The basic principles of migration health: Population mobility and gaps in disease prevalence

Currently, migrants and other mobile individuals, such as migrant workers and asylum seekers, are an expanding global population of growing social, demographic and political importance. Disparities often exist between a migrant population's place of origin and its destination, particularly with relation to health determinants. The effects of those disparities can be observed at both individual and population levels. Migration across health and disease disparities influences the epidemiology of certain diseases globally and in nations receiving migrants. While specific disease-based outcomes may vary between migrant group and location, general epidemiological principles may be applied to any situation where numbers of individuals move between differences in disease prevalence. Traditionally, migration health activities have been designed for national application and lack an integrated international perspective. Present and future health challenges related to migration may be more effectively addressed through collaborative global undertakings. This paper reviews the epidemiological relationships resulting from health disparities bridged by migration and describes the growing role of migration and population mobility in global disease epidemiology. The implications for national and international health policy and program planning are presented.     

Access to health care for migrants returning to Mexico

Continued migration from Mexico over the past several decades has created a large population of elderly Mexicans in the U.S. There is no system in Mexico for those Mexicans who would like to retire there to obtain health insurance during their retirement years. Using a nationally representative dataset of Mexican elders, we explore the current state of health insurance status for Mexican elders with a history of migration to the U.S. We find a robust negative association between years spent in the U.S. and the probability of being insured. Coordination between the U.S. and Mexico on policy options to insure Mexicans migrants may prove beneficial to the social security systems in both countries as well as to migrants themselves.     

International migration and control of communicable diseases

The epidemiology and policy implications of communicable disease (CD) transmission associated with international migration have received little systematic study. This is a review of clinical and epidemiological reports in search of strategies to assess and manage the impact of international migration on the transmission of CDs. The economics and demography of migration from less developed to industrialized nations is considered. Migration-related transmission should differentiate between actual transmission as opposed to geographic relocation of disease. Limitations of current screening and disease prevention strategies are discussed. Social and ecological processes through which migration can contribute to increased CD transmission are described, including placement in refugee camps, unclear legal status of migrants in recipient nations, and temporary return migration. Strategies for non-discriminatory and non-punitive control of migration-related CDs, needed changes in clinical practice, and complexities presented by CDs of long latency (such as HIV infection) are reviewed.     

Displacement and disease: The Shan exodus and infectious disease implications for Thailand

Decades of neglect and abuses by the Burmese government have decimated the health of the peoples of Burma, particularly along her eastern frontiers, overwhelmingly populated by ethnic minorities such as the Shan. Vast areas of traditional Shan homelands have been systematically depopulated by the Burmese military regime as part of its counter-insurgency policy, which also employs widespread abuses of civilians by Burmese soldiers, including rape, torture, and extrajudicial executions. These abuses, coupled with Burmese government economic mismanagement which has further entrenched already pervasive poverty in rural Burma, have spawned a humanitarian catastrophe, forcing hundreds of thousands of ethnic Shan villagers to flee their homes for Thailand. In Thailand, they are denied refugee status and its legal protections, living at constant risk for arrest and deportation. Classified as "economic migrants," many are forced to work in exploitative conditions, including in the Thai sex industry, and Shan migrants often lack access to basic health services in Thailand. Available health data on Shan migrants in Thailand already indicates that this population bears a disproportionately high burden of infectious diseases, particularly HIV, tuberculosis, lymphatic filariasis, and some vaccine-preventable illnesses, undermining progress made by Thailand's public health system in controlling such entities. The ongoing failure to address the root political causes of migration and poor health in eastern Burma, coupled with the many barriers to accessing health programs in Thailand by undocumented migrants, particularly the Shan, virtually guarantees Thailand's inability to sustainably control many infectious disease entities, especially along her borders with Burma.     

