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A Newcomer Health Plan for Ontario – the time is right

Access Alliance Vaccine Ambassadors group picture from 2022

It is time to design, validate, and evaluate an equity-focused Newcomer Health Plan (NHP) in Ontario.

Why a Newcomer Health Plan?

Approximately 250,000 people immigrate to Canada annually, contributing to about two-thirds of the country’s annual population growth (1); and almost half of all new Canadians settled in Ontario in 2025 (2). Upon arrival, they discover a public‑health system that is not built with them in mind. Newcomer communities face persistent barriers to healthcare access: language exclusion, fragmented navigation, limited culturally safe services, racism, and systemic discrimination (3,4,5,6,7,8,9,10,11,12,13). The COVID-19 pandemic amplified these inequities. While immigrants comprise 30% of Ontario’s population (14), they were disproportionately affected by COVID-19 due to social and structural determinants of health, including precarious employment, crowded housing, mistrust of health institutions, and their lack of consideration in health promotion and literacy efforts (3,4,5,6,7,8,10,11,12,13). 

While newcomer concerns are included within some broader targeted health plans (e.g., the Black Health Plan (15)), there is no newcomer-focused strategic approach in Ontario Health’s Equity, Diversity, Inclusion, and Anti-Racism framework (16). Lacking a provincial mechanism to coordinate equity-centred public health planning for newcomers, or to embed newcomer-specific, culturally responsive practices across sectors, magnifies structural inequities.

In practice, newcomers show up as parts of other plans, without being fully represented. The result is a piecemeal public health system response to well-documented needs for newcomer health access. 

Recent research builds on and echoes decades of prior research findings, recommendations, and solutions (3,4,5,6,7,8,10,11,12,13), indicating that a different approach, which centres newcomers, is needed. We propose using a community-based implementation science approach to co-design and validate an Ontario Newcomer Health Plan (NHP), a sustainable, scalable governance and systems-level intervention that targets structural leverage points within the health system. That’s public health, primary care, community care, and individual health. Our work includes Municipal Public Health Units, Public Health Ontario, Community Health Centres, Primary Care teams, Solo Practitioners, and community-based organizations such as settlement agencies and ethnocultural groups that provide essential health-related orientation and outreach, trust-building, and preventive care.

What is the Newcomer Health Plan?

The NHP will involve policy and program interventions, workforce and service delivery models, and governance frameworks. It will strengthen prevention, health promotion, equity-focused outreach, and system navigation through improved access, cultural safety, accessible language, including translation, and coordinated pathways linking newcomers to public health services and health-adjacent social supports. The plan will integrate trauma-informed, culturally tailored strategies and address governance and workforce barriers. 

This is a provincial-scale effort to test an evidence-informed, community-governed NHP for integration into Ontario’s public health system. It builds governance structures, accountability tools, and cross-sector service integration that embed newcomer needs into public health planning. Methodologically novel in its use of co-led research governance, applied systems design, and community-engaged evaluation, it draws on lessons from the Black Health Plan while advancing scalability and provincial adoption. 

Why it matters

By co-designing, validating, and creating a scalable system-level model rooted in community governance and cross-sector collaboration, this project strengthens health system resilience by integrating culturally safe, accountable, and newcomer-responsive models of care at the structural level. Its focus on building feedback loops, training infrastructure, and aligning policies with Ontario Health ensures not only service improvement but also system transformation that endures beyond the project period. Outcomes directly advance population health and health equity by providing not only publicly visible access to care but also structural system elements such as responsiveness, trust, accountability, and uptake, all of which are foundational to resilient and equitable health systems.

The NHP provides a coordinated, equity-centred approach rooted in community governance and cross-sector collaboration. Through feedback loops, training, and policy alignment, it supports immediate service improvement and lasting system transformation, enhancing access, trust, accountability, and uptake. By the end of the project, a newcomer arriving in Ontario will discover a health system that is being built with them in mind.

