Hanefeld, J., Vearey, J. and Lunt, N. on behalf of the Researchers on Migration, Mobility and Health Group
The Lancet 2017; 389 2358-2359
With 1 billion people on the move globally—more than 244 million of whom have crossed international borders – and a recognised need to strengthen efforts towards universal health coverage, developing a better understanding of how to respond to the complex interactions between migration, mobility, and health is vital.
At the 2nd Global Consultation on Migrant Health in Sri Lanka earlier this year, a group of global experts in health and migration discussed the progress and shortfalls in attaining the actions set out in the 2008 World Health Assembly (WHA) Resolution on the Health of Migrants.
An anticipated outcome from the 2017 consultation is a “roadmap towards research and policy dialogue milestones”. At the 70th WHA in May, 2017, migration and health were discussed with delegates requesting the WHO’s Director-General to provide guidance to countries on promoting the health of refugees and migrants, with a draft global action to be considered at the 72nd WHA in 2019.
The specific challenges we have encountered in our fieldwork in migration contexts highlight the need for better evidence to improve health-system responses to migration, mobility, and health. We have identified five core areas in which action is needed to support the development of a global research agenda on migration, mobility, and health.
SAIIA Occasional Paper No 285, August 2018
This paper explores the potential risks associated with the blurring of global migration governance and health security agendas in Southern Africa, a region associated with high levels of population mobility, communicable, and – increasingly – non-communicable diseases.
The current development of the Global Compact on Safe, Orderly, and Regular Migration and the Global Compact on Refugees – agreements that aim to guide global practice – have a securitisation agenda at their core. This framing responds to the global moral panics associated with the movement of people across national borders; these increasingly nationalistic and racist panics are dangerous for multiple reasons, and the securitisation agendas of the Global Compacts risk negatively affecting health in Southern Africa in two ways.
Firstly, increasing securitisation may undermine much-needed efforts to develop migration-aware and mobility-competent cross-border, regional health system responses. Concerns include the ways in which an increasingly securitised migration management system will likely result in a growing population of irregular migrants who, due to fear of arrest, detention and deportation, will avoid (and evade) public healthcare services with negative consequences for all.
Secondly, the development of (im)migration interventions centred around a securitisation approach may provide opportunities for co-opting components of the global health security movement – itself a problematic and contested terrain – by using health status (or perceived health risk) as an additional securitisation measure through which to further restrict movement across national borders and/or to justify deportation of non-nationals. This could be achieved through an increase in compulsory health screening, risk assessments, and health-related restrictions on movement across borders.
Collectively, these processes risk producing challenges that will further stall progress towards global health goals by undermining attempts to develop coordinated, cross-border, migration-aware, and mobility-competent health programmes; and, by deterring irregular cross-border migrants from accessing prevention and treatment programmes for both communicable and non-communicable diseases. If these concerns are not addressed proactively, the consequences could be devastating for Southern Africa and the global community.
Journal of the International AIDS Society (JIAS) 21 (S4)
Global migration policy discussions are increasingly driven by moral panics – public anxiety about issues thought to threaten the moral standards of society. This includes the development of two Global Compacts – agreed principles to guide an international response – for (1) “Refugees” and (2) “Safe, Regular and Orderly Migration.” While the need to address migration and health is increasingly recognized at the global level, concerns are raised about if this will be reflected in the final Compacts. The Compacts focus on securitization, an approach that aims to restrict the movement of people, presenting potentially negative health consequences for people who move. Globally, concern is raised that migration‐aware public health programming initiatives could be co‐opted through a global health security agenda to further restrict movement across borders. This is particularly worrying in the Southern African Development Community (SADC) – a regional economic community associated with high levels of migration and the largest population of people living with HIV globally; this case is used to explore concerns about the health implications of the Global Compacts.
Current HIV responses in SADC do not adequately engage with the movement of healthcare users within and between countries. This negatively affects existing HIV interventions and has implications for the development of universal HIV testing and treatment (UTT) programmes. Drawing on literature and policy review, and ongoing participant observation in policy processes, I outline how Global Compact processes may undermine HIV prevention efforts in SADC.
The global health imperative of developing migration‐aware and mobility‐competent health responses must not be undermined by moral panics; the resultant international policy processes run the risk of jeopardizing effective action at the local level. Globally, migration is increasingly recognized as a central public health concern, providing strategic opportunities to strengthen public health responses for all. Without mainstreaming migration, however, health responses will struggle. This is particularly concerning in SADC where HIV programmes – including UTT initiatives – will struggle, and key health targets will not be met. Globally, contextually appropriate migration‐aware responses to health are needed, including and a specific focus on HIV programming in SADC.
The Migration and Health Project Southern Africa, University of the Witwatersrand
Involving a series of unique research and public engagement projects, the Migration and Health Project Southern Africa (maHp) aims to explore (and evaluate) ways to generate and communicate knowledge in order to improve responses to migration, health and well-being in the Southern African Development Community (SADC) region. Multiple disciplinary perspectives, mixed method approaches, and the involvement of various stakeholders – including migrants themselves – are central.