Elsevier

The Lancet

Volume 381, Issue 9873, 6–12 April 2013, Pages 1235-1245
The Lancet

Series
Migration and health in an increasingly diverse Europe

https://doi.org/10.1016/S0140-6736(12)62086-8Get rights and content

Summary

The share of migrants in European populations is substantial and growing, despite a slowdown in immigration after the global economic crisis. This paper describes key aspects of migration and health in Europe, including the scale of international migration, available data for migrant health, barriers to accessing health services, ways of improving health service provision to migrants, and migrant health policies that have been adopted across Europe. Improvement of migrant health and provision of access for migrants to appropriate health services is not without challenges, but knowledge about what steps need to be taken to achieve these aims is increasing.

Introduction

Europe needs migrants to make up for its shrinking birth rate but it seems increasingly unwilling to welcome them. This attitude was all too apparent from the way in which the flight of migrants from the upheaval in north Africa in spring, 2011, led to the reinstatement of national passport controls in the European Union (EU) and political wrangling over so-called burden-sharing schemes.1 Although accounting for only a small share of migrants to Europe and taking place at a particular moment of time, these reactions illustrate the politically loaded nature of migration. Indeed, since the 1990s, many European countries have witnessed political backlash over immigration, with a particularly hostile reception for asylum-seekers and a rise in anti-Muslim rhetoric. Anti-immigrant parties have made electoral gains in several countries, while France made headlines by establishing a Ministry of Immigration, Integration, National Identity and Codevelopment of France and deporting Roma originating from central and eastern Europe.2 Worryingly, the deaths of migrants trying to reach Europe every year, reaching about 2000 in 2011,3 do not make headlines any more.

Key messages

  • Migrants make up a growing share of European populations, but immigration is politically controversial and the need for continued immigration to Europe is still poorly recognised.

  • Although some exceptions exist, most health information systems in Europe still have a long way to go to improve data collection for the health differences between migrants and non-migrants. Improvements in this respect will be crucial to assess health disparities and improve equity of service provision.

  • Although migrants are often, at least initially, relatively healthy compared with the non-migrant population in the host country, available data suggest that they tend to be more vulnerable to certain communicable diseases, occupational health hazards, injuries, poor mental health, diabetes mellitus, and maternal and child health problems. Some groups might be at particular risk of non-communicable diseases arising from obesity and insufficient physical activity.

  • Undocumented migrants face the greatest problems in accessing health services and are expected to cover the full costs of their medical treatment in many European countries.

  • Legal entitlements need to be expanded, but health systems also need to become more migrant-friendly in other ways—eg, through overcoming language and cultural barriers, improving the competencies of health workers and organisations, and increasing the health literacy of migrants.

  • We argue that explicit migrant health policies are needed in all European countries with a substantial proportion of migrants in their population.

These attitudes contrast with the continued need for immigration, resulting from falling birth rates and ageing populations in many European societies. Although demand exists for migrant labour in many sectors, the health and social sectors are especially prominent, with migrants needed to fill both low-skilled jobs, such as those providing basic domestic care for sick and elderly people,4 and high-skilled positions. A shortage of about 1 million health workers in the EU is expected by 2020.5 This figure emphasises the crucial contributions that migrants make to the functioning of both health and long-term care systems in Europe—a fact that is often forgotten in misguided discussions about the perceived burden of migrants on European welfare systems.

Section snippets

Trends in international migration involving Europe

An international long-term migrant is defined by the UN as a “person who moves to a country other than that of his or her usual residence for a period of at least a year”.6 Europe, a source of emigrants to the USA, Canada, Australia, and other parts of the world in the 19th and first half of the 20th century, is now a net recipient of migrants. In 2010, an estimated 72·6 million migrants lived in the WHO European region, 5·1 million more than in 2005.7 This represented one in three of all

Data for the health of migrants

Information about the health of migrants in Europe is patchy,13, 14 which makes it difficult to monitor and improve migrant health.15, 16 Some of the greatest gaps in knowledge are in the former Soviet countries of the Commonwealth of Independent States. Health information systems in most European countries are generally not designed to identify people by migration status and the information collected in medical files rarely includes such information.17 The main exception, in many EU countries,

Health disparities

Most studies of migrant health focus on differences with the non-migrant population in the respective host countries. Migrants are often (at least initially) more healthy than non-migrant populations in their host countries (the so-called healthy migrant effect), not least because the act of migration usually requires those involved to be in good health. However, migrants do face particular health challenges, although some only become apparent after a lag period.

Where data for migrant health

Whom to compare migrants with?

Most studies of migrant health, including most of those mentioned previously, focus on disparities with the non-migrant population in the respective host countries, providing insights into differences in exposures and access to health services. However, this approach ignores how different factors affect migrants' health at different stages of their lives, preceding, accompanying, and after the migration process.71 By contrast, a life course approach acknowledges the strong temporal component in

Barriers to access to health services

One of the most fundamental barriers for migrants in accessing health services in Europe are inadequate legal entitlements and, where entitlements exist, mechanisms for ensuring that they are well known and respected in practice.79 The basic human right of access to health services has been enshrined in numerous international and European legal instruments, applicable to varying degrees to all countries in Europe. The 1946 WHO constitution first enunciated the right to health,80 and Article 12

Improvement of health service provision

Migrants should not be unduly disadvantaged in access to health services compared with the rest of the population. Although many of the broader determinants of health lie outside the narrow confines of health systems, they have an important part to play in making health services more accessible to migrants.94 One way of doing so is to provide migrants with information about health and the health system of their host country in their own language. Another is to address language barriers in

A call for action

Although this paper provides a broad overview of migrant health in Europe, it is important to recognise that there are huge gaps in available knowledge. Many countries do not collect registry or survey data for migrants and much of the migrant health research that is available has been done in only a few western European countries, such as England or the Netherlands.101 Research into migrant-related policies and entitlements for migrants has also been focused on western Europe or EU Member

Search strategy and selection criteria

This paper synthesises and updates findings from our study on Migration and Health in the European Union, which was undertaken by the European Observatory on Health Systems and Policies, the International Organization for Migration, and the European Public Health Association Section on Migrant and Ethnic Minority Health, in 2010–11. The study, reported elsewhere,31 brought together the latest available evidence for key aspects of health and migration in the European Union through a series of

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