Knowledge products will include policy briefs, webinars, peer-reviewed publications, and community toolkits. A targeted knowledge mobilization strategy will link government bodies (e.g., Ontario Health, Toronto Public Health), settlement agencies, and newcomer networks to ensure timely uptake and influence on provincial health equity strategies.

What’s next?

We have submitted a 3-year project proposal to the Canadian Institutes of Health Research (CIHR). Our proposal to CIHR focuses on the public health system, as required by the funding eligibility criteria. But a Newcomer Health Plan (NHP) is much broader in scope. For example, Ontario’s Primary Care Attachment Plan is focused on connecting every Ontarian to a primary care provider. Attachment is merely the tip of the iceberg of health care.

The experience of receiving service needs to be consistent, no matter where newcomers interact and intersect with the health system. An overarching plan can help achieve that. At its most basic, the NHP creates a consistent service framework and roadmap. At its most complex, it mandates health equity and a safe and equitable service experience. 

Even with a strong proposal and an even stronger group of partners, there is no guarantee that we will receive funding. We won’t hear until at least May. We have decided not to wait and will start the process now.

In early April we’ll convene an information and working session to work towards true health equity and inclusion for newcomers in Ontario. More details coming soon.

Newcomer Health Plan – convening session on April 2nd

It is time to design, validate, and evaluate an equity-focused Newcomer Health Plan (NHP).

When: Coming soon in April – 9:30am – 12pm (Eastern)
Where: Virtual (Zoom)
Who should attend: This is a working session. You will be participating in active discussions to help shape ideas and discuss how best to co-create it with health, settlement, community, and newcomers themselves. You should attend if you work at the intersection of health, settlement, equity, and inclusion. The goal is to embed the NHP into Ontario’s health system. System transformation; not new research, or a new program. What role might you or your organization play in moving this forward? What do you need to be able to contribute?

Register here.

Full event information

 Agenda

  • Introduction (15 minutes)
  • Two Panels (80 minutes)
  • Breakout Discussions (30 min)
  • Final discussion & next steps (25 minutes)

Introduction (15 minutes)

  • Brief recap of research journey (years of extensive community research & community consultations → CIHR STEPS grant proposal → community conversation).
  • Framing: This convening is about moving from “what we all know” to “what we do together.”

Two Panels (80 minutes)

Panel 1: Evidence for Change – The Case for a Newcomer Health Plan (40 min panel)

Why systemic change is needed, not just service improvements. What are the most critical elements that must be included in a Newcomer Health Plan for it to meaningfully address health inequities?

Key message: This isn’t a new problem. It’s a persistent gap that requires coordinated provincial action. There is an opportunity moment in Ontario (Equity, Inclusion, Diversity and Anti-Racism Framework, Primary Care Action Plan).

Focus areas:

  • Research findings from various community and academic research projects (disparities, structural barriers)
  • Lessons from Black Health Plan and other equity frameworks
  • Gap analysis: What exists vs. what’s needed for newcomers in Ontario’s health equity landscape
  • Community expertise and readiness for policy-level engagement

Confirmed panelists (more to be added):

  • Duberlis Ramos
  • Akm Alamgir
  • Saleema Allana

Panel 2: From Consultation to Co-Ownership – Principles of Equitable Co-Creation (40 min panel)

What does meaningful community co-leadership look like at each stage: design, implementation, and evaluation? What specific mechanisms would ensure communities have real power, not just a seat at the table?

Key message: Communities aren’t just consulted – they co-lead design, implementation, and evaluation.

Focus areas:

  • Power-sharing and data sovereignty (EGAP framework principles)
  • Community Advisory Board models and governance structures
  • Lessons from community consultations: What communities are telling us works
  • Asset-Based Community Development (ABCD) vs. deficit-based approaches
  • Role of peer researchers, IEHPs, and community organizations as knowledge holders

Confirmed panelists (more to be added):

  • Akm Alamgir
  • Kate Sellen
  • Rosanra Yoon

Breakout Discussions (30 min total)

Breakout Guidance
Breakout groups will self-facilitate and work through the questions as they determine important (they may decide to focus on fewer than 3 questions, for example).

