Migration has always been a source of population growth in Europe, and in recent decades it has become the principal driver of urban growth throughout much of the EU, if not Europe in general. Given the continuing decline in fertility and the rapidly ageing nature of Europe’s domestic situation, migration can be expected to continue growing as a way of compensating for the loss of labour and taxpayers. Despite the importance of migration as an essential source of socioeconomic and demographic stability, however, health policy makers and planners have largely overlooked the complex nature of the migration process, and have failed to take into account its many positive and potentially negative health and healthcare implications. As a result relatively little is being done to promote and protect the health of the 40 or so million people who fit the definition of “migrant” living in and contributing to European social and economic development.
One of the outcomes of this benign neglect is that today relatively little is known about the health and health needs of migrants in Europe. One of the difficulties in understanding the phenomenon better is that the term migrant covers a variety of people on the move, including refugees, asylum seekers, legal and undocumented economic migrants. The backgrounds and migration histories of these different groups are sufficiently distinct that aggregating them under one single rubric can be misleading, and more must be done to look at them as distinct entities. What is nevertheless beginning to be understood, however, is that the process of uprooting, transition through other countries before finally trying to integrate into societies of final destination is replete with potential health pitfalls. Thus despite the fact that most migrants tend to be young and relatively healthy when they leave their countries of origin, the movement itself and the social conditions in which they are ultimately received, housed, and expected to work, can quickly erode whatever good health they originally enjoyed.
Migrants appear to be at greater risk of both communicable and non-communicable diseases than the national populations that host them. Some of these diseases, such as TB, have always been associated with people moving from poor socioeconomic backgrounds, but there is growing evidence that a proportion of the new cases that are reported well after arrival in host countries are the products of the housing conditions and poor overall quality of life many low income migrants are exposed to in the countries of resettlement. The high rates of viral hepatitis seen in some migrant groups may be much more a product of where migrants came from, but again there is also a suggestion that much of the hepatitis B seen in some migrant groups is being transmitted after they arrive.
Non communicable diseases are also a major challenge to migrants. Mental health indicators are consistently poor and because migrants come from cultures that are often poorly or not at all understood by healthcare providers, misdiagnosis and inappropriate treatment remains a major problem. For a mixture of reasons, migrants also seem to have a high risk of developing obesity and type 2 diabetes. When they do develop these and other diseases, moreover, migrants tend to have worse outcomes, suggesting that they may have greater difficulty dealing with their problems because of a lack of familiarity with local healthcare systems and treatment cultures.
Manuel Carballo is the executive director of the International Centre for Migration, Health and Development, Geneva, Switzerland.