Canada continues to be a prominent immigrant and refugee-receiving country in worldwide migration, resettlement, and search for refuge, yet there is a gap in our understanding of these newcomers' views of the specific meanings of social support and their support needs and resources. The purpose of this study was to understand the meanings of social support for immigrants and refugees in Canada, and to explore the types and adequacy of formal supports. Individual interviews were conducted with 60 service providers and policymakers initially (Phase 1), and 120 immigrants and refugees (60 Chinese, 60 Somali) in the second phase. The implications of these findings were elicited in group interviews (Phase 3) of policy decision-makers, advocates, service providers, and managers. This investigation revealed many interrelated challenges facing refugees and immigrants such as language difficulties, inadequate information on services, poor health, racism, needs for retraining, rejection of foreign qualifications, unemployment, social isolation, social insecurity, dwindling social networks, and family conflicts. The study also illuminated culturally and socio-economically determined perceptions of social support and

BackgroundDramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses.MethodsThis mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers’ migration of relevant policy documents and academic literature on health workers’ migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists.ResultsFilipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility.ConclusionsUnless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

PurposeThis paper seeks to explore varied interrelated challenges and barriers experienced by immigrant seniors.Design/methodology/approachSenior immigrants representing diverse ethnicities (Chinese, Afro Caribbean, Former Yugoslavian, Spanish) described their challenges, support needs, and barriers to service access. Service providers and policy makers from organizations serving immigrant seniors were interviewed to elicit their views on barriers to access and appropriateness of services for immigrant seniors. Qualitative methods were employed to enhance understanding of meanings, perceptions, beliefs, values, and behaviors of immigrant seniors, and investigate sensitive issues experienced by vulnerable groups. The qualitative data were subjected to thematic content analysis.FindingsSeniors reported financial and language difficulties, health problems, discrimination, family conflicts, and social isolation. Although most immigrant seniors appreciated the standard of living in Canada and the services provided to seniors, most believed that support received was inadequate. Seniors encountered systemic (e.g. government policies), institutional (e.g. culturally inappropriate programs), and personal (e.g. transportation, language problems) barriers to accessing social and health services. Service providers and policy makers faced high costs of programs, inadequate financial and human resources, inadequate information about needs of immigrant seniors, inadequate geographical coverage, and lack of inter‐sectoral collaboration.Practical implicationsThe challenges experienced by immigrant seniors have implications for programs and policies and can inform the development of culturally sensitive and appropriate services.Social implicationsThe barriers encountered by service providers in assisting immigrant seniors point to the importance of inter‐sectoral coordination, cultural sensitivity training, and expansion of service providers' mandates.Originality/valueThis study revealed numerous unmet needs for successful acculturation of immigrant and refugee seniors in Canada. It also reveals that the most cogent and sustainable approach to close this chasm of support deficits, unattended challenges, and complex stressors is to implement a model that simultaneously addresses the three levels and use a multisectoral approach.