Completed Projects
IRIS
Evaluating Inequities in Refugee and Immigrants’ Health Service Access in British Columbia, Canada
Funding
Summary
This project brought together information from qualitative interviews and focus groups with people who are im/migrants in British Columbia with analysis of confidential linked health and immigration data. Our goal was to better understand health services access, and generate recommendations for policies and programs that improve health, wellbeing, and access to health services, including in the context of the COVID-19 pandemic.
Findings
Findings call attention to the varied and intersecting ways that immigration status, access to health insurance, language, experiences of trauma and discrimination, lack of support for health system navigation limits access to healthcare, and the roles community-based organizations play in supporting health and access to care. Recommendations are intended to help make sure that all health services are accessible to everyone, and provide practical, meaningful strategies that attend to diverse and intersecting community needs.
The following publication contains a high-level project summary, as well as more information on recommendations for health systems and associated questions for organizations to consider in planning services that meet the needs of im/migrants: Wiedmeyer ML, Machado S, Tayyar E, Sierra-Heredia C, Bozorgi Y, Hagos S, Goldenberg S, Lavergne R. (2024). How immigration shapes health disadvantages and what healthcare organizations can do to deliver more equitable care. Healthcare Management Forum, 38(1): 16-22.
Team Members
Principal Investigators
Mei-ling Wiedmeyer, Ruth Lavergne, Shira Goldenberg
Co-Investigators & Research Staff
Cecilia Sierra Heredia, Elmira Tayyar, Eloina Alberto, Germaine Tuyisenge, Maggie Hammel-Smith Grassby, Padmini Thakore, Refugio Reyes, Ridhwana Kaoser, Ruth Carrillo, Samira Karsiem, Sandra Peterson, Selamawit Hagos, Stefanie Machado, Yasmin Bozorgi, Hanah Damot
Partners
Migrant Rights Network, MOSAIC, Sanctuary Health, Watari
Acknowlegements
We are extremely grateful to the IRIS study participants and community partners for their time, trust, courage, and valuable contributions to this research, as well as our study staff for their expertise. Some of our former team members are not listed above, but their efforts, knowledge, and contributions have fundamentally shaped our work and findings, and we thank them for the time they spent with us.
Contact
Outputs
Papers
Healthcare experiences
Machado S, Tayyar E, Berry NS, Lavergne R, Wiedmeyer ML, Krüsi A, Goldenberg S. (2022). “It’s not just about being here, but what brought you here”: A qualitative study of the role of migration experiences in shaping im/migrant women’s access to healthcare in British Columbia, Canada. Health and Place, 77: 102888.
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Health systems currently do not adequately attend to healthcare needs shaped by experiences during migration.
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Barriers to accessing healthcare in destination settings, including insufficient prior health system information, can be especially severe after precarious migration journeys.
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Comparative healthcare experiences across places shapes future healthcare expectations and experiences.
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Healthcare must be trauma-informed, culturally humble, and center migration journeys.
Machado S, Zaki S, Villasin R, Berry NS, Lavergne R, Wiedmeyer M, Krüsi K, Goldenberg S. (2023). “When I came to Canada, I almost forgot myself: where I am, who I am”: A qualitative exploration of how im/migration shapes young women’s experiences of pregnancy, motherhood, and marriage. SSM Qualitative Research in Health, 4: 100299.
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Ineligibility for health insurance contributes to barriers to contraception and unplanned pregnancies.
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Workplace discrimination among im/migrants contributes to fewer work hours and barriers to maternity benefits.
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Unaffordable childcare exacerbates caregiving roles and unsafe marital relationships.
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Health systems must decouple im/migration status from health insurance and governments must provide all people with accessible childcare.
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Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. (2022). Determinants and inequities in sexual and reproductive health (SRH) care access among im/migrant women in Canada: findings of a comprehensive review (2008–2018). Journal of Immigrant and Minority Health, 24(1): 256-99.
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Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specifc factors; discrimination and racialization; and gender and power relations.
Health services use and COVID-19
Wiedmeyer ML, Goldenberg S, Peterson S, Wanigaratne S, Machado S, Tayyar E, Braschel M, Carrillo R, Sierra-Heredia C, Tuyisenge G, Lavergne MR. (2023). SARS-CoV-2 testing and COVID-19–related primary care use among people with citizenship, permanent residency, and temporary immigration status: an analysis of population-based administrative data in British Columbia. Canadian Journal of Public Health, 144(3): 389-403.
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People with temporary immigration status in BC experience higher SARS-CoV-2 test positivity and lower access to testing and primary care.
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Expanding pathways to permanent residency to all immigrants residing in Canada may reduce the health precarity associated with temporary immigration status.
