Navigating Equitable Access to Cancer and Mental Health Services During Pandemics: Stakeholder Perspectives on COVID-19 Challenges and Community-Based Solutions for Immigrants and Refugees – Proceedings from Think Tank Sessions 

What is this research about? 

This report is part of a larger project that looked at the compounded effects of the COVID-19 pandemic on immigrants and refugees living with cancer and/or mental health and addiction disorders. The project sought to develop community-based solutions to address health inequities.  

This report provides an overview and findings from Think Tank sessions that engaged stakeholders to identify barriers and co-create actionable strategies to safeguard immigrant and refugee health and well-being during current and future crises. The sessions brought together affected community members, service providers, policymakers, and researchers, to discuss challenges and co-develop solutions. 

What do you need to know? 

The research was conducted in response to growing evidence that the COVID-19 pandemic disproportionately impacted structurally marginalized populations, particularly immigrants and refugees living with chronic conditions like cancer and mental health and addiction disorders. These groups faced higher rates of COVID-19 cases, hospitalizations, and deaths compared to non-immigrants and white Canadians. 

The study builds on previous studies that detailed the impact of COVID-19 on immigrants and refugees with cancer or mental health and addiction disorders in Ontario. Similarly, these earlier findings revealed that immigrants and refugees with these conditions experienced worse COVID-19 outcomes compared to both non-immigrants with similar conditions and those without these conditions. 

A Think Tank approach provided a structured medium for knowledge transfer and exchange, allowing for strategic and solution-oriented discussions among participants. Drawing on participants’ brainstormed ideas and their assessment of the importance and feasibility of various solutions, researchers developed a set of actionable recommendations to address the compounded impacts of pandemics and crises on immigrants and refugees living with chronic conditions. 

What did the researchers find? 

The researchers identified several key themes and actionable strategies through the Think Tank sessions: 

Lack of primary care access: Immigrants faced significant barriers in accessing timely primary care. This pre-existing issue was exacerbated during the pandemic and was identified as a significant issue disproportionately impacting immigrant and refugee populations. One patient participant described their difficulties: “[I was] vaccinated 114 days before entering Canada as [a] new immigrant with cancer. Did not have OHIP. Did not find [a] family doctor. Did not know how to access care. Could not receive follow-up COVID-19 vaccination”. 

Exclusion of foreign-trained healthcare providers: The inability to integrate foreign-trained healthcare professionals into the system was a missed opportunity to address workforce shortages and provide culturally sensitive care. 

Poor communication during COVID-19: Insufficient or unclear public health messaging disproportionately affected immigrant communities, leading to misinformation and reduced vaccination rates. 

Compounded language barriers: Limited language support during the pandemic created additional challenges for immigrants seeking healthcare services. 

Disruption of prevention programs: Preventive care services were halted, leaving many without essential screenings and early interventions. 

Mental health impacts: The pandemic significantly worsened mental health conditions. A caregiver shared: “Managing my son, diagnosed with mental health issues since 2005, was not easy. During the pandemic, his condition got worse. He threw out his medications and threatened me at knife point, saying, ‘call the cops’. It took the cops 1.5 h to arrive, and when they did, they broke down our door with force and came with guns. I still cannot forget that scene”. 

Increased siloing of systems and the need to recognize social determinants of health: The pandemic further fragmented healthcare and social service systems. A participant emphasized: “Before we even engage in those health conversations, people need housing, necessary clothing, and social support like childcare or caregiving to participate in addressing their health needs”. 

Challenges with virtual care: The transition to virtual services created significant obstacles, especially for those unfamiliar with technology or lacking digital access. “Appointments became frustrating. You’d wait all day for a quick call, and if you went to the washroom and missed the call, it would be dropped. That alone created anxiety: What now? When will I get another appointment?” 

Economic, social, and structural disadvantages faced by immigrants and refugees: for many newcomer communities, the daily struggle to meet basic needs often overshadowed health priorities, such as getting vaccinated or accessing the limited healthcare services provided at the time. “The pandemic isolated seniors and women. Living in an overcrowded apartment during lockdown made everyone stressed because they didn’t have free time or their own space often escalating tensions and leading to quarrels and conflicts”. 

Key action items that came out of the Think Tanks included: 

• Fast track pathways to service for internationally trained healthcare providers (HCPs) & leverage the existing workforce of internationally trained HCPs. 
• Address digital and health literacy and systems navigation for new immigrants and seniors. Leveraging internationally trained HCPs as community health ambassadors can help. 
• Connect immigrants and refugees with healthcare providers at entry. Establish connections with health and social services at the Immigration Health Check to provide immediate connections to health care providers for immigrants and refugees as they arrive in Canada. 
• Listen to the community and engage them in decision-making, tailor programs to local needs. 
• Expand access to community health centres and preventative services to enable health connections for all. 
• Promote intersectoral collaboration, move away from a cookie-cutter approach and embrace inclusive and diverse approaches 
• Provide cultural sensitivity and safety training to service providers 
• Create a provincial health portal with culturally responsive information. 

