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The Complexities of Migration and Health

Monday, February 12, 2018   (0 Comments)
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Liliana Osorio, Deputy Director, Health Initiative of the Americas, UC Berkeley School of Public Health


Liliana is presenting on this topic at NWRPCA's Western Forum for Migrant and Community Health


Although migration is a natural phenomenon that has always been an integral part of human history, the politics, regulations and debates about migration have intensified in recent years. Moreover, when talking about migrant health it is quite common to find confusion and inconsistencies in the terminology used to refer to migrant populations, as well as misconceptions regarding their health issues.


For example, the term “migrant” is frequently used as a synonym for immigrant, migrant worker, farmworker, Latino, or undocumented migrant, when it may actually be referring to different populations or subpopulations with diverse health profiles.  In addition, countries and agencies use their own criteria to define migrants, based on their respective legislation and policies. Although there is not a universally accepted definition, the United Nations (UN) recommends defining an international migrant as a person who is living in a country other than his or her country of birth. It includes naturalized citizens, legal permanent residents, temporary resident visas for work or study, unauthorized immigrants, and refugees.


According to the UN, the number of international migrants has grown rapidly in recent years, reaching 258 million in 2017. People migrate for different reasons; some seek new job opportunities, a better life, family reunification. Others are forced to migrate, escaping from war, violence, discrimination, natural disasters, or unhealthy conditions. Historically, the United States has been a county of destination for migrants from all over the world. The latest statistics indicate that there were 43.7 million foreign-born persons in the U.S. in 2016, which is the equivalent to one out of eight U.S. residents. The foreign-born is a very diverse population in terms of race, language, religion, education, economic status, occupation, legal status, mobility patterns, and place of residence, making it increasingly more important to use caution when generalizing about the health of migrant populations.


No different from any other individual, the health of a migrant depends on a combination of factors known as the determinants of health. These determinants are complex and interrelated, and can be divided into several categories: biologic and hereditary factors, lifestyle, social and community networks, living and working conditions, access to healthcare, and general socioeconomic, cultural and environmental conditions.  In the case of migrants however, migration is another determinant of health that affects all the above-mentioned factors, across each phase of migration.


The migratory process has four main phases: 1) Pre-departure in the country of origin; 2) the journey or travel to the destination (this phase may involve one or more transit countries); 3) the post-journey or resettlement in the country of destination; and 4) the return to the country of origin (although this phase does not apply for all migrants). 

Disease prevalence in the country of origin, as well as socioeconomic status and living conditions, can be important determinants to the health of migrants. For example, if a migrant comes from a country with high prevalence of tuberculosis, there is a chance he/she would have been exposed to or acquired the disease, even if he/she is now living in a host country with lower prevalence of tuberculosis. The characteristics, circumstances, and length of the migratory journey can also affect the health of the individual. It is not the same to reach your destination by airplane, legal documents safely in hand, as it is to arrive by foot or by boat, smuggled through multiple countries while facing extreme hardship, danger, and adverse environmental conditions.


Culture and lifestyle also play a substantial role on the health outcomes of migrants—sometimes in their favor, sometimes not. A clear example is that many migrants have healthier diets than the native population in the host country, such as the U.S. For example, some migrants are less likely to use alcohol or drugs because of religious principles or cultural practices, protecting them from associated health risks. On the other hand, some migrants have cultural health practices that could negatively affect their health, such as female genital mutilation or the use of harmful traditional treatments.


In the country of destination there are several factors migrants have to cope with, making them more vulnerable in comparison to the native population. Legal status is one of the main factors, since governments usually deny or restrict social and human services, including access to health care, to non-citizens. Job opportunities are also more limited for undocumented migrants, oftentimes forcing them to take hard, dangerous, and underpaid jobs. The language barrier further exacerbates difficult conditions, negatively affecting their lives and their mental and physical health.


Migrants contribute to the economic growth and development in their countries of origin and destination, but without good health, migrants cannot provide for themselves, their family, and their communities. Addressing the health needs of the migrant population is a human right responsibility that will benefit all.




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