Health: A key factor in the reception of migrants in Europe

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1 Conference on Civic Orientation and Health Communication Health: A key factor in the reception of migrants in Europe WHO/Europe project Public Health Aspects of Migration in Europe (PHAME) Stockholm 4 June 2015 Ayesha Kadir, MD, MScPH, CTropMed Consultant, Public Health Aspects of Migration project WHO European Office for Investment for Health and Development

2 Why is migration a public health issue? How can public health improve the well-being of migrants and host communities? What is the role and influence of communication on migrant health? Temporary centre for unaccompanied children in Sicily, Italy ( WHO) 1. Migration and health in the WHO European Region setting the scene 2. Complexity and challenges 3. Inter-sectoral action for health: good communication is critical for all aspects of migrant reception

3 Migration and health in the WHO European Region 214 million international migrants million internal migrants worldwide (UNPD data) European Region undergoing important demographic and epidemiological changes 53 Member States, 886 million people 77 million are migrants = 8% of the WHO European Region s total population are migrants Patterns of migration in the WHO European Region ( WHO)

4 Migration and health in the WHO European Region Demographic decline without migration Source: Eurofund.eu

5 Migration and health in the WHO European Region Age structure of the national and non-national populations in the European Union, 2010

6 Migration and health in the WHO European Region Citizens of non-member countries resident in the EU-27 by continent of origin, 2010

7 Migration and health in the WHO European Region Italy: 5.1 million immigrants In 2012, state revenues due to immigrants: Costs incurred during the management of migration and migrants Net income from migration 13.3 billion Euros 11.9 billion Euros 1.4 billion Euros This is not communicated by the press or recognised in political discourse Source: Italian Statistical Institute (2013)

8 Complexities: Media coverage, public reaction

9 Complexities: Political reaction Impact of the financial crisis on migration policy Most countries resorted measures to reduce the inflow of migrants, restricting entry conditions and cutting the number of migrants granted entry Lowering the quota for labour migrants Italy, UK, Spain and Russia Revision of employment procedures for favour local workers Financial bonus to migrant to return home (pay to go) Norway, Ireland, Czech Republic Spain, Czech Republic, France

10 Migration as a social determinant of health Source: How health systems can address health inequities linked to migration and ethnicity. Copenhagen. WHO Regional Office for Europe, 2010.

11 Migration as a social determinant of health Migration-related health issues: Pre-departure and journeyrelated health risks Change in health profile after resettlement Challenges for the health system: Barriers to care physical, cultural, social and linguistic Economic impact Monitoring health public health data collection Health Inequities in health system access: Recognition and responsiveness to specific health needs of migrants: context-dependent Need to for cultural competence in the care of an increasingly diverse population Different health needs require different health services Migrant-friendly health services Integration Economic, social, political contribution to host society

12 Migration as a social determinant of health Communicable diseases: Tuberculosis in the EEA Overall rates of new TB cases in EEA decreasing in recent decades Rates of TB in migrants is increasing Higher risk due to risks in country of origin and their living conditions once in Europe This has had no impact on the overall rates of TB in the EEA There are no outbreaks. In fact, TB rates are decreasing! Odone et al. Tuberculosis among migrant populations in the European Union and the European Economic Area. European Journal of Public Health, 2015;25(3):

13 Migration as a social determinant of health Communicable diseases: Tuberculosis in Italy Spread of TB: close contact poor housing conditions poor nutrition prison Most European people are not living in these conditions Strong public health systems, with good prevention, treatment, and monitoring measures International Health Regulations Data (2013):

14 Migration as a social determinant of health Noncommunicable diseases Misra A, Ganda OP. Migration and its impact on adiposity and type 2 diabetes. Nutrition2007;23:

15 Migration as a social determinant of health Complexity and Contradictions Undocumented Migrants Access to Medical Care in Europe Degree of access Access only to emergency services Greater access to some services or for some categories of undocumented migrants Full access under specified conditions Countries Austria, Bulgaria, Cyprus, Czech Republic, Denmark, Germany, Greece, Estonia, Finland, Hungary, Ireland, Latvia, Lithuania, Luxembourg, Malta, Poland, Romania, Slovak Republic, Slovenia Belgium, Italy, Norway, and the United Kingdom France, Netherlands, Portugal, Spain, Switzerland, Sweden In 2010, 9 of 27 EU countries denied free emergency care to undocumented migrants

16 Current work by WHO A public health approach to migration Health of migrants: the way forward - report of a global consultation, Madrid, Spain, 3-5 March 2010., World Health Organization 2010

17 Current work by WHO Public Health Aspects of Migration project (PHAME) Technical support to Member States Toolkit for assessing health system capacity to manage large influxes of migrants in the acute phase Joint technical assessments with MoH: Italy, Portugal, Malta, Spain, Greece, Cyprus, Bulgaria Upcoming in Serbia and Turkey Assessment reports: Looking at best practices and potential gaps for future collaboration, strengthening know-how transfer throughout the region: - Inter-sectoral collaboration - Health risk assessment - Strengthening chain of command and communication flow Example outcome: Regional Health Contingency Plan to manage large influxes of migrants in Sicily, Italy

18 Current work by WHO Public Health Aspects of Migration project Gathering evidence on migrant health European Advisory Committee on Health Research (EACHR) Health Evidence Network (HEN) reports: Asylum seekers Undocumented migrants Economic migrants Advocating for migration and public health Quarterly newsletter on public health and migration Multi-sectoral brief on health and migration

19 Current work by WHO September 2014: Technical briefing on Public Health and Migration at the WHO Regional Committee for Europe December 2014: Standing Committee of the WHO Regional Committee for Europe approved the following two-year process: What s next? 2015 RC RC66 Development of key policy documents on migration and health Ministerial lunch to identify countru priorities and needs Presentation of key policy documents on migration and health External and internal technical expert meetings towards the development of a European Action Plan and Resolution on Migration and Health Submission of European Action Plan and Resolution on Migration and Health

20 Communication Who is a migrant? Undocumented migrants Migrants in irregular situations Trafficking victims Economic migrants Asylum seekers Migrants in regular situations Refugees

21 Communication Counteracts fear Encourages rational thinking Particularly important for messages to the public Improves the reception process Better outcomes Health and well-being Employment Education Integration and social cohesion Da Krigen Kom Til Toftlund. Outcome: 1. Better understanding of migrants health needs 2. Better understanding of how best to meet these needs 3. Better coordination of sectors

22 Communication across sectors Health is influenced by policies from all sectors. Good communication is necessary to take into account the health impact of policy. Health Access Security measures Synergy between sectors is needed to foster joint actions that improve migrant health and wellbeing. Human Rights National Regulation There is an increasing attention to immigration issues, but the dominant emphasis is still on restriction, control and expulsion.

23 Communication: health sector Factors: Language Culture Health beliefs Exposures Before travel During travel After arrival Previous experiences Affect: Compliance Health outcomes World Migration Report 2013: Migrant Wellbeing and Development. IOM, Geneva 2013.

24 Inter-sectoral action Health and migration: a multi-sectoral agenda Ministry of Interior Ministry of Labour Ministry of Social Affairs Ministry of Foreign Affairs Ministry of Health Ministry of Education Synergy between sectors is needed to foster joint actions that improve migrants health and well-being

25 Conclusions Health is an important aspect of migration Affects all sectors, and is affected by all sectors Need to invest in evidence-based, honest communication within sectors, between sectors, with migrants, and with the public Need to support policy makers in using evidence to guide decision-making Advocacy communication should be a major investment

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