child.”

In terns of population, Statistics Canada estimated 834,691 people lived in New Brunswick as of July 1st, 2023. Immigrants represent about 4.6% of New Brunswick's Population (HHN, 2020). There was major growth the last 10 years in the province. There are a total of 44,120 immigrants currently living in the province. There was some growth between 1980-1990 (an additional 2,750 persons), compared to 2016-2021 – where this almost increased 8 times, for a total of 16,040 new immigrants locating to the province. This includes newcomers from Philippines (3,780), India (2,265), China (2,125), Syria (1,890), UK (4,910), Germany, 1,400 (Stats Canada, 2021).

Compared to the national numbers, immigration represents two-thirds of Canada’s population growth, and immigrants make up more than 20% of the nation’s population. Both of these metrics are expected to increase (Gushulak 2011), which means the time for action is now. The arrival of newcomers in New Brunswick and Canada continues to skyrocket.

So how can New Brunswicker's better serve?

I was grateful to read New Brunswick was the first province in Canada to have a provincial Commissioner on Systemic Racism. Dr. Manju Varma, PH.D, shared her report in December 2022 including a total of 86 recommendations on how to better serve newcomers, marginalized groups, Indigenous persons, 2SLGBTQ+ communities, black persons, persons of color, and refugees. Dr. Varma shares all sectors (private and public) of New Brunswick must first determine what a welcoming community means to them. We must insure our services are flexible and accessible to the greatest number of New Brunswickers. The Report captures how we need to treat newcomers in N.B. as human beings; anything less is systemic racism. To better serve newcomers, as New Brunswickers, we must strive to mitigate their stressors and trauma. Our aim should be to provide a comprehensive range of inclusive and supportive services and institutions, thereby encouraging more newcomers to choose to stay rather than seeking refuge in more welcoming provinces. The report also captured that all organizations must create greater oversight, transparency, and accountability to ensure fairness in the funding process for organizations working in the areas of anti-racism. With respect to employment, New Brunswick must do better matching of newcomers with the jobs they want, and this first starts with greater communication between departments and organizations. A perfect example of systemic racism impacting everyone is the longstanding dilemma of foreign credentials recognition. I was able to identify that New Brunswick lost a radiologist (the best job they could get was directing traffic at a COVID-19 clinic), a dentist, two cardiologists and several nurses. Similar barriers exist for foreign-trained teachers even though our province needs more teachers (GNB, 2022). We must do better.

So whose responsibility is it? This is the responsibility of all New Brunswickers, all teams, all governing bodies. When offering better service for immigrants and newcomers, we must first start with accessible health care. We must make sure individuals can get the care they need in the right place, at the right time, and in the official language of their choice (NBHC, 2023). Marginalization can be combatted by promoting human rights advocacy and strengthening equity measures (Government of Canada, 2017).

Where my background circles around oncology, I did do some digging to identify what I could do. I am grateful to partake on an initiative to improve cancer experiences and outcomes through equitable culturally safe care for First Nations people in New Brunswick. The initiative receives funding from the Canadian Partnership Against Cancer (CPAC) and Health Canada. At the end of the day we must do better at relationship building. Health system can better engage marginalized groups in collective problem-solving and decision-making (Canadian Partnership Against Cancer, 2020). This must be taken seriously since there are so many barriers that prevent at-risk groups from accessing cancer care services, reducing their chances of achieving better outcomes and a positive experience. CPAC recommended bringing the voices of disadvantaged groups to the table to help us better understand the values and preferences of those facing sociodemographic barriers and identify acceptable trade-offs related to specific policy alternatives.