How can you use this research? 

This research can be used to inform policy and practice in several ways: 

Healthcare providers can leverage foreign-trained healthcare professionals as community health ambassadors to provide culturally relevant health information and improve access to services. Provide cultural sensitivity and safety training to administrative staff, gatekeepers, and service providers to improve the accessibility and inclusivity of cancer and mental health services. Bring immigrant communities into service and support decision-making processes. Don’t stop preventive care services during crises. 

Policymakers should expand access to community health centres, cancer screening and mental health and addiction services in underserved areas. They can promote intersectoral collaboration across health, social services, immigration, housing, and finance to ensure comprehensive care for immigrants and refugees. Fast-track licensure for internationally educated health professionals to address workforce shortages and provide culturally sensitive care. Mandate cultural safety training in accreditation standards and promote intersectoral collaboration across health, social services, immigration, housing, and finance policies. Fund interpreter services. 

Community organizations can empower local communities and tailor mental health and addiction programs to specific cultural and social contexts. Train community health workers in trauma-informed health support and establish pop-up vaccination clinics in faith centres and other spaces where newcomers congregate. Develop programs to improve computer literacy and health navigation skills, particularly for new immigrants and seniors. Educational programs can be developed to increase digital and health literacy for newcomers and vulnerable groups, helping them navigate the healthcare system more effectively. 

All actors need to work together to address the emergence of a combination of misinformation spread and infodemic challenges during a health crisis. Clear public health messaging targeting immigrant communities, in multiple languages, with culturally sensitive approaches should be a priority. 

What did the researchers do? 

The researchers organized two virtual Think Tank sessions in September 2023. Each session included 40-41 participants, comprising immigrants and refugees affected by these conditions, service providers, policymakers, and researchers. To ensure trust and safety concerns, researchers worked with community partners to recruit clients affected by cancer or mental health & addiction disorders.  

The Think Tank sessions consisted of three main components: 

1. An introduction and panel discussion to understand how Phase 1 findings resonated with stakeholders. 
2. Small group discussions to identify data gaps in the Phase 1 findings. 
3. A plenary session to collaboratively develop actionable health protection and well-being solutions. 

The sessions were recorded, transcribed, and analyzed using thematic analysis to identify key themes and priority actions.  

Study authors and journal   

Authors: Mandana Vahabi, Kimberly Devotta, Cliff Ledwos, Josephine P. Wong, Miya Narushima, Jennifer Rayner, Roula Hawa, Kenneth Fung, Geetanjali D. Datta, Axelle Janczur, Cynthia Damba and Aisha Lofters

Publication: Healthcare 2025, 13(5), 564.

Related Project Articles  

The Disproportionate Impact of COVID-19 on Immigrants and Refugees with Chronic Illnesses   
This community-based research project delved into the compounded effects of the COVID-19 pandemic on immigrants and refugees living with cancer, and mental health and addiction disorders. The study, a collaboration including Access Alliance, sought to understand the challenges faced by individuals at the intersection of social and clinical disadvantage during a public health crisis. The central question guiding the research was: What happens to those who are at the intersection of social and clinical disadvantage during a pandemic?   

Silent Voices of Immigrants and Refugees Battling with Mental Health and Addiction during COVID-19: A Follow- Up Population-Based Cohort Retrospective Study in Ontario, Canada  
This article examines the compounded effects of social and clinical disadvantages, specifically focusing on the combined impact of immigration status and pre-existing mental health and addiction, on COVID-19 outcomes (vaccination rates, diagnoses, hospitalizations, ICU admissions, and mortality). 

The impact of COVID-19 on Immigrants and Refugees living with Cancer: A Population-Based Cohort Study in Ontario, Canada  
This article explores the impact of COVID-19 on immigrants and refugees living with cancer in Ontario, Canada. Immigrants and refugees with active cancer had significantly worse COVID-19 outcomes compared to other groups, particularly non-immigrants without cancer. They were 66% more likely to be diagnosed with COVID-19, 3.3 times more likely to be hospitalized, 3 times more likely to be admitted to ICU, and 4.2 times more likely to die from COVID-19. 

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Recognizing the significant changes and challenges facing the centre and our community a year into the COVID-19 pandemic in Toronto, Access Alliance initiated a strategic planning process in the spring of 2021. To fully understand the situation, we needed to engage directly with our service-users. We conducted seven virtual focus groups between April 8 and 21, 2021 (using the Zoom platform). A total of 64 community members took part, including people of various genders, ages, education levels, sexual orientations, and cultural backgrounds.    

Vaccine Engagement Impact Report    
Taylor Massey-Oakridge-Victoria Village was one of the least vaccinated neighbourhoods  during the summer/fall of 2021. With a coordinated effort between the partners, we raised the vaccination rate above the City’s average and significantly reduced the COVID-19 hospitalization rates during the pandemic peak.    

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