Friday, May 27, 2011

[EQ] Migration and Health: A Framework for 21st Century Policy-Making

Migration and Health: A Framework for 21st Century Policy-Making

Cathy Zimmerman, Ligia Kiss, Mazeda Hossain

Gender Violence & Health Centre, Social and Mathematical Epidemiology Group, Department of Global Health & Development,
London School of Hygiene & Tropical Medicine, London, United Kingdom

PLoS Med 8(5): e1001034. doi:10.1371/journal.pmed.1001034 – May 2011

Available online at:


“……With an estimated 214 million people on the move internationally and approximately three-quarters of a billion people migrating within their own country, there can be little doubt that population mobility is among the leading policy issues of the 21st century [1]–[3]. Human migration is not a new phenomenon, but it has changed significantly in number and nature with the growth of globalization, including the ease of international transport and communication, the push and pull factors of shifting capital, effects of climate change, and periodic political upheaval, including armed conflict.


As a result, migrant networks that facilitate mobility and circular migration, in particular, have expanded in unprecedented ways [4],[5]. Yet, there has not been commensurate development of coordinated policy approaches to address the health implications associated with modern migration. Internationally, policy-making on migration has generally been conducted from policy sector “silos” (e.g., international aid, security, immigration enforcement, trade, and labor) that rarely include the health sector and which often have different, if not incompatible, goals [6],[7].


As discussions on “global migration governance” and “global health governance” expand, it will be increasingly important for policy-makers to engage in cross-sector coordination and move beyond narrow protectionist policy approaches, such as migrant-screening, and the simplistic view of migration as a one-way trajectory [8].


Health policy-making in the context of migration has generally been viewed either in terms of its “threats” to public health or from a rights-based approach that focuses on health hazards faced by individual migrants and the associated service challenges [9]. The former lens dates back to medieval quarantine measures and prioritizes public health security and communicable disease control, relying heavily on monitoring and screening (e.g., tuberculosis, pandemic flu). The rights-based perspective is more recent and grounded in medical ethics. It recognizes migrants' special vulnerability to, for example, interpersonal and occupational hazards, social exclusion, and discrimination, and the importance of universal access and culturally competent health care services [10]….”


            Summary Points:

- Migration is a global phenomenon that influences the health of individuals and populations.

- Policy-making on migration and health is conducted within sector silos that frequently have different goals. Population mobility is wholly compatible with health-promoting strategies for migrants if decision-makers coordinate across borders and policy sectors.

- Policies to protect migrant and public health will be most effective if they address the multiple phases of the migratory process, including pre-departure, travel, destination, interception, and return. Health intervention opportunities exist at each stage.

- This article forms the introduction to a PLoS Medicine series on Migration & Health, laying out a new framework for understanding the migratory process and the five phases of migration, which are discussed in depth in five subsequent articles.

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