What does "in good health" mean with respect to Canadian entry?

Question

According to the Canadian government's basic guidance on visitor visas, the "Basic travel requirements" for traveling to Canada are (my emphasis):

• have a valid travel document, like a passport
• be in good health
• have no criminal or immigration-related convictions
• convince an immigration officer that you have ties—such as a job, home, financial assets or family—that will take you back to your home country
• convince an immigration officer that you will leave Canada at the end of your visit
  • have enough money for your stay.
  • The amount of money you will need depends on how long you will stay and if you will stay in a hotel, or with friends or relatives.

Similarly, a page on inadmissibility mentions "you have a serious health problem" as a reason for being refused admission, but does not define what constitutes a serious health problem versus a non-serious health problem (that, logically, would not result in inadmissibility to Canada).

A more detailed page specifies that persons may be refused entry or a visa on...

• health grounds – if their condition is likely to:
  • endanger public health or public safety, or
  • cause excessive demands on health or social services (some exceptions exist 2 3)

Still, no actual guidance is provided on when exactly a health problem is serious enough to trigger refusal.

What is the definition of "in good health" as it relates specifically to entering Canada? I'm guessing that a cold, a broken arm, a hernia, or athlete's foot isn't enough to result in entry refusal, but how serious does a condition have to be?

• Is it based on formal diagnosis (e.g. there is a list of diagnoses that are per se deemed to "endanger public health or public safety" and a list of diagnoses that are not)?
• Does the CBSA official make an independent judgment of a person's overall health and whether that person is likely to need "excessive" services?
• Is there a specific dollar amount that constitutes excessive (e.g. officials are supposed to refuse you entry if your medical bills for the previous 12 months were over $10,000)?

There is a procedure for obtaining an officially recognized Medical Exam, but not all visitors to Canada are required to obtain one. I'm more asking the question with reference to these visitors.

This is not a request for advice - I've never been refused entry to Canada on health grounds or warned that I might be. I'm just curious as to what the actual rule is and thought that it would be helpful for people who might not be in such great health to know as well. E.g. is this requirement really just a way to protect Canada from major threats like Tuberculosis and Ebola, or are people actually getting turned away at the border for arthritis and varicose veins?

Answer 1

The policies adopted by Immigration, Refugees, and Citizenship Canada (IRCC) are given in the Immigration & Refugee Protection Regulations. The regulations concerning "public health" and "public safety" are in Paragraphs 31 & 33, respectively; they deal with, effectively, communicable diseases and mental illness that could lead to the applicant harming someone.

I was unable to find a list of specific diseases and conditions that fall on either side of the admissibility line; such guidelines may exist but not be publicly available, or the decisions may be made on an ad hoc basis based on the guidance in the above-mentioned paragraphs. As pointed out user71659 in the comments, the standards may need to change quickly during outbreaks of communicable disease, such as the SARS outbreak of 2002–3.

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The "excessive demand" clause is more interesting. The current definition is

Excessive demand means

(a) a demand on health services or social services for which the anticipated costs would likely exceed average Canadian per capita health services and social services costs over a period of five consecutive years immediately following the most recent medical examination required under paragraph 16(2)(b) of the Act, unless there is evidence that significant costs are likely to be incurred beyond that period, in which case the period is no more than 10 consecutive years; or

(b) a demand on health services or social services that would add to existing waiting lists and would increase the rate of mortality and morbidity in Canada as a result of an inability to provide timely services to Canadian citizens or permanent residents.

The actual procedures followed by IRCC to determine whether an immigrant would cause "excessive demand", along with the notification and appeals process, are listed on a page titled "Excessive demand on health services and on social services" on the IRCC webpage. In particular, any cases that are potentially inadmissible due to "excessive demand" are evaluated by a dedicated unit, not your front-line level immigration officers:

When a review of immigration medical examination (IME) results shows that the foreign national (principal applicant, accompanying family member or non accompanying family member) is potentially inadmissible on health grounds, responsibility for final assessment of the IME is transferred to the MHB Centralized Medical Admissibility Unit (CMAU) in Ottawa.

Once the IME is accepted for continued processing by the CMAU, MHB medical officers should complete all medical assessments, based on the definition of excessive demand found in subsection R1(1).

Until recently, the threshold for "excessive demand" was if your estimated medical costs over five years were more than the Canadian per capita average, or about CAD 33,000 for a five-year period. However, earlier this year, the Government of Canada announced a large increase in the cost threshold for inadmissibility (specifically, tripling it to approximately CAD 100,000), as well as the exemption of some social services from this calculation. A temporary policy to this effect was enacted in June 2018, and presumably more permanent regulations will be enacted soon.

As an aside, this clause has caused approximately 1000 people per year with chronic diseases and/or disabilities to be deemed inadmissible due to their conditions. Moreover, the inclusion of "social services" in the paragraph above means that some of the applicants were denied due to disabilities that would require ongoing care. This policy therefore amounted to constructive discrimination against the disabled, which understandably caused a certain amount of criticism among disabled-rights advocates. The new policy was largely designed to lessen this discrimination.