The UCL Lancet Commission on Migration and Health Report

The Lancet Commission on Migration and Health published their comprehensive report last week.  The Commission makes a timely contribution to contemporary global discussions on migration and health, and provides new empirical insights and a series of important policy recommendations.  Critically, the report highlights the urgent need to address political and public rhetoric, and to challenge pervasive myths relating to migration and health.  The report which recognises migration and health as a global health priority, is open access – a simple, free online registration with the Lancet is required to access content.

Commissioners and Steering Group members included MHADRI members Ibrahim Abubakar (Chair of the Commission), Rachel Burns, Davide Mosca, Michael Knipper, and Paul Spiegel.  MHADRI member Kolitha Wickramage co-authored a commentary that accompanies the report.

The newly published UCL-Lancet Commission on Migration and Health, including commentaries and side papers can be found here.  For interactive figures from the report please click here. The Commission addresses one of the defining issues of our time and presents evidence based approaches to inform public discourse and policy to address migration as a global health priority, including proposing recommendations for maximising the health of all people on the move. It is the result of a two-year project led by 20 leading experts from 13 countries, and with 46 contributing authors on the final report and is the most comprehensive review of the available evidence on migration and health to date.

A series of launch events are planned in different regions, details can be found here.

The Commission presents evidence based approaches to inform public discourse and policy to address migration as a global health priority, and proposes recommendations for maximising the health of all people on the move. The Commission is an independent group of academics, policymakers, and health system experts with experience across the world to review current knowledge and producing new empirical work and policy recommendations on the role of migration on health.  The report takes an inter-disciplinary approach to the appraisal of information and data and the presentation of recommendations including sociological, political, legal, epidemiological, humanitarian and anthropological perspectives.

[PAPER] A global research agenda on migration, mobility, and health (2017)

A global research agenda on migration, mobility, and health [Open Access]

Hanefeld, J., Vearey, J. and Lunt, N. on behalf of the Researchers on Migration, Mobility and Health Group

The Lancet 2017; 389 2358-2359

Summary

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.

[PAPER] Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: a protocol for a suite of systematic reviews for public health and health systems (2017)

Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: a protocol for a suite of systematic reviews for public health and health systems [Open Access]

Pottie K, Mayhew A, Morton R, Greenaway C, Akl EA, Rahman P, Zenner D , Pareek M, Tugwell P, Welch V, Meerpohl J, Alonso-Coello  P, Hui C, Biggs BA, Requena-Méndez A, Agbata E, Noori T, Schünemann HJ.

BMJ Open 7 (9), e014608. 2017

https://bmjopen.bmj.com/content/7/9/e014608

 

Abstract

Introduction The European Centre for Disease Prevention and Control is developing evidence-based guidance for voluntary screening, treatment and vaccine prevention of infectious diseases for newly arriving migrants to the European Union/European Economic Area. The objective of this systematic review protocol is to guide the identification, appraisal and synthesis of the best available evidence on prevention and assessment of the following priority infectious diseases: tuberculosis, HIV, hepatitis B, hepatitis C, measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis (polio), Haemophilus influenza disease, strongyloidiasis and schistosomiasis.

Methods and analysis The search strategy will identify evidence from existing systematic reviews and then update the effectiveness and cost-effectiveness evidence using prospective trials, economic evaluations and/or recently published systematic reviews. Interdisciplinary teams have designed logic models to help define study inclusion and exclusion criteria, guiding the search strategy and identifying relevant outcomes. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination There are no ethical or safety issues. We anticipate disseminating the findings through open-access publications, conference abstracts and presentations. We plan to publish technical syntheses as GRADEpro evidence summaries and the systematic reviews as part of a special edition open-access publication on refugee health. We are following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols reporting guideline. This protocol is registered in PROSPERO: CRD42016045798.

[PAPER] Capacity strengthening through pre-migration tuberculosis screening programmes: IRHWG experiences (2017)

 

Abstract

Effective tuberculosis (TB) prevention and care for migrants requires population health-based approaches that treat the relationship between migration and health as a progressive, interactive process influenced by many variables and addressed as far upstream in the process as possible. By including capacity building in source countries, pre-migration medical screening has the potential to become an integral component of public health promotion, as well as infection and disease prevention, in migrant-receiving nations, while simultaneously increasing capabilities in countries of origin. This article describes the collaborative experiences of five countries (Australia, Canada, New Zealand, United Kingdom and the United States of America, members of the Immigration and Refugee Health Working Group [IRHWG]), with similar pre-migration screening programmes for TB that are mandated. Qualitative examples of capacity building through IRHWG programmes are provided. Combined, the IRHWG member countries screen approximately 2 million persons overseas every year. Large-scale pre-entry screening programmes undertaken by IRHWG countries require building additional capacity for health care providers, radiology facilities and laboratories. This has resulted in significant improvements in laboratory and treatment capacity, providing availability of these facilities for national public health programmes. As long as global health disparities and disease prevalence differentials exist, national public health programmes and policies in migrant-receiving nations will continue to be challenged to manage the diseases prevalent in these migrating populations. National TB programmes and regulatory systems alone will not be able to achieve TB elimination. The management of health issues resulting from population mobility will require integration of national and global health initiatives which, as demonstrated here, can be supported through the capacity-building endeavours of pre-migration screening programmes.

