Global health spending: immigrant and refugee seniors

Portrait of asian senior man looking outside the window while wearing face mask

Join us on Tuesday, September 14 at 8:30 EST (for your local time click here), as we explore ways to address the competing challenges for immigrant seniors experiencing social isolation during this pandemic.

We will be joined by Shanthi Johnson @ShanthiJohnson, the Dean of the School of Public Health at the University of Alberta, who has done research in this area.

We are excited to talk about this important topic with someone who is working to address this unique challenge. Below is Johnson’s blog.



As we are all well aware, the pandemic has impacted all segments of the population and has been particularly difficult for certain groups such as immigrant seniors. A recent study by Statistics Canada reported that immigrants and refugees are more likely to be worried about the economic and social impacts of the pandemic than the general population.

Older adults aged 65 and older, people with chronic conditions and/or cognitive impairment, and minority populations are disproportionately affected by the pandemic.Immigrant seniors are especially vulnerable to the social, physical, and psychological issues from the pandemic as they face a heightened risk of morbidity and mortality. A resilient and healthy future for Canada depends on our using our collective experiences from the pandemic to find sustainable solutions.  WHO has emphasized that speed, scale, and equity must be our guiding principles to create solutions. Social isolation is defined as the level and frequency of one’s interactions with others. Loneliness is different than social isolation as it reflects the subjective feeling that results from inadequate social connections and feeling disconnected from others.

Canada is a multicultural society with an increasing number of immigrant and refugee seniors. In 2011, 21% of the total Canadian population was foreign-born with a projected increase to 40% in 2055. Among seniors, 30% were foreign-born, compared to 21% of the total population. Immigration policy in Canada is one of a small number of enumerated constitutional powers that is shared between the national and provincial governments. The majority of immigrant seniors in Canada live in Ontario, British Columbia and Québec.

Canada has been quite successful in integrating immigrants and refugees, however, in comparison to Canadian-born seniors, new immigrant and refugee seniors face a higher risk of social isolation. Social isolation among this group can arise in a number of circumstances and from a variety of causes. What is common among those different manifestations of social isolation is that it often arises unseen by government agencies, immigrant communities and even families. Identifying socially isolated older adults is one of the biggest challenges.Immigrants and refugees are also diverse with different countries of origin, cultures, familial customs, living arrangements, and languages.

In Canada, various programs and services exist to reduce social isolation among immigrant and refugee seniors. In a recent environmental scan, 40 programs and services to support this population across the country were identified. Service and program gaps were noted for immigrant and refugee seniors living outside of large urban centres as the majority were offered in large, urban centers.No specific programs or services were identified in rural or remote communities, suggesting that newcomer seniors would be relatively disadvantaged in these areas. Programs and services for immigrant and refugee seniors often focused on supports for English Language training, settlement services, social support, computer classes, and information to access available resources. These programs and services typically incorporated opportunities to meet people and build friendships to help prevent and reduce social isolation.

What do we need to do?

We need more programs and services to target vulnerable subgroups among immigrant and refugee seniors. Only a few of the providers appeared to be working in partnership with other organizations to support immigrant and refugee seniors. Programs were typically supported by limited grants and government funding. Increased collaboration between the service providers could strengthen coordination for capacity-building and sustainability to support programs and services over time.

Individuals and groups working to reduce social isolation among immigrant and refugee seniors require access to an integrated, up-to-date guide of existing programs and services available. In moving forward, we need an online resource featuring a nation-wide perspective with current information on available programs and services to support simplified access of information for supporting seniors. 

Moving forward to reduce social isolation in Canada and beyond

There are many specific factors that we need to look into to reduce social isolation among immigrant and refugee seniors including the following: English and French proficiency; cultural differences; duration of residence in host country; status in host country; stigma/discrimination; loss of social roles; financial status; living arrangements; and pandemic and other emergencies.

