Italian National Focal point

Infectious Diseases and Migration

ISS 17.2. 2015

Migrazione e salute: l’impatto della crisi

economica nelle politiche e nei sistemi sanitari

della Regione Europea dell’OMS

Dr. Santino Severoni MD. MHE

Coordinator Public Health and Migration

Division of Policy and Governance for Health and Well-being

European Office for Investment for Health and Development

WHO Regional Office for Europe

Venice, Italy

sev@euro.who.int

http;//www.euro.who.int

Data, perceptions and facts

• European Region undergoing important demographic and epidemiological changes

• 214 mil International migrants • (3% of global population UNPD data)

• 740 mil. Internal migrants (UNPD data)

• 8% of the WHO European Region’s total population are migrants

• Political and communication sensitivity

The maps of European Parties against integration From Corriere della Sera 29-11-

2013

• Variation in GDP/person/year (2009):

- Tajikistan $ 1,900 [rank192]

- Luxembourg $ 104,000 [rank 3]

77 million migrants in WHO EURO Region, (36% of global migrants population)

WHO European Region

53 Member States,

886 million people

Migration associated with emergency situation

• Recurrent phenomenon in the WHO EURO Region

• The health risks related to migration process associated with emergency or crises situations are not fully studied/addressed despite the growing number and intensity of these types of events

• Main causes: conflicts, economic crises, natural and manmade disasters, climate changes

Increased migration

Belarus

Moldova

Ukraine

Armenia

Azerbaijan

Georgia

Kazakhstan

Population movements

Cambiamenti demografici

Migration and economic financial crises the pre-crisis period: migration as an asset for development

In the middle of the 2000s,

• Migration, asset for development, was elevated to the highest international level, becoming part of the United Nations agenda

• 2006, High Level Dialogue on Migration and Development under the auspices of UN General Assembly and Global Commission Migration Development

Migration as an asset for development

Over the two decades preceding the global crisis:

financial flows from migrants in developed countries to

developing nations:

• $31 billion in 1990

• $77 billion in 2000

• $336 billion in 2008

Migration as an asset for development

• 5.1 Mill migrants in Italy

• In 2011 State incum taxes paid by migrants,

13.3 billions euro

• State expenditure for migration management,

11.9 billions

• Net balance, 1.4 billions

Source: Dossier Statistico Immigrazione 2013 (Idos-Unar)

Migration and economic financial crises

• affected all the regions of the world

• provoked new debates

on the effects of

migration on nations

Migration and the impact of the crises

• Most countries resorted measures to reducing inflow of migrants, restricting entry conditions and cutting the number of migrants

• Italy, UK, Spain, and Russia, lowering the quota for labour migrants was applied as a crisis containment measure

• Norway, Ireland, Czech Republic, employment procedures were revised to favour local workers

• Spain, Czech Republic, France introduced financial bonuses for migrants to return home ("pay-to go")

Switzerland, won the vote against

immigrants

The federal government

has said yes to the

referendum to limit

foreign workers

Population perception can influence public opinion and politics

the case of Venice….

Undocumented Migrants’ Access to Medical Care in

European

Access only to emergency

services

Austria, Bulgaria, Cyprus, Czech Republic,

Denmark, Germany, Greece, Estonia,

Finland, Hungary, Ireland, Latvia,

Lithuania, Luxembourg, Malta, Poland,

Romania, Slovak Republic, Slovenia

Greater access to some services

or for some categories of

undocumented migrants

Belgium, Italy, Norway, and the United

Kingdom

Full access under specified

conditions

France, Netherlands, Portugal, Spain^,

Switzerland, Sweden

Degree of access Countries

Why Health & Migration matter to public health Health system access

………Border control spending in Europe is 20

higher than spending for assistance to

asylum seekers…… Nils Muiznieks, EU Commissioner for Human Rights

Legal framework for health care access

• Key question is the legal provision of access to health care for

undocumented migrants

• Documented migrants are entitled to access the health care system, (with specific rules depending on their legal status as permanent settlers, temporary workers, refugees, asylum seekers, etc)

Health & Migration a multy-sector agenda

• Ministry of Interior

• Ministry of Labour

• Ministry of Social affairs

• Ministry of Foreign Affairs

• Ministry of Education

• Ministry of Health

Policy implications

Health Access Security

measures

Human Rights National

Regulations

Public Health approach

HEALTH ISSUES STEMMING from MIGRATION

• Migration policy and integration

• Access to health services and overcoming health system access barriers (cultural, social and linguistic)

• Health System capacity & Economic impact

• State of health of migrants: changing health profile, CD & NCD, re-emerging neglected diseases

• Health risk assessment, expose to hazards and public health implication for migrants and resident community

• Screening guidelines

• SOPs on immunization, TB continuity of care, etc

• Public health data collection/generation

• Health system structural setting

Public health data problem, collection/generation

Main challenges

•High mobility

•Undocumented persons

•Health system barriers

•Variety of health service providers (NHS, NGOs)

•No routine collection of data in NHS on migration

variables

•incompatibility of sources, as well as

conceptual and definitional problems

Denominator?

What actions are we taking

MIGRANTS HEALTH SYSTEMS

Address migrants’ special vulnerabilities and health-care needs

Services that are migrant sensitive

Financial protection mechanisms

Workplaces employing migrants provide basic occupational health services

To define minimum package of health services and goods

STRATEGIES FOR IMPROVING HEALTH OF MIGRANTS in the WHO REGION

Advocacy and policy development

Assessment, research and information dissemination

Capacity building

Thank You!

To subscribe to the WHO Health and Migration

Newsletter:

www.euro.who.int/en/health-topic/health-

determinants/migration-and-health/phame-newsletter