Standing up for the health of migrants againt anti-immigrant rhetoric

Krisztian Magori reviews the recently published report by the UCL-Lancet Commission on Migration and Health, with particular emphasis on dispelling myths and misconceptions about migrants in the context of health.

On Tuesday, December 11, 2018, President Trump has openly argued with the Democratic leaders of the U.S. Senate and House of Representatives, Chuck Schummer and Nancy Pelosi, about the upcoming federal funding appropriations, demanding that it includes $5 billion funding for a physical wall along the Mexican border, vowing the shut down the federal government if the Democrats do no concede to his demands. This border wall is an embodiment of the anti-immigrant, nationalistic rhetoric that made a comeback in the United States with the 2016 campaign and election of President Trump. Similar sentiments have flared in the last decade or so in many other parts of the world, from Brazil to the UK to Australia.

Unfortunately, there are many myths, misconceptions and prejudices concerning migrants propagated by politicians, some of it having to do with the economic and health risks and costs posed by accepting migrants. Amid all these rhetoric, a group of researchers (sociologists, public health, law and policy experts, and anthropologists) at the University College London, led by Ibrahim Abubakar, established a Commission on Migration and Health in order to provide a solid evidence base for these controversial questions, and make recommendations for the future to protect the health of migrant populations. They worked for two years to produce a 42-page report with many additional comments and materials on the topic, as well as a meta-analysis on the global mortality of international migrants in high-income countries, and other topics. I only briefly scratched the surface of their undertaking, but feel like I already learned a lot, which I will share below.

So what did they find in terms of these misconceptions? Basically, they found all of them to be unfunded. Let’s see them one by one:

  1. Are there more migrants now than before?
    While looking at the news, it might seem to be the case, but this is certainly not true. While there are 1 billion people on the planet who could be classified as migrants based on the above definition, most of those people are internal migrants who move within their home countries (e.g. rural to urban). The percentage of international migrants was only 3.4% in 2017, with little change over 30 years. Most of these international migrants move from one low-to-middle-income country (LMIC) to another similar country, e.g. within South America or Asia, and only 7.6-13.4% from and LMIC to a high-income country (HIC). People migrate for many different reasons, some to join family, and some for labor or better opportunities (economic migrants). Many of the international migrants in high-income countries are there to study and pay for their education, or contribute to the local economy. However, 2 billion people today live in regions of the world with ongoing conflict, civil unrest, or violence, which can spur millions of people to migrate in a short amount of time, such as millions of Syrian refugees in 2015. Anthropogenic climate change is already causing many people to migrate as part of their adaptation to changing conditions, and some argue that the Syrian conflict was also climate related.
  2. Are migrants a burden on government services, including health-care?Macroeconomic analysis of the effect of migrants on their host country’s economies concluded that they have a net positive effect. The health-care workforce in many high-income countries relies heavily on migrant workers, and benefit from a brain gain from low-to-middle-income countries. For example, 37% of the doctors in the UK got their medical degree abroad, and moved to the UK for more money, better working conditions, less demanding work schedule, and more opportunities for professional advancements. Migrants also work in child-care centers, education and understaffed services, such as domestic and professional cleaning services. In addition, migrant workers are also critical to obtain sufficient labor in agriculture, such as orchard in the Pacific Northwest. The systematic review and meta-analysis completed by the authors also found that international migrants who chose to migrate to high-income counties tended to live longer than the host population where they moved to (termed the healthy migrant effect), and healthier, and therefore costs even less than the residents.
  3. Do migrants have more children than resident populations, can they outgrow and replace them?
    Available evidence shows that migrants have lower first-birth rates (fewer children) than resident women. In addition, migrants reproduce at a level barely above the population replacement rate of 2.1 births per woman, and are often falling. Therefore, it is unlikely that migrants would outcompete residents.
  4. Are migrants draining the economies of their host countries, do they provide enough taxes to cover their benefits?
    Similar to Question #2, migrants provide a substantial economic benefit, contributing more in taxes than using in terms of benefits. In advanced economies, every 1% increase in migrants leads to a 2% increase in per capita GDP. Within the EU, the free movement of workers was successful in fixing the imbalance in the labor market by redistributing them to where they were needed. Finally, migrants send vast amounts of remittance to their families, e.g. $613 billion just in 2017, three quarters of which went to low-to-middle-income countries. This was 3 times the amount sent to these countries as official development assistance by governments of high-income countries. For some countries, these remittances constituted up to 1/3 of their annual GDP.
  5. Do migrants bring infectious diseases that pose a risk to resident populations?
    Despite many historical examples of infectious diseases transported to new populations by immigrants (e.g. smallpox at the discovery of the Americas), available evidence suggest that infectious disease transmission from migrants to resident populations is very low. A study conducted on tuberculosis found that transmission was increased in migrant but not resident populations. Countries vary widely on their vaccine requirements, but immigration procedures in many high-income countries require additional vaccinations, to the point where migrant receive many more vaccines than residents. International spread of infectious diseases does not rely on migrants, as both tourism, business travel and transportation provides ample opportunities to transport infectious agents. Despite these facts, migrants are portrayed as responsible to spread communicable diseases, such as by the Fox Nation host Tomi Lahren