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Efforts to reduce precarity due to immigration status, including regularization pathways already under consideration, can reduce the burden of COVID-19 for both the health system and immigrants residing in BC and Canada.
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Decoupling health insurance and immigration status is needed to improve access to care for people with precarious or temporary immigration status.
Tayyar E, Bozorgi Y, Sierra-Heredia C, Damot H, Carrillo R, Machado S, Wiedmeyer M, Goldenberg S, Lavergne R. (2024). Ongoing impacts of the COVID-19 pandemic on access to primary care among im/migrant communities in British Columbia, Canada. SSM - Health Systems, 3: 100037.
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Changes in healthcare during the COVID-19 pandemic were experienced differently by different people. Some experience opportunities for accessibility, quality of care, human connection, and safety, while others experience obstacles.
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Security of im/migration status, access to language support, and access to regular primary care shapes healthcare experiences.
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Virtual care can provide opportunities for improved access among im/migrants when appropriately supported.
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Attention and proactiveness is required to rebuild trust in the healthcare system.
Sierra-Heredia C, Tayyar E, Bozorgi Y, Thakore P, Hagos S, Carrillo R, Machado S, Peterson S, Goldenberg S, Wiedmeyer ML, Lavergne MR. (2024). Growing inequities by immigration group among older adults: population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada. BMC Primary Care, 25(1): 332.
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In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period.
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Disparities in access to primary care by immigration group among people aged 60 and older grew wider over the course of the pandemic, particularly among people who had immigrated recently with low official language level.
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Targeted interventions to ensure acceptable, accessible care for older immigrants are needed.
Structural racism and COVID-19
Tuyisenge G, Goldenberg SM. (2021). COVID-19, structural racism, and migrant health in Canada. The Lancet, 397(10275): 650-652.
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Structural racism exacerbated COVID-19’s impact on racialized migrants in Canada, who face disproportionate health inequities due to precarious labor conditions, limited healthcare access, and systemic barriers linked to immigration policies.
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Policy changes are needed to address healthcare and labor inequities for migrants, including universal healthcare access regardless of immigration status, protections against workplace exploitation, and culturally appropriate care.
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Community-led advocacy is essential in shaping equitable pandemic responses and long-term structural reforms.
Machado S, Goldenberg S. (2021). Sharpening our public health lens: advancing im/migrant health equity during COVID-19 and beyond. International Journal for Equity in Health, 20(1): 57.
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Differential impacts of the COVID-19 pandemic have brought deeply rooted inequities to the forefront, where increasing evidence has shown that racialized im/migrant populations face a disproportionate burden of COVID-19.
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We must also strengthen anti-racist and equity-oriented curriculum within health education, and ensure sufficient attention to the needs of im/migrant communities within public health, clinical, and research training.
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Policymakers and practitioners must ensure that healthcare policies and practices do not exacerbate inequities, and instead meaningfully address unmet needs of communities, including racialized im/migrants.
Mental health services
Kaoser R, Thakore P, Peterson S, Wiedmeyer ML, Sierra-Heredia C, Goldenberg S, Machado S, Hagos S, Tayyar E, Bozorgi Y, Lavergne MR. (2024). The relationship between neighbourhood income and youth mental health service use differs by immigration experience: analysis of population-based data in British Columbia, Canada. International Journal for Equity in Health, 23(1): 270.
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First- and second-generation immigrant youth used substantially fewer mental health services (i.e., community-based, emergency department, hospitalization) than non-immigrant youth across all income levels.
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There was a clear income gradient for community-based service use among both immigrant and non-immigrant youth, but the direction of the gradient was reversed. Service use was highest for non-immigrant youth in low-income neighbourhoods, while it was lowest for immigrant youth.
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Among youth who were hospitalized for psychiatric reasons, the proportions of involuntary admissions were higher for immigrant youth thannon-immigrant youth.
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Findings suggest there are enhanced barriers for immigrant youth in accessing community-based mental health services, especially when living in lower-income neighbourhoods.
Health insurance
Hamel-Smith Grassby M, Wiedmeyer ML, Lavergne MR, Goldenberg SM. (2021). Qualitative evaluation of a mandatory health insurance ‘wait period’ in a publicly funded health system: Understanding health inequities for newcomer im/migrant women. BMJ Open, 11(8): e047597.
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Mandatory wait periods produce and exacerbate inequitable health and social outcomes for im/migrants and their families.
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Resulting harms include delays and unmet care needs, negative pregnancy and children’s health outcomes, internalized stigma, and socioeconomic stressors.