Instructions: 

  • Break-out rooms will be open for 30 minutes
  • Find your group number in the document and delegate someone from your group to take notes on this shared Google document.
  • Try to capture all insights from your conversation – this will help us to create a summary of the conversations across all rooms to share. Bullet points/short form notes are great.
  • Delegate someone to share highlights with the larger group when we come back together in next section of the agenda.

For each question, capture:

  • Points of strong agreement/consensus
  • Diverse perspectives or tensions
  • Specific, actionable ideas
  • Surprises or new insights not in the research

These questions are designed to help us move from research findings to concrete strategy. There are no wrong answers. We want to hear your authentic perspectives based on your experience and expertise.

  • Question 1: 10 min discussion
  • Question 2: 10 min discussion
  • Question 3: 10 min discussion

Question 1: Evidence & Priorities (10 min)

Years of research identified a variety of key barriers to health equity and inclusion for newcomers: IEHP integration gaps, complex navigation, language/interpretation quality, digital inequity, long wait times, lack of cultural safety, and fragmented cross-sector connections. What are your priorities for the Newcomer Health Plan to address first? Why?

Question 2: Community Partnership (10 min)

Community consultations show that newcomers have a sophisticated understanding of health systems and are ready for policy-level involvement. How can we ensure the Newcomer Health Plan is co-owned by communities throughout – not just consulted on? What would this look like in practice?

Question 3: System Integration (10 min)

The NHP needs to integrate into Ontario’s existing health equity frameworks (not become another separate initiative). What existing policy levers, partnerships, or mechanisms should we connect to? Where are the best entry points for embedding the NHP? (Examples: Ontario Health EDI framework, OHT accountability, Primary Care Action Plan, PHU strategic planning, etc.)

Final discussion & next steps (25 minutes)

Synthesis & report-back prep from discussions: Each room shares 2-3 key takeaways per question (not a full summary of the discussion, which is captured in the Google Doc). After all reports, the facilitator identifies:

  • Strong consensus: What did we hear across ALL rooms?
  • Productive tensions: Where did perspectives differ? Why might that be valuable?
  • Actionable next steps: What concrete ideas emerged?
  • Commitments: What are people ready to do?

Next steps:

  • Report out about session, engage and invite others
  • Identify policy windows and levers (Ontario Health’s EDI framework, Primary Care Action Plan, OHT accountability)
  • Identify building blocks approach: Governance, workforce, service delivery, financing
  • Identify accountability mechanisms and measurement frameworks
  • Build cross-sector collaboration (health, settlement, municipalities)
  • Moving from idea to pilot to scale

Register here.

