Regional Symposium on Gender, Migration, Health and Public Policy & South African Launch of the UCL-Lancet Commission Report on Migration and Health
This report captures a two-day programme of presentations, panel discussions and group discussions at the regional symposium on gender, migration, health and public policy. The aim of day one was to discuss a number of migration-related topics including: health and universal health care (UHC) in Southern Africa, researching migration and health, associated ethical and methodological challenges, and reflecting on the politics and practice of migration and health research. Day one also included the launch of the UCL-Lancet Commission on Migration and Health in South Africa.
Day 2 of the symposium focussed on ‘Gender, Migration, Health and Public Policy: Improving gendered responses to migration and health across the Southern African Development Community (SADC)’. The aim was to present feedback from a research report on gender, migration and health and to develop a joint plan of action amongst stakeholders and participants for improving gendered responses to migration and health in SADC.
MHADRI member Dr Roomi Aziz reflects on her participation in a week’s worth of migration and health events, co-hosted by MHADRI, that took place at the University of the Witwatersrand, Johannesburg at the end of July 2019. This post was originally published here.
Just got some time to review and recap the last week of July 2019, which was everything Gender and Migration and South Africa, beginning with a research workshop, having the privilege of being on an all-female panel on decolonizing global migration and health research, weaving a high level policy dialogue, closing with the UCL-Lancet Commission Launch of report on Migration and Health, and a symposium on gender, migration, health and public policy at the dynamic University of the Witwatersrand and the African Centre for Migration & Society.
We also went through some existential questions, of what does it even mean to be a migrant? What does health access imply? Especially since health often gets short-handed for the biomedical healthcare system, and this understanding is one of the many structural determinants leading to health inequities. For example, health insurance is not universal health coverage, but one of the many factors contributing to it. At the end of it, what stayed with me was the birth-right of a human, to live a meaningful life, and create a home.
Just want to record my five key Points-to-Ponder from the week, one for each day:
P1 | CHANGE THE PERSPECTIVE: It is important to step outside the box we live and operate in, to understand and grasp a broader, ‘helicopter’ vantage point of the situation and the context. Unlearn. Couldn’t be more truer for migration and health, and their bidirectional journey. There was a lot of discussion on the need to look at both systems response and global governance, and be conscious of the rhetoric of migrants’ health. Current public health policies do not engage with migration or mobility of populations, which raised some pertinent questions, on whether the local conversations are reflective of global realities? And about the drivers of policy-making? Is it fear or rights-based approach? Then again, as long as health is discussed in humanitarian paradigm where migration is discussed in securitization paradigm, challenges will continue to grow. We must remember Ellis Island. Exceptionalism in policy frameworks can further hurt a cause. #Mobility is the new normal. It is time that we accept it. We also need to know what we do not know, to truly understand and learn. It is important that we acknowledge the lack of evidence, rather than pretending that we have all the answers/ solutions. We need more data, better data to feed into politics and decisions, and understand the issue enough to take action.
P2 | WHO HOLDS THE POWER: Are we aware of what the rights-based arguments may drive away, and what are the most effective ways to make our case on policy tables? We have limited orientation as to who holds the power in the global discourse. Who has the loudest voice and who is determining the global or the national agenda? While we are continuously dealing with complexities, we must find levers of change within the system that are on our side, and learn to influence them. We must also not forget the key role of national treasury, which can make or break our comprehensive action plans. We religiously talk of evidence-informed decision making, when we also need to remember that sometimes this evidence is not politically correct, and sometimes lack of evidence is desirable for scape-goat-ing. More importantly, how do we make sure that the research generated is responding to the evidence need and who needs it. In either case, we need to be cognizant of our complicity and role in this system of control, and our responsibility towards challenging the global narrative.
P3 | AFFILIATIONS AND IMPLICATIONS: We are very trigger-happy when it comes to the use of adjectives like ‘vulnerable’ and ‘marginalized’, but are we aware of the implications that assignment of such adjectives has? We speak of biometrics and blockchain, without realizing the cost to personal security and implications for non-nationals as well as nationals. These discussions are critical today, when we are still grappling with the idea of profiling people on the basis of their looks, professions, languages, socio-economic status, beliefs and nationalities.
P4 | STAYING AWARE: By virtue of things beyond our control, like the country we were born in, the family we were born into, the skin color we inherited, we hold unequal power and privilege. It is critical that we do not centralize our agenda or usurp the central stage and remember the ‘invisible’. That is the crux of the bone of contention we have with Eurocentric understanding of migration and health and inequalities vis-à-vis Global South being reinstated. This goes back to the ‘changing the perspective’ point, where we must endeavor to visibilize the invisible, profile them to understand what can be done for them, since they cannot be passive actors in the society, lest they are left behind. We must remain acutely aware of the danger of propagating a single narrative, recognize the associated complexities and contestations associated with it.