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Infographic
Goldenberg SM, Schafers S, Grassby MH, Machado S, Lavergne R, Wiedmeyer ML; IRIS Study Team. (2023). ‘We don’t have the right to get sick’: A qualitative study of gaps in public health insurance among Im/migrant women in British Columbia, Canada. PLOS Global Public Health, 3(1): e0001131.
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Ineligibility for public health insurance coverage results in unmet needs for essential health care, preventive care, and curative services among im/migrant women, children, and families.
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Ineligibility for public health insurance can result in negative impacts including a high economic burden, and perpetuated experiences of discrimination, invisibility, and exclusion from systems of care amongst im/migrants.
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Expanding health insurance options to cover all residents, decoupling health insurance eligibility from immigration status, and implementing local-level ‘Sanctuary’ policies can reduce access barriers and better reflect principles at the foundation of universal health systems.
Immigration policy
Damot H, Schafers S, Wiedmeyer ML, Machado S, Tayyar E, Thakore P, Lavergne R, Goldenberg SM; IRIS team. (2025). Impacts of local, provincial, and federal immigration policies on health and social services access among women with precarious immigration status: a qualitative study. BMC Public Health, 25(1): 1570.
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Ineligibility for health and social services and fear of detention and/or deportation are barriers to routine, preventive, and emergency health services, as well as enrolment of children in schools.
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Social isolation and exclusion are key consequences of federal immigration policies that produce precariousness through temporary and undocumented status.
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Political reform is needed to protect im/migrants’ human rights, reduce instances of delayed or denied care, untreated illnesses, and social isolation.
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Committed implementation of Sanctuary City principles at the local level is required to improve access to health and other services based on need regardless of immigration status.
Research methods and community engagement
Machado S, Karsiem S, Lavergne MR, Goldenberg S, Wiedmeyer ML. (2023). Respectful community engagement in health research with diverse im/migrant communities. BMJ Open, 13(12): e077391.
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Community engagement in im/migration and health research requires financial resources, time, and commitment and accountability from a research team with varied expertise and lived experiences.
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Engaging community members throughout the research process, from research planning to dissemination, including as part of the research team, can deepen the rigor and quality of research.
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Lavergne R, Carillo R, Goldenberg S, Hagos S, Machado S, Peterson S, Tayyar E, Thakore P, Sierra-Heredia C, Wanigaratne S, Wiedmeyer ML. (2022). Engaging im/migrant communities in cross-sectoral health and immigration data linkage research. International Journal of Population Data Science, 7(3): 1879.
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Linking health and immigration data helps uncover barriers to healthcare access for im/migrant communities, particularly during COVID-19. Key factors affecting access include immigration status (temporary or permanent), time since arrival, and language ability, which influence workplace risks, healthcare eligibility, and system navigation.
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Careful categorization and interpretation of immigration data are essential in research, as administrative classifications may not fully reflect individuals’ lived experiences. Using immigration data recorded for provincial health insurance presents a new opportunity to analyze the impacts of temporary status on healthcare access.
Theses
Machado, S. (2023). Im/migration experiences, healthcare access, and impacts of the COVID-19 pandemic: Findings of community-based qualitative research with im/migrant women in British Columbia, Canada. Simon Fraser University.
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Wiedmeyer, M. (2020). "This is what labels you": Examining the structural context of how limited English proficiency and experiences with interpretation services interact to shape health and health access for im/migrant women in Metro Vancouver, British Columbia. Simon Fraser University.
Presentations
Wiedmeyer ML. (2025). Voices for Health Equity: Dr. Mei-ling Weidmeyer. UBC Health.
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Wiedmeyer ML. (2024). Evaluating Inequities in Refugee & Im/migrant Health Service Access. Centre for Gender and Sexual Health Equity.
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Lavergne R. (2023). Equity in access to primary care: Reimagining a “front door” for health care. Centre for Gender and Sexual Health Equity.
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Thakore P, Kaoser R, Peterson S, Tayyar E, Sierra-Heredia C, Machado S, Hagos S, Bozorgi Y, Goldenberg S, Wiedmeyer M, Lavergne R. (2023). Changes in patterns of mental health service use among immigrant and non-immigrant youth before and during the COVID-19 pandemic in British Columbia, Canada [Oral Presentation]. British Columbia Mental Health and Substance Use Services Research Day.
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Mental health service use varied significantly between immigrants and non-immigrants, non-immigrants and people with female administrative sex overall had higher service use before and during the pandemic, particularly for community-based mental health services.
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Refugees and protected persons had a higher proportion of involuntary hospitalizations than other immigrants and non-immigrants.
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Urgent care visits for psychotic disorders for refugees and protected persons were almost twice those of non-immigrants and other immigrants.
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Mental health needs and access to mental health services vary between immigration categories and gender. A more targeted approach for delivery of mental health services is required for immigrants.