Refugees and health care--the need for data: understanding the health of government-assisted refugees in Canada through a prospective longitudinal cohort.

Canada is a country with large populations of immigrants and refugees. These populations face unique health challenges and barriers to accessing health care services. Amendments to the Canadian Immigration and Refugee Protection Act in 2002 have resulted in an increase in refugees with complex medical needs. However, little is known about the health of refugees on arrival and their subsequent health care trajectories. There is an urgent need for an improved understanding of refugee demographics and health status on arrival, changes in health status over time, utilization of health services, and characteristics associated with optimal health outcomes. This knowledge gap could be addressed through the creation of a longitudinal cohort study of government-assisted refugees (CARs) in British Columbia (BC). The provision of services for CARs in BC lends itself readily to the creation of a prospective CAR cohort. This, combined with access to highly reliable, valid and comprehensive administrative databases available through Population Data BC, would allow for longitudinal follow-up, and ensure low attrition rates. Establishment of such a cohort would improve knowledge of refugee health and could guide health service providers and policy-makers in providing optimal services to GARs.

Does ratification of human-rights treaties have effects on population health?

Human-rights treaties indicate a country's commitment to human rights. Here, we assess whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less wealthy settings, but this was not associated with treaty ratification. The status of treaty ratification alone is not a good indicator of the realisation of the right to health. We suggest the need for stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states with treaty obligations, and financial assistance to support the realisation of the right to health.