Impact of migration on illness experience and help-seeking strategies of patients from Turkey and Bosnia in primary health care in Basel

Migration, particularly among refugees and asylum seekers, poses many challenges to the health system of host countries. This study examined the impact of migration history on illness experience, its meaning and help-seeking strategies of migrant patients from Bosnia and Turkey with a range of common health problems in general practice in Basel, Switzerland. The Explanatory Model Interview Catalogue, a data collection instrument for cross-cultural research which combines epidemiological and ethnographic research approaches, was used in semi-structured one-to-one patient interviews. Bosnian patients (n=36) who had more traumatic migration experiences than Turkish/Kurdish (n=62) or Swiss internal migrants (n=48) reported a larger number of health problems than the other groups. Psychological distress was reported most frequently by all three groups in response to focussed queries, but spontaneously reported symptoms indicated the prominence of somatic, rather than psychological or psychosocial, problems. Among Bosnians, 78% identified traumatic migration experiences as a cause of their illness, in addition to a range of psychological and biomedical causes. Help-seeking strategies for the current illness included a wide range of treatments, such as basic medical care at private surgeries, outpatients department in hospitals as well as alternative medical treatments among all groups. Findings provide a useful guide to clinicians who work with migrants and should inform policy in medical care, information and health promotion for migrants in Switzerland as well as further education of health professionals on issues concerning migrants health.     

Health promotion for older people in the Czech Republic in a European perspective

This article describes health promotion for older people in the Czech Republic from the European perspective. It is based on findings from the European project healthPROelderly. Implementation of health promotion in the Czech republic as a new public health concept is outlined from the historical point of view. Structures and processes of health promotion in the Czech Republic are described in the context of social policy, demography and health. The European project healthPROelderly is presented and the outcomes of an international literature search statistically analysed. Participating countries were divided into three macro-regions according to their geographical location and political and historical tradition - Mediterranean, West-European and formerly East-European macro-regions. The outcome of correspondence analysis partially confirms the hypothesis on the cultural background of the health promotion activities and strategies. Concerning themes addressed by health promotion projects most countries belonging to the Mediterranean or "Western European" macro-regions have concentrated on similar themes whereas this is not valid for the countries of the "Former Eastern European" macro-region. The hypothesis on macro-regional similarities in relation to settings of health promotion projects was not confirmed. In the conclusions the location of the Czech Republic in an international perspective is discussed and three Czech selected best practice projects are evaluated in relation to the statistical findings.     

The role of wages in the migration of health care professionals from developing countries

Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries - especially within Africa - the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows.This paper uses data on wage differentials in the health care sector between source country and receiving country (adjusted for purchasing power parity) to test the hypothesis that larger wage differentials lead to a larger supply of health care migrants. Differences in other important factors affecting migration are discussed and, where available, data are presented.There is little correlation between the supply of health care migrants and the size of the wage differential between source and destination country. In cases where data are available on other factors affecting migration, controlling for these factors does not affect the result.At current levels, wage differentials between source and destination country are so large that small increases in health care wages in source countries are unlikely to affect significantly the supply of health care migrants. The results suggest that non-wage instruments might be more effective in altering migration flows.     

Glossary: migration and health

The literature on migration and health is quite heterogeneous in how migrants are labelled and how the relation between migration and health is conceptualised. A narrative review has been carried out. This glossary presents the most commonly used terms in the field of migration and health, along with synonyms and related concepts, and discusses the suitability of their use in epidemiological studies. The terminology used in migrant health is ambiguous in many cases. Studies on migrant health should avoid layman terms and strive to use internationally defined concepts.     

Exploring perceptions of HIV risk and health service access among Zimbabwean migrant women in Johannesburg: a gap in health policy in South Africa?

We present qualitative data from a 2005 exploratory study, recently published studies, and an analysis of the Department of Health's strategic plan to highlight the need for a broader policy debate on health-care access for migrants in South Africa. We conducted in-depth interviews with 15 Zimbabwean women living in inner-city Johannesburg to document the special characteristics of this group of migrants, enquiring about their perceptions of HIV risk, and experiences of health services in South Africa. We identified access barriers, namely perceptions of relatively low HIV risk, severely constrained financial circumstances, uncertain legal status, and experiences of unresponsive health workers. We recommend that migrant-health rights be placed on South Africa's policy agenda, migrants be included in HIV prevention programs and that health workers be sensitized to the needs of migrants.     