Final words

Canada’s population is aging, and the immigrant and refugee is increasing at a proportionally higher rate.  With the added challenge of the pandemic, social isolation must occupy a significant place in the policy dialogue on seniors and healthy aging. The complexity of the issue requires a broad lens from the perspective of: the policy context; available programs and services for addressing social isolation; and, research including conceptualization and measurement considerations. It would be useful to identify high risk seniors, collaborate with agencies and families and spread accurate and timely information. During the pandemic it is imperative to adapt interventions and make them accessible in a way that protects seniors.  Specific efforts need to be made to strengthen connections between service agencies and the seniors at risk of social isolation using remote and digital modalities. 

The digital divide, and/or lack of Internet access or electronic devices may be a problem for seniors and should be considered for alternate modalities of support.  Innovations to meet the health and social needs of the growing population of older adults, particularly those for immigrant and refugee seniors require fiscal and policy commitments to expanded access and distribution of devices and the means to instruct seniors in how to use laptops, tablets, phones and apps. We need a more complete understanding of social isolation to inform policy, programs, and research which must be pursued with speed, scale and equity. 

4 topic areas

On Tuesday September 14th at 8:30pm ET (for your local time click here), we will be discussing the following topics on the weekly HCLDR tweetchat:

  • T1 Studies demonstrate that seniors, women and racialized individuals are more socially isolated than other groups as a result of the pandemic. What are the big factors that perpetuate this isolation? Geography? Language? Level of education?
  • T2 Healthcare policies treat seniors who are refugees or immigrants as a homogenous group of people. How do you design policies and programs that promote healthy aging and consider their unique needs? 
  • T3 What kinds of resources are needed to sustainably support this growing population of older adults who are refugees or immigrants? Evidence-informed research? Technology? Employment?
  • T4 If the government suddenly gave you a $5M grant to create a program to address the needs of immigrant seniors, what would that program look like?


This paper examines social isolation among immigrant and refugee seniors in Canada by focusing on: the policy context; available programs and services to reduce social isolation; and the conceptualization and measurement considerations for advancing research to address social isolation among this growing population. Drawing on specific examples, we discuss immigration, aging and social isolation within the context of Canada. While our paper focuses on Canada as a case study, our discussion has relevancy and implications for other high income countries with aging immigrant and refugee populations. In moving forward, we argue that a more complete and targeted understanding of social isolation is essential to informing program and policy development to support immigrant and refugee seniors in Canada and beyond. The transformation needed in our societies to create health for all requires a strong equity and determinants of health perspective and a systems approach beyond health to ensure lasting change.

About the AuthorDr. Shanthi Johnson, Professor and Dean, School of Public Health, University of Alberta

Building on a strong foundation from India, Dr. Shanthi Johnson has significant academic and leadership experiences in Canada and beyond.  She is Professor and Dean of the School of Public Health, University of Alberta. Previously, she served as an Associate Dean at the Faculty of Kinesiology and Health Studies, University of Regina and a Professor at the School of Nutrition, Acadia University.   Her community-engaged research program focusses on falls/injury prevention, aging in place in rural communities, and social isolation among immigrant and refugee seniors.  Her work is enriched by collaborative international experiences as a Fulbright Scholar in the US, an Endeavour Executive Fellow in Australia, a DAAD Scholar in Germany, a GIAN visiting professor in India, and an Understanding China fellow. 

Beyond academia, she has served or continues to serve on local to international boards including the Eastern Kings Community Health Board and Annapolis Valley Health, Saskatchewan Health Research Foundation, National Seniors Council, and Shastri Indo-Canadian Institute.  She has been awarded fellowships with the Dietitians of Canada, the American College of Sports Medicine, and the Gerontological Society of America.  Dr. Johnson was honoured as the Female Professional of the Year by the India Canada Chamber of Commerce, received the Award of Innovation by the Regina Chamber of Commerce and was recently named one of RBC’s Top 25 Canadian Immigrants. 

Dr. Johnson’s personal and professional work has spanned many groups around the globe, fostered by key tenets of international cooperation, equity, and inclusive diversity, which underpin her worldview. She is deeply committed to addressing issues that help elevate the human condition.

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