This course will provide you with an overview of the most important health challenges facing the world today. You will gain insight into how challenges have changed over time, we will discuss the likely determinants of such changes and examine future projections. Successful international strategies and programs promoting human health will be highlighted and global health governance structures will be mapped and the role of the key actors explored.
10.2: Migrants and Health (S Tellier)
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An Introduction to Global Health
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From the lesson
Environment, Climate and Migration
In the fifth module we are looking at some great global crises that profoundly impact the health of populations, namely environment, climate change, and migration. We will examine the health acpect of these mega trends - how are they influencing and challenging policy, health systems, and the health of individuals in both low and high income countries?
Meet the Instructors
Flemming KonradsenProfessor, Director
Copenhagen School of Global Health
[MUSIC]
Hello, my name is Siri Tellier and I'm an external lecturer.
But the Copenhagen School of Global Health, and
the topic of this session is, migration.
When you hear the term migrants,
often discussions focus on one particular kind of migrant.
Migrants are actually a very varied group.
I've been a migrant most of my life.
Possibly you have too.
And therefore, what I would like to do in this section is to open up for
discussion about the different types of migrants and
analyze what their very different conditions are with respect to health,
including the frameworks that are in place to protect their health.
So let's begin with the term International migrants.
This is a term usually referring to persons
who are residing in countries other than their country of birth.
The number of International migrants was estimated to be 231 million in 2013 and
that was about 3% of the world population.
So it's not a very large proportion.
And in fact the proportion of total population has stayed rather
constant over the last decades.
And indeed if we go further back in history.
For example to the 19th Century,
several countries in Europe saw upto a third of their populations immigrate.
For example, to North America seeking better economic opportunities or
freedom from prosecution.
So international migration is not new.
And neither are the motivations which people have from migrating.
What is changing is the direction of the migration.
In recent decades, the proportion of international migrants
who migrate from less developed to more developed regions,
what on this slide is called South-to-North migration has increased.
But it's still only about a third of all migrants, that is 35%.
Another 34% migrate among countries in the south,
and 25% migrate among countries in the north.
So South-to-North migration is only a third
with respect to age composition, a large majority of international markets,
around 72%, are prime working ages from 20 to 64.
The median age is 39, which is actually a little bit older than the world average,
part of the reason for that is a statistical problem.
Children born to migrants in their country of destination are not counted as
international migrants in accordance with the definition that I just stated above.
However, on average, migrants are of working age and therefore also of
the age where economic productivity is high and health is realistically good.
The one issue where they may have more need for healthcare than other age groups
is reproductive healthcare, which is particularly concentrated at those ages.
However again it's national migrant is umbreliton covering
many different kinds of groups with very very different health situations and
protect the framework to help them with their health.
One of those groups is refugees.
The estimate by the United Nations is that there were about 20 million
as of the end of 2014, a number which has grown quite a bit since 2011.
There's a relatively well developed framework for protecting their health.
For example, the 1951 Refugee convention.
There are also organizations which are specifically charged with helping them
such as the UN High Commission for Refugees and
the United Nations Relief and Works Agency for Palestinian Refugees.
But otherwise,
they are fairly well addressed as it were in international frameworks.
Other groups include asylum seekers, that is people who have applied for
refugee status, and they are estimated at around 1 million.
These numbers are changing by the day, but that's what they are now.
And stateless people who are estimated at around 12 million people.
However, if we turn to undocumented migrants some of whom were trafficked.
They face very special challenges.
Numbers for trafficked persons vary with one recent estimate around 27 million.
Although trafficked person in principle are also protected
by special conventions and regional agreements.
They often live by the nature of their work,
under the radar with a little access to health care.
Similar considerations hold for others who are undocumented.
For example, some domestic workers who may be working in families
without the benefit of public workplace scrutiny.
And as mentioned in the beginning, international migration is not
very large scale, accounting for only about 3% of world population.
But let's now turn to internal migration within countries,
which is where you see enormous movements of migration.
The mega trend,
the sort of thing that works anything else, is rule to urban migration.
The world's population is predicted to increase from the present of just over
7 billion to around 9.6 billion by 2050.
However in more developed regions, the richest areas of the world that is,
both rural and urban population is expected to stagnate.
In less developed regions, the poor areas of the world,
rural population is also expected to stagnate or even to decrease.
But the population which is expected to grow dramatically
is urban populations of less developed countries.
In fact, almost all population growth in the next decades that is 2 billion people
is expected to happen in urban centers of less developed regions.
So then what are the health implications of this mega-shift?
And what are the implications for protecting the right to health?
One aspect is that, at present, about 1 billion or
one-third of world urban population is living in slums.
And many recent migrants to urban areas settle into those slums.
Not all slums are health hazards but, in terms of water and
sanitation, they can present great challenges.
Very different challenges from the more affluent areas,
often right next to each other, as in this photo.
Although such migrants who come from the rural areas to the urban areas,
in principle are protected by the laws of their country.
Some urban migrants are not covered by the same health and
education privileges as persons who are urban residents.
For example, that has been the case in China for
the rural to urban migrants who still retain their so-called, hukou.
That is identity card then they do not have the protection from the urban areas.
There are also other kinds of internal migrant who face special challenges.
The term internally displaced persons or
IDP's has received much attention in the last two decades.
Estimates are that as of the end of 2014,
there were close to 40 million persons internally displaced
within their own country only counting because of conflict or violence.
This conflict that they have experienced maybe with
the government of their own country.
And therefore, IDP's may not be willing or able
to seek protection from the government, including in the area of healthcare.
And although a set of guidelines has been developed two decades ago, and
although for example, the African Union has formalized those guidelines.
This group of people, the internally displaced persons,
remains very difficult to identify and to protect.
However, those displaced by conflict and
violence are not the only persons who are internally displaced.
Recently, in the last ten years or so, that has been increasing attention to
persons who have been displaced by disasters, either sudden onset such as
earthquakes or hurricanes, or slow onsets such as rising seawater or drought.
The term climigrants has been coined to refer to these persons.
Estimates from the Internal Displacement Monitoring Center,
is one the few that actually has numbers for these things, indicate that
around 42 million people were newly displaced by sudden onset disasters,
mostly weather related disasters, in 2010.
The numbers fluctuate from year to year and methodologies have yet
been developed, which makes projections very unstable.
For example, estimates from different organizations for
2050 projections that is, vary between 50 million and 20 times that many.
That is just to indicate the difficulties in estimating the number.
And makes any kind of action, planning very difficult to do.
But this is an area which could potentially have great impact
on future global health and what we do to protect.
It will be a question not only of what numbers are displaced, but
also the conditions to which they move.
For example, this is a photograph from Cotonou in Benin
showing the recent migrants who are settling in rather vulnerable housing
close to the water where they're exposed to slow-onset
rises in the water levels, as well as, sudden onset storms.
Where those who are more fortunate they live in safer housing up the hill.
Thus, to repeat my suggestion from the beginning of this session,
when considering the health of migrants, it's very important to recognize the great
differences which exist among the different groups of migrants.
And this is also reflected in their health conditions
as well as in the possibilities which we have to address their health.
It's also important to note that data on migrants are particularly challenging and
difficult to assemble.
It's just difficult to count somebody who has left.
There is great need for further research into the field and
I do hope that some of you will conduct such future research.
[MUSIC]
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