P5 | CREATE OPPORTUNITIES: Not always there is a demand and supply match. Sometimes one must push and manipulate situations and strategize for interest. There are important advocacy windows all around us. There is a need to identify these strategic windows, the sticking points, and realize the power of our personal networks, to push forward our agendas. There is no time to wait for tailor-made opportunities.
Last week, the Lancet Commission on Migration and Health’s Report – The health of a world on the move – was formerly launched in South Africa at the University of the Witwatersrand (Wits). Using the attention drawn by this event, the African Centre for Migration & Society (ACMS), alongside colleagues in Demography and Public Health, held a series of events for those of us working on migration and health in the region – to come together, reflect on current realities, and think about the way forward.
Reflecting global trends, issues of migration and health, including whether cross-border nationals should have access to health care in host countries, are incredibly contentious in South and southern Africa. Although countries across both the global North and South have committed to implementing and realizing Universal Health Coverage (UHC), many are reticent to include cross-border migrant populations in their plans. Which, as I have argued in an IHP blog post before, will undermine attempts to realize UHC and meet other global health targets, including UNAIDS 90:90:90.
To give you a broad sense of the migration and health landscape in the region, there are four things worth highlighting.
Current public health responses are not migration-aware or mobility-competent. In other words, health systems don’t acknowledge and engage with the reality that people move both within and across borders, with implications for continuity of care and communicable disease control; and, finally,
Within this context, across all four of the events last week three key themes emerged.
The first, which I believe will surprise no frequent reader of this blog, is that the development and implementation of schemes in the name of UHC, in the South African case the National Health Insurance (NHI), do not necessarily mean that UHC will be realized. The exclusion of non-nationals from the NHI is a clear example of this in South Africa. Rather than being a comprehensive system of coverage, the NHI threatens to be one in which a select package is offered to select categories of people.
The second theme was around the increasing securitization of health as a consequence of concerns about migration. The use of healthcare service providers and healthcare facilities as immigration control needs to be guarded against. While communicable disease control and monitoring remain important, these efforts will in fact be undermined if the accessibility of healthcare to non-nationals is further limited and if non-nationals actively avoid healthcare facilities over fears of arrest and deportation.
The third emergent theme was that a rights-based argument for ensuring that non-nationals have equitable access to healthcare does not seem to be working in South Africa, or globally for that matter. Alternatives have been suggested, a global public goods approach that argues that limiting the access to healthcare and wellbeing for non-nationals will ultimately undermine the health and wellbeing of nationals, for example. Increasingly efforts have also been made to recognise the economic benefit that migration and migrants have for their host communities. Whether such arguments will work where the rights-based argument has failed and whether it is desirable to be making these kinds of arguments is however up for debate.
Ways forward and one caveat
Given the particularly depressing nature of these conversations, important questions were asked about the way forward. An obvious point of departure for those of us in South Africa is the need to work to improve the NHI prior to its roll out and once it has been implemented; to ensure that UHC is realized through the scheme, and that key populations are not left behind.
In addition, improved responses are needed for key populations that have traditionally been left behind by the healthcare system, as well as ignored by researchers. Although, as Loren Landau argued, a key example of the latter are in fact policy makers. Researching migration does not simply mean researching migrants and their lived experiences, but also the mechanisms for governing migration and the people who are involved in their development and implementation.
Here, the potential for bibliometrics to illuminate gaps in our research and knowledge, and as such, direct future research emerges. As we know, while most migration happens within the global South, most of the research and literature on migration has been focused on, or at least written, in the global North.
However, while there is a tendency to lament the fact that we need more data, a key tension emerges between the fact that there is this need, but that the data that is already available is often used nefariously and to further anti-migration mechanisms. Making invisible populations visible, quantifying and qualifying migrants, opening up the black box around the mechanisms that migrants use to circumnavigate increasingly restrictive bureaucratic structures may not be in the best interests of those who migrate, and may simply be strengthening the hand of those who are trying to put a stop to migration.
Not a particularly positive note on which to end things, but, given the state of the world, fairly inevitable. As researchers and practitioners, the need to be rigorous and rigorously ethical – to ensure confidentiality and anonymity; to push back against entities that seek to fund work that would improve their efforts at securitization; and to improve research collaborations and partnerships so that research produced reflects local realities rather than a global agenda – in our work has never been more imperative.
With this editorial we launch a new series from The BMJ. The series seeks to improve understanding of the complexities of delivering better health for migrants and communities affected by migration, tackle unhelpful stereotypes and prejudices aimed at migrants, and focus on the role of health in improving the societal response to migrants. Developed by The BMJ in collaboration with the UN Migration Agency (IOM) and the Migration Health and Development Research Network (MHADRI), the first three articles consider the migrant health system and political dimensions of navigating policy, politics, and diplomacy in this complex field.
