Health Barriers for Migrants
Migrants and mobile populations face many barriers in accessing equitable, essential health care services due to factors such as living and working conditions, education level, gender, irregular migration status, language and cultural differences, anti-migrant sentiments, and lack of migrant-inclusive health policies, among others.
Migration is a social determinant of health that can impact the well-being of an individual, as well as the community at large. Most migrants are healthy and young, and migration can improve the health status of migrants and their families through providing a safer haven or better education and purchasing power for ‘left behind’ family members, thanks to remittances. However, the migration process can also expose migrants to health risks and many migrants lack access to adequate, equitable health services and financial protection. Health systems may not have sufficient capacity to manage migrant health needs especially in the case of large movements. Furthermore, human mobility, whether resulting from migration or international travel can be a critical factor in the spread of disease and/or a challenge to controlling it.
While few countries collect sufficiently disaggregated data on the health of migrants, population movements “generally render migrants more vulnerable to health risks and expose them to potential hazards and greater stress”. Key risk factors in the migration process include poverty, poor and dangerous working conditions, limited access to health-care services, and social exclusion, among other factors.
Recent global events have brought unprecedented challenges and new crises, highlighting the indisputable association between population mobility and human and health security, along with paramount concerns for basic human rights, global public health, and the need for collaborative action amongst multi-sector stakeholders to affect change and avert unnecessary and avoidable deaths.
Many of the threats and challenges of diseases epidemics, or the vulnerability of migrants, result from the intersection of travel, population mobility and significant disparities in health.
In many parts of Asia, information on communicable diseases among mobile and migrant populations is not available in regular health surveillance reporting, as this surveillance does not provide disaggregated data on migrants.
Specific data on migrants’ health may not be readily available, and data collection tools not standardized, and thus it is difficult to compare the information at regional level, harmonize systems and policies, and prepare for rapid and effective responses that are inclusive.
As many governments in Asia continue working towards greater ease of travel across borders, improvement of road infrastructure, growing cross-border trade, increasing private investment and construction activities, etc., the possible health and disease impacts on mobile and migrant populations (MMPs) need to be addressed collaboratively at a broader, regional level, through platforms such as JUNIMA.
In the face of continued globalization, climate change and ongoing political instability, it is anticipated that the size and scale of migration will continue to increase. The health needs of migrant populations are considerable and merit greater attention for several reasons:
Healthy migrants contribute to positive development outcomes;
Health promotion and disease prevention among migrants contributes to overall public health;
Migrants have a right to health.
MIGRANT HEALTH IN SOUTHEAST ASIA
The search for a better life and economic opportunities within and outside Southeast Asia continues to be the primary reason for migratory movements in the region. The potential for a more integrated, interdependent regional market among countries in the Association of Southeast Asian Nations (ASEAN) helped to drive the momentum towards the establishment of the ASEAN Economic Community in 2015. Throughout Southeast Asia, governments have been working to more effectively regulate the movement of professionals and migrant workers, while also ensuring better protection of low-skilled labourers. Cognizant of growing cross-border, intraregional and interregional mobility, governments and key actors alike are acknowledging the need to enhance migration management and increase bilateral and multilateral dialogue and cooperation, through multi-sector platforms such as JUNIMA.
The region as a whole does not have reliable longitudinal data for disease trends. However, evidence from studies of disease prevalence shows a strong inverse association with national wealth, which can be largely attributed to the social determinants of health, including the provision of more efficient health systems with greater population coverage. Migration-related public health challenges continue to be a concern for governments, particularly with emerging and re-emerging infectious diseases such as tuberculosis, HIV and malaria.
All Southeast Asian countries are members of ASEAN, with the exception of Timor-Leste, whose membership application is currently under consideration. The sub-region has an aggregate nominal GDP of USD 2.4 trillion, presently the sixth-largest economy in the world and projected to become the fourth-largest after the European Union, the United States and China by 2030. Unlike rapidly aging East Asia, the median age in Southeast Asia remains one of the world’s youngest and the working age population is not expected to decline until 2055.
Movements within the region mainly involve temporary and/or undocumented migrants, with most employed in low- and semi-skilled work places in the informal sector. Rural to urban migration is one of the major factors behind rapid urbanization in the region. Against the backdrop of these trends, governments in the sub-region have increased their cooperation around labour mobility through bilateral arrangements, various steps taken by ASEAN to promote the protection of migrant workers, and initiatives towards freer movement of skilled labour under the ASEAN Economic Community blueprint. While building on these gains, there is a pressing need for increasing the protection of migrant workers by developing more efficient and transparent legal channels of labour mobility, especially in the low-skilled sectors, and promoting greater private sector engagement in addressing forced labour and human trafficking in labour supply chains.
Governments and partners are also increasingly recognising the critical importance of migrants’ inclusion within national health systems, but acknowledge that they have limited capacity, knowledge and resources. Technical and operational support is needed, along with resources on how to systematically address the challenges involved.
MIGRANT HEALTH IN SOUTH ASIA
South Asia is home to 1.8 billion people or approximately 25 per cent of the global population, and is presently one of the fastest growing developing sub-regions in the world. By 2050, it is projected that three-quarters of all population growth in Asia and the Pacific will occur in South and Southwest Asia, making the sub-region home to the largest workforce in the world.
With over 15.6 per cent of international migrants (an estimated 36 million people) and more than 2 million people migrating annually, internal and cross-border migration is likely to continue to increase as South Asia experiences a youth bulge. A long-standing major geographic region of origin for migrants, South Asia is now increasingly associated with transit and final destination. According to IOM, by 2050, South Asia will have the largest workforce in the world. Despite many positive outcomes for both migrants and origin and destination countries, the individual and social costs of migration are high, including lack of decent work, exposure to health risks, deaths among migrants from this sub-region, and families left behind. Given the highly commercialized recruitment processes in which some agencies circumvent regulations intended to protect migrants, the causes of the abovementioned vulnerabilities also include malpractice involving high fees and misrepresentation of the jobs on offer, contract substitution, low wages, and a heavy debt burden on migrants.
There is a pressing need to address the health of migrants and their families along the mobility continuum, from pre-departure to destination and upon eventual return. There is also a pressing need to promote private sector engagement especially in relation to adopting ethical recruitment practices, reinforcing migrants’ awareness of their rights, including the right to health, and supporting their access to remedies in case of rights violations, among other safe migration practices.