[2018] Intergovernmental collaboration for the health and wellbeing of refugees settling in Australia

Intergovernmental collaboration for the health and wellbeing of refugees settling in Australia [open access]

Belinda Martin, Paul Douglas

Public Health Res Pract. 2018; 28(1):e2811807.

https://doi.org/10.17061/phrp2811807

Abstract

As outlined in the Department of Immigration and Border Protection Annual report 201617, Australia granted 21 928 humanitarian visas in 2016–17, 13 760 of them offshore. This number will increase in future to a planned offshore program of 18 750 in 2018–19. The report notes that the United Nations High Commissioner for Refugees ranks Australia third for the number of refugees resettled. With such a massive program and commitment by the Australian Government, the need to ensure that health and wellbeing are maintained or gained during the settlement process is paramount. This article outlines how collaboration between like-minded national governments can improve premigration health screening through information sharing, collaborative learning and increased capability in countries of origin to not only screen for illness and disability, but to more effectively put measures in place to address these before, during and after arrival. Australia, Canada, New Zealand, the UK and the US have worked together for more than a decade on migration health screening policies to ensure better management of health needs and successful resettlement. A case study about the Syrian refugee cohort, which began arriving in Australia in late 2015, illustrates how intergovernmental collaboration can improve settlement.

[PAPER] Danger of blurring global migration governance and health security agendas in Southern Africa (2018)

Danger of blurring global migration governance and health security agendas in Southern Africa [Open Access]

Jo Vearey

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.

[2018] Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review

Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review [Open Access]

Charles Hui 1,,Jessica Dunn 1,Rachael Morton 2,Lukas P. Staub 2,Anh Tran 2,Sally Hargreaves 3,4,Christina Greenaway 5,Beverly Ann Biggs 6,7,Robin Christensen 8 and Kevin Pottie 9,10

Abstract

Newly arrived migrants to the EU/EEA (arrival within the past five years), as well as other migrant groups in the region, might be under-immunised and lack documentation of previous vaccinations, putting them at increased risk of vaccine-preventable diseases circulating in Europe. We therefore performed a systematic review conforming to PRISMA guidelines (PROSPERO CRD42016045798) to explore: (i) interventions that improve vaccine uptake among migrants; and (ii) cost-effectiveness of vaccination strategies among this population. We searched MEDLINE, Embase, CINAHL, and Cochrane Database of Systematic Reviews (CDSR) between 1 January 2006 to 18 June 2018. We included three primary intervention studies performed in the EU/EEA or high-income countries and one cost effectiveness study relevant to vaccinations in migrants. Intervention studies showed small but promising impact only on vaccine uptake with social mobilization/community outreach, planned vaccination programs and education campaigns. Targeting migrants for catch-up vaccination is cost effective for presumptive vaccination for diphtheria, tetanus, and polio, and there was no evidence of benefit of carrying out pre-vaccination serological testing. The cost-effectiveness is sensitive to the seroprevalence and adherence to vaccinations of the migrant. We conclude that scarce but direct EU/EEA data suggest social mobilization, vaccine programs, and education campaigns are promising strategies for migrants, but more research is needed. Research should also study cost effectiveness of strategies. Vaccination of migrants should continue to be a public heath priority in EU/EEA.

Migration and health: a global public health research priority (2018)

Kolitha Wickramage, Jo Vearey, Anthony B. Zwi, Courtland Robinson and, Michael Knipper

 

Migrant and Refugee Health in Malaysia (2017): Meeting Report

UNU-IIGH organized a 2-day workshop on Migrant and Refugee Health in Malaysia on 9-10 November 2017, with the support of the China Medical Board Foundation’s Equity Initiative. Over 40 participants from industry, medical professions, civil society and academia in Malaysia attended, including regional speakers presenting case studies of migrant health inclusion from Thailand’s Ministry of Public Health (MOPH) and the International Organization for Migration (IOM) as well as several NGO service providers in Malaysia and Singapore. Participants identified gaps in knowledge and suggested practical steps forward to improve the evidence base in the Malaysia, which is detailed in these proceedings.

Additionally, an open access article reporting on the meeting was published in BMC Proceedings.

8-e1510718158456.jpg
Dr. Hartini Zunaidin (Yayasan Chow Kit), Dr. Muhammad Azrin Bin Mohd Asihin (MERCY Malaysia) and Ms. Sharifah Shakirah (Rohingya Women’s Development Network) with Dr. Raudah Yunus (University Malaya) responding to questions from participants. Photo: UNU-IIGH. Creative Commons BY-NC 2.0
 

Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority (2018)

Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority [open access]

Jo Vearey

2018

Journal of the International AIDS Society (JIAS) 21 (S4)

https://doi.org/10.1002/jia2.25137

Open Access

Abstract

Introduction

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.

Discussion

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.

Conclusions
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.