Better health for migrants isn’t simply a moral imperative. It is an evidence informed, economically wise choice that will improve health for all. It is a choice that must be made in defiance of populism, prejudice, and political expediency.
January 20th: call is announced
May 15th: deadline for abstracts
June 15th: Decisions regarding selection of abstracts
September 1st: registration
September 15th: the full program is announced
October 9th: Deadline for submission of full papers
General call for papers – specific calls under each Sub-theme Growth in international migration has prompted a diversity of efforts to manage global migratory flows as well as improve and streamline the economic, social and political integration of migrants into the host countries. Migration and integration today involve a myriad of actors such as international and regional bodies, state agencies and municipalities, companies, interest groups, community-embedded, civil society organizations as well as individuals, including migrants, who design, implement reproduce, participate in, and replicate individual or collaborative initiatives aimed at facilitating migration and integration. Some efforts are planned and involve years of preparation and the engagement of large coalition of actors; others are ephemeral and ad hoc, emerging from one day to the next only to disappear again quickly. Some efforts aim at facilitating transnational migration others at improving migrants’ health, at supporting migrants’ inclusion into the host countries’ education system or the labour market, at preventing radicalization, or securing migrants’ civic, social and legal inclusion in the new country. From a coordination and organizing perspective, this myriad of actors and activities separated in time and space poses not only far-reaching challenges, but also great opportunities.
These challenges and opportunities demand novel and critical research and interdisciplinary approaches from a range of disciplines, such as anthropology, educational sciences, health sciences, information technology, international studies, law and human rights, management and organization studies, migration studies, political science, social work and sociology. This to rethink how migration shapes and produces inclusion and exclusion around the world – from welfare states in the Global North to the states of the Global South.
Health, risk, and resilience: Transcending the biological, the psychological, the social, and the structural in migration and integration
Josephine T. V. Greenbrook Health is more than pulse and blood pressure; it transcends the biological, the psychological, the social, and the structural. Health, in all its existential complexity, is fundamental to the enjoyment of all human rights. Due to the syndemic nature of migration, substantial impacts on health can occur through exposure to cumulative risk factors relating to disparity, structural violence, and social condition. Migrating populations have largely suffered interpersonal and structural trauma, such as having been exposed to conflicts of war and extreme poverty, having lost family and close relations, and having suffered bodily harm, sexual violence, and torture, as well as oppression, neglect, and maltreatment. Beyond other social vulnerabilities, harsh living circumstances involved in pre, during, and post-migration, also contribute to a number of health-related issues in all those affected. Notwithstanding this, substantial barriers in seeking health care exist for migrants, and discrimination, neglect, and prejudicial attitudes amongst health care practitioners have been reported. Clinicians have also been found to struggle with a variety of difficulties, ethical dilemmas, and other conflicts in transcultural health care encounters. Cultural stigma, low health literacy, and low healthcare utilization amongst migrant populations further compound existing problems.
This stream aims to highlight health as it relates to migration, as well as the fundamental role of health in integration. The objective is to present empirical research and critical academic debate exploring risk and resilience in migrant health and transcultural care, in theory, policy, and practice. We warmly welcome contributions from a wide variety of disciplines, as well as multi-disciplinary work.
This will include, and is not limited to, topics covering:
• The foundational role of health in integration
• Upholding health as a human right in the context of migration
• Migration and healthcare barriers
• Migrant health rights and health equity in applied settings
• Syndemics and migration
• Health and intersectionality in relation to migration
• Mental health and belonging in migration and integration
• Clinical and organisational challenges to care delivery
• Transcultural health care encounters
• Ethical considerations related to transcultural care provision
• Community health engagement
• NGO and other outreach practices
• Other related topics
Within the Department of Migration Management (DMM), the Migration Health Division (MHD) has the institutional responsibility to oversee, support and coordinate the Organization’s provision of migration health services globally. The Division provides technical guidance and policy advice, establishes partnerships with relevant governmental, multilateral, civil society and private entities in the domain of migration health, and identifies strategies and programmatic approaches that are informed by agreed policies, evidence, standards and trends in the sector.
The successful candidate will support day-to-day strategic activities and liaison to strengthen the Division’s ability to bridge the needs of migrants and IOM Member States through evidence-based policy activities, and thus to ensure the delivery of equitable, rights-based and accessible migration health programmes and initiatives for its beneficiaries. He/she will be support the Senior Migration Health Policy Advisor in liaising with relevant Divisions/Units in HQ on policy related matters.