Corporate governance in Czech hospitals after the transformation

BackgroundThis contribution is a response to the current issue of corporate governance in hospitals in the Czech Republic, which draw a significant portion of funds from public health insurance. This not only has a significant impact on the economic efficiency of hospitals, but ultimately affects the whole system of healthcare provision in the Czech Republic. Therefore, the effectiveness of the corporate governance of hospitals might affect the fiscal stability of the health system and, indirectly, health policy for the whole country.ObjectivesThe main objective of this paper is to evaluate the success of the transformation in connection with the performance of corporate governance in hospitals in the Czech Republic. Specifically, there was an examination of the management differences in various types of hospitals, which differed in their ownership structure and legal form.Methodology/ApproachA sample of 100 hospitals was investigated in 2009, i.e., immediately after the transformation had been completed, and then three years later in 2012.With regard to the different public support of individual hospitals, the operating subsidies were removed from the economic results of the corporations in the sample. The adjusted economic results were first of all examined in relationship to the type of hospital (according to owner and legal form), and then in relation to its size, the size of the supervisory board and the education level of the senior hospital manager. A multiple median regression was used for the evaluation.FindingsOne of the basic findings was the fact that the hospital's legal form had no influence on economic results. Successful management in the form of adjusted economic results is only associated with the private type of facility ownership. From the perspective of our concept of corporate governance other factors were under observation: the size of the hospital, the size of the supervisory board and the medical qualifications of the senior manager had no statistically verifiable influence on the efficiency of the hospital management, though we did record certain developments as a result of the transformation process. The economic results that were reported were significantly distorted by the operating subsidies from the founder.Practical ImplicationsThe results can be used immediately on several practical levels: on the macro level as part of the state's formulation of health policy, particularly in the optimization of the structure of healthcare providers, as well as for the completion of reforms in legal forms and hospital founders, and on the micro level as part of the effective administration and governance of hospitals through corporate governance regardless of the form of ownership.     

Violence Committed Against Migrants in Transit: Experiences on the Northern Mexican Border

Thousands of Mexican and Central American migrants converge at the Mexico-United States border. Undocumented migrants in transit to the United States are vulnerable due to their lack of access to health care and legal assistance. This study attempts to provide evidence on the violent-related consequences that migration has on migrants. A mixed-method study was conducted between April 2006-May 2007 in shelters in Baja California, Mexicali and Tijuana, Mexico. 22 in depth interviews were performed and fifteen hundred and twelve migrants responded a questionnaire. Results from both in-depth interviews and the analysis of the quantitative data shows the different types of violence experiences by migrants which include threats, verbal abuse, and arbitrary detention based on ethnicity, as well as assaults, beatings and sexual violence. It is crucial to stress the importance and the need to evidence the condition in which migrants’ transit to the US and to effectively respond to the violence they experience.     

Health care provision for illegal migrants: may health policy make a difference?

Illegal migrants in Europe are, generally, only entitled to emergency care and services for children and pregnant women. In 2002 legal changes in Spain made accessible medical cards and free medical care for illegal migrants in similar terms than the legal migrants or the Spanish population. We interviewed 380 migrants to assess whether there were differences on health services utilization by legal status. We did not find differences in the utilization of health services when ill between legal and illegal migrants. However, a significantly lower utilization of health services was associated with less education (RP = 0.4; 95% CI: 0.2-0.9).     

Migration und Gesundheit

The article provides an overview of the contemporary literature on the social and psychological factors which are associated with migration. Derived from the operationalisation of "migration" and an examination of the methodological peculiarities of migration research, a (transactional) stress model of migration is proposed incorporating potentially stress-eliciting influences of migration including occupational pressures, social isolation and/or family-related problems and their impact on psychological and physical health. There are inconsistencies in the findings regarding psychological health, which can in part be explained through the phenomena of the "healthy migrant effect", duration of stay in the host culture or the culture-specificity. Moreover, a discussion is provided of the extent that disorders associated with differentially stressed migrants will be manifested in the health care system. Finally, concluding remarks are offered together with a short discussion of the implication of these findings for future research and social and health policy decision-making.     

Editorial ‐Left out,left off,left over: Why migrants from non‐English speaking backgrounds are not adequately recognised in health promotion policy and programs

Australia has a long history of migration. Up to 1945 there was a ‘white Australia’ policy, which changed to accepting a more diverse migrant pool, including forced migrants (e.g. refugees). There is increasingly a need to understand and cater for the specific health needs of migrants, especially those from non‐English speaking (NES) backgrounds, many of whom are not adequately recognised in population health planning. The vast increase in investment in prevention and health promotion may not cater for their needs without their participation in research and planning. Below we discuss the main five challenges.     

