The impact of policy changes on the health of recent immigrants and refugees in the inner city - A qualitative study of service providers' perspectives

Background: Dramatic changes to health and social policy have taken place in Ontario over the last five years with few attempts to measure their impact on health outcomes. This study explored service providers' opinions about the impact of four major policy changes on the health of recent immigrant and refugee communities in Toronto's inner city. Methods: Semi-structured key informant interviews. Results: Reductions in funding for welfare, hospitals and community agencies were seen to have had major effects on the health of newcomers. Emergent themes included erosion of the social determinants of health, reduced access to health care, increased need for advocacy, deterioration in mental health, and an increase in wife abuse. Conclusions: Several areas were identified where policy changes were perceived to have had a negative impact on the health of recent immigrants and refugees. This study provides insights for policy-makers, inner-city planners and researchers conducting population-based studies of immigrant health.