migration and health: some key issues, dr mary haour-knipe

Migration and Health: Some key issues in introduction

Mary Haour-Knipe

Migration and the Right to Health ConferenceInternational Development and Human RightsLondon26th-27th May 2010

Outline

• International migration today

• Phases of the migration process, and health effects

• Policy and legal frameworks affecting migrants’ health

• Challenges and needs

World migration: some numbers & trends

• 214 million international migrants • 740 million internal migrants

• Most population movement remains within regionse.g. developing country developing country

• Half of labour migrants now women• Migration of skilled labourers

• Increase of short-term & circular migration

• Migration flows more complex– Most countries simultaneously countries of origin, transit and

destination

International migration

UNDP Human Development Report 2009

Migration & human development directly related

• The individual who migrates– Is usually successful before migration– After arrival, migrants from low HDI countries gain:

• Income (x15)• Education (x2 enrolment rate)• Health (x16 less child mortality)

• Factors that increase movement– Differences in income trends – Demographic imbalances– Decrease in transport & communications costs

The individual who migrates also:

• Is usually both pushed and pulled

• May change official category/status

• Has a family

Type Reason

International migrants Usually labour migration, or to join family members

Refugees, asylum seekers Flee conflict, violence, human rights violations, natural disasters

Internally displaced persons

Same as for refugees

Irregular migrants Usually the same as for international migrants: labour or family

Types of population mobility

Type

International migrantsIrregular migrants

Refugees, asylum seekersInternally displaced persons

Reason

Usually labour migration, or to join family members

Flee conflict, violence, human rights violations, natural disasters

In sum: traditional migration pattern

Modern migration patterns

Outline

• International migration today

• Phases of the migration process, and health effects

• Policy and legal frameworks affecting migrants’ health

• Challenges and needs

Transit:

Especially dangerous for irregular migrants

Return:

Benefits, and also risks, for communities of origin Carry health conditions back home

Health of children of migrants?

Origin:

Healthy migrant effect

Destination:

(see next slide)

Factors potentially affecting health at destination

• Isolation, separation from family & community, lack of social support

• Health not a priority

• Barriers in access to health & social services– Limited legal rights– Not knowing about rights– Fear, stigma – Language barriers– inappropriate, ill-adapted services

Factors potentially affecting health at destination (2)

Inadequate living & working conditions (for some)– Dirty, dangerous and

degrading work or working conditions

– Vulnerability to abuses, especially for irregular migrants

• Or working below one’s level of qualification

Pictures: from Thomas, Haour-Knipe, Aggleton (Eds) ‘Mobility, Sexuality and AIDS’, 2010

Outline

• International migration today

• Phases of the migration process, and health effects

• Policy and legal frameworks affecting migrants’ health

• Challenges and needs

Destination countries: confrontation between migration trends & migration

policies

• Lopsided demographic patterns will persist

• Growing legal & administrative barriers

Policy and legal frameworks affecting migrants’ health

• Traditional approach: disease control & containment

• Human rights approach to health– Some rights universal, regardless of migration status– Several legally binding international human rights treaties signed– Basic components

• equality & non-discrimination• active and informed participation of individuals & communities• sustained focus on most vulnerable & marginalized • Effective accountability mechanisms

Concerted global efforts towards policy change re migrant health

• Migration moving into social equity discourse

• Specific promises re migrants and HIV

• Migrants direct or indirect focus of WHA resolutions

• Several European projects on migrant health

Outline

• International migration today

• Phases of the migration process, and health effects

• Policy and legal frameworks affecting migrants’ health

• Challenges and needs

Case study: HIV-related travel restrictions

• Established as soon as HIV test became available – U.S. followed by many other countries

• Arguments– Control and containment– Potential cost to host country

• Activism• Issue became latent

– Approx. 60 countries with restrictions (total, partial)

• Global task force established– Involvement of IAS, some Governments, Global Fund– U.S. removed restrictions Jan. 2010

Lessons suggested

• Difference between laws, policy and practice!

• Difficulties gathering good data

• Important role of activists… but in alliance with others

• Tension: – Rights & access for all – Limited resources: who should get them?

Migration & right to health: other challenges & needs (1)

• Better data on– migrants health– access to health services

• Creating linkages / building bridges between – Countries, regions– Sectors

• On broad spectrum of health issues beyond infectious diseases

• Linking with wider focus on social equity – Nationals (policy makers, care givers etc) & migrant groups

Other challenges & needs (2)

• Tension between access for all and deciding how to distribute limited resources becomes worse during economic downturns…

• Leadership & advocacy– Creative thinking– Models of what works

Thank you!