I am grateful to work in a Regional Health Authority (RHA) which aims to do better. One of the objectives in the 2021-2026 RHA Strategic Plan was to meet the differing needs of diverse populations. It was recognized health care must be provided equitably. They promised to examine existing practices and work collaboratively to develop an understanding so we can adjust the conditions and remove barriers without contributing to health inequities. The goal was to develop a focus on improving diversity, inclusion and anti-racism (HHN, 2021)

I was pleased to see similar language in the New Brunswick Medical Societies (NBMS) 2021 “Visions for Success" document. They noted Immigration remains an important force shaping New Brunswick demography and identity; however, they recognized health status is not equitable across all subgroups of immigrants. New Brunswick welcomes many new immigrants each year, which places additional strain on the health-care system. Certain immigrant populations experience a higher risk of infectious diseases, cancer, diabetes, and heart disease, which has clinical implications for those providing care to immigrant communities. The NBMS supports programs to enhance the health status of immigrants throughout the province to ensure all New Brunswick citizens receive equitable access to services (NBMS, 2021).

I was happy to have come across the first ever New Brunswick Newcomer Summit (2023), which served as a proactive and supportive initiative aimed at assisting newcomers in navigating available resources and programs.

Newcomer Summit 2023 -Fredericton: http://www.cbc.ca/player/play/2254404163648

I conclude my blog post by simply noting it is evident that while immigration continues to play a significant role in shaping Canadian and New Brunswick demographics, there are systemic issues that must be addressed to ensure that newcomers and immigrants are truly welcomed and supported in their new home. The stories shared from the Systemic Racism Commissioner’s Final Report serve as important reminders of the challenges faced by immigrants and marginalized groups.

References

Canadian Partnership Against Cancer (2020, August 20). How to better engage marginalized groups in healthcare systems. Retrieved March 10, 2024, from https://www.partnershipagainstcancer.ca/news-events/news/article/how-to-better-engage-marginalized-groups-healthcare-systems/

Government of Canada (2023, January 2). Census Profile, 2021 Census of Population. Statistics Canada. Retrieved March 10, 2024, from https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/details/page.cfm?Lang=E&SearchText=New%20Brunswick&DGUIDlist=2021A000213&GENDERlist=1,2,3&STATISTIClist=1&HEADERlist=0

Government of Canada (2017, May 6). Inclusion of Marginalized People. Retrieved March 9, 2024, from https://www.international.gc.ca/world-monde/issues_development-enjeux_developpement/human_rights-droits_homme/inclusion.aspx?lang=eng

Government of New Brunswick (2022, December 1). Systemic Racism Commissioner’s Final Report 2022. Retrieved March 6, 2024, from https://www2.gnb.ca/content/dam/gnb/Corporate/Promo/systemicracism-racismesystemique/SystemicRacismCommissionerFinalReport.pdf

Gushulak, B. D., Pottie, K., Hatcher Roberts, J., Torres, S., DesMeules, M., & Canadian Collaboration for Immigrant and Refugee Health (2011). Migration and health in Canada: health in the global village. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 183(12), E952–E958. https://doi.org/10.1503/cmaj.090287

Horizon Health Network (n.d.). Horizon's Strategic Plan 2021-2026 Building a Healthier Future. Retrieved March 10, 2024, from https://horizonnb.ca/wp-content/uploads/2021/10/Horizons-Strategic-Plan-2021-2026-Building-a-Healthier-Future.pdf

Smith R. (1999). Medicine and the marginalized. They deserve the best, not the poorest, care. BMJ (Clinical research ed.), 319(7225), 1589–1590. https://doi.org/10.1136/bmj.319.7225.1589

New Brunswick Health Council (2023, July 21). Annual Report 2022-2023. Retrieved March 10, 2024, from https://nbhc.ca/sites/default/files/publications-attachments/NBHC-Annual%20Report%202022-2023.pdf

New Brunswick Medical Society (2021, August 25). Health Care in New Brunswick Physicians' Vision for Success. Retrieved March 10, 2024, from https://www.nbms.nb.ca/wp-content/uploads/2021/06/Health-care-in-New-Brunswick-Physicians-Vision-for-Success.pdf