Test of the 'healthy migrant hypothesis': a longitudinal analysis of health selectivity of internal migration in Indonesia

Previous studies show migrants are generally healthier than the populations in receiving societies, a result generally attributed to the positive selection of migrants on health. This hypothesis, however, has not been adequately evaluated due to lack of adequate data. In this article, using high-quality longitudinal data from Indonesia, the health selectivity hypothesis, also referred to as the healthy migrant hypothesis, is examined with respect to internal migration. Specifically, this study explores whether pre-migration health status affects the likelihood of migration by comparing those from the sending population who do and do not move. Results show that migrants in Indonesia tend to be selected with respect to health and that this selection is robust to household unobserved heterogeneity. However, the strength and direction of the health-migration association vary by types of migration and dimensions of health.     

Migration and health: fact, fiction, art, politics

The recent Immigration Bill debate in the United States Congress has again re-ignited the polemic regarding immigration policy. In this essay, I argue that disputes surrounding the legality of migrant workers highlight chronic, underlying problems related to factors that drive migration. The public health field, although concerned primarily with addressing the health needs of migrant populations, cannot remain disengaged from the wider debates about migration. The health needs of migrants, although in themselves important, are merely symptoms of deeper structural process that are intrinsically linked to equity and human rights, and simply focusing on health issues will be insufficient to address these societal pathologies.     

Impacts of migration on health and well-being in later life in China: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Unprecedented internal migration to urban areas has happened in China over the last few decades. While, we know that migration has a bidirectional relationship with health, this relationship has only been studied to a limited extent in China. In particular, the exiting literature has neglected the effects of migration on health and well-being in later life, instead focusing on the relationship between these outcomes over the short term, and also have only focused on temporary rural-to-urban migrants with a rural hukou rather than the broader range of internal migration flows. The hukou system, also known as the Chinese household system, an institutional feature with the power to restrict population mobility and access to local welfare resources.Using an inter-disciplinary approach, drawing on literature from economics, epidemiology and sociology, this paper conceptualises and examines the association between different forms of internal migration and their relationship with later-life health and well-being in China. It then attempts to draw conclusions on likely mechanisms through which migration affects health and well-being, including taking account of the selective nature of migration. To do this, we use the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative and multi-disciplinary dataset that examines the circumstances of the Chinese population aged over 45 years old.The results show that there are strong associations between migration status and later life health and well-being in China, with migrants to or within urban areas report the greatest health. Even after controlling for the selective nature of migration and other post-migration factors, there is still an unexplained, positive and statistically significant association between temporary rural-to-urban migration and depression scores. In addition, there are no differences between rural-to-rural migrants and rural non-migrants across all models. In terms of relevant mechanisms, selection of migrants seems to be particularly important in explaining the health and mental health differences between non-migrants and migrants to or within urban areas. Current socioeconomic circumstances and post-migration adaptation also explain some health differences between migrant groups and non-migrants.     

Local understandings of, and responses to, HIV: rural-urban migrants in Tanzania

Migration is an important process of change for rural populations in developing countries. Migration is a primary cause of behaviour change-by their very act of migrating, migrants are different from those who do not migrate. The focus of the current study is male rural-urban migration in Tanzania and its interaction with sexual behaviour. The analysis presents results from a comparison with individual-level analyses of two populations, one (composed of recent rural-urban migrants) in an urban area and one made up of residents in a rural area. Detailed migration histories (n=96 rural-urban migrants) and in-depth interviews form the basis of the analysis. Three key research questions are addressed: How does the sexual behaviour of migrants differ from that of rural residents? How do HIV knowledge levels vary between rural-urban migrants and rural residents? What factors are associated with either intentions of behaviour change or reported behaviour? The results are counter-intuitive: rural-urban migrants-both married and unmarried-are not having sex in town. Despite limited understanding of the nature of HIV, the migrant population studied here regulates its behaviour in a way that reflects local understandings of the disease. This finding is important, not least because it challenges the view that HIV in sub-Saharan Africa is largely transmitted to rural areas by return migrants. Maasai rural-urban migrants in Tanzania-both married and unmarried-are not having sex in town. The policy and service provision implications of the results are explored.