 References

  1. Statistics Canada. Immigrants make up the largest share of the population in over 150 years and continue to shape who we are as Canadians. (2022) https://www150.statcan.gc.ca/n1/daily-quotidien/221026/dq221026a-eng.htm
  2. Ontario Ministry of Finance. (2026). Ontario Demographic Quarterly: Highlights of third quarter. Government of Ontario. https://www.ontario.ca/page/ontario-demographic-quarterly-highlights-third-quarter#secti on-2
  3. Vahabi M, Matai L, Lofters A, Rayner J, Damba C, Janczur A, Kopp A, Fung K, Narushima M, Hawa R Datta G, Tharao W, Wong JP. 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. Journal of Environmental Science and Public Health. 8 (2024). https://accessalliance.ca/wp-content/uploads/2025/03/Silent-Voices-of-Immigrants-and-Refugees-Battling-with-Mental-Health-and-Addiction-during-COVID-19-A-Follow-Up-Population-Based-Cohort-Retros.pdf
  4. Vahabi M, Matai L, Damba C, Kopp A, Wong J, Rayner J, Narushima M, Tharao W, Hawa R, Janczur A, Datta G, Fung K, Lofters A. The impact of COVID-19 on Immigrants and Refugees living with Cancer: A Population-Based Cohort Study in Ontario, Canada. Journal of Environmental Science and Public Health. 8 (2024): 116-132. https://www.fortunejournals.com/articles/the-impact-of-covid19-on-immigrants-and-refugees-living-with-cancer-a-populationbased-cohort-study-in-ontario-canada.html
  5. Vahabi, M.; Devotta, K.; Ledwos, C.; Wong, J.P.; Narushima, M.; Rayner, J.; Hawa, R.; Fung, K.; Datta, G.D.; Janczur, A.; et al. 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. Healthcare 2025, 13, 564. https://doi.org/10.3390/healthcare13050564
  6. Lou NM, Noels KA, Zhang YS, Kurl S. Ethnic minority, immigrants, and Indigenous people’s well-being disparities in Canada during the COVID-19 pandemic: The mediating role of threat perceptions. International Journal of Intercultural Relations. 2022 May 1;88:148-56. https://doi.org/10.1016/j.ijintrel.2022.04.006
  7. Council of Agencies Serving South Asians (CASSA), Roots Community Services (RootsCS), Hispanic Development Council (HDC), Chinese Canadian National Council – Toronto Chapter (CCNCTO), & Canadian Arab Institute (CAI). (2024). 2024-CASSA Health Equity Summit: Proceedings report. https://www.cassa.ca/wp-content/uploads/2025/02/2024-Summit-Proceedings-Report.pdf
  8. Council of Agencies Serving South Asians (CASSA), Roots Community Services (RootsCS), Hispanic Development Council (HDC), Chinese Canadian National Council – Toronto Chapter (CCNCTO), & Canadian Arab Institute (CAI). (2024) Bridging health divides: A collaborative study on addressing healthcare disparities in racialized communities. https://www.cassa.ca/wp-content/uploads/2025/04/Bridging-Health-Divides-A-Collaborative-Study-on-Addressing-Healthcare-Disparities-in-Racialized-Communities.pdf
  9. Toronto Public Health and Access Alliance Multicultural Health and Community Services. The Global City: Newcomer Health in Toronto. November 2011. https://accessalliance.ca/wp-content/uploads//2018/06/GlobalCity-Final.pdf
  10. Niles C, Yoshida K, Vickers K, Anderson J, El-Lahib Y, Hamdy R, Al Awamry N. Untold Stories of Black and Racialized Immigrants with Disabilities During COVID-19 in the Greater Toronto and Hamilton Area. Healthcare. 2026; 14(2):205. https://doi.org/10.3390/healthcare14020205
  11. Jackson C, Mondal S, Di Ruggiero E, Gautier L. Building Responsive Intersectoral Initiatives for Newcomers in Toronto: Learning from Service Providers’ Experiences in the Context of COVID-19. Annals of Global Health. 2025; 91(1): 3, 1–15. DOI: https://doi.org/10.5334/aogh.4583
  12. Alamgir Akm, Yahia M, Pradhan SM, Janczur A. Healthcare Service Needs for Refugees, Asylum Seekers and Residents with Precarious Immigration Status in Canada: A Scoping Review. J Scie Res Reports, 2025;31(1):117-144. https://doi.org/10.9734/jsrr/2025/v31i12752
  13. Alamgir Akm, Kong C. Implementation Research with Expressive Arts Therapy (EAT) to Support the Newcomer Survivors of Gender-based Domestic Violence (GBDV) in Toronto. Proceedings of the 7th International Conference on Gender Research, 2024;7(1):19-26. DOI: https://doi.org/10.34190/icgr.7.1.2265
  14. Statistics Canada. Focus on Geography Series, 2021 Census of Population – Ontario, Province. (2025). https://www12.statcan.gc.ca/census-recensement/2021/as-sa/fogs-spg/Page.cfm?lang=e& topic=9&dguid=2021A000235
  15. A Black Health Plan for Ontario. Ontario Health. https://www.ontariohealth.ca/system/equity/black-health-plan
  16. Equity, Inclusion, Diversity and Anti-Racism Framework. Ontario Health. https://www.ontariohealth.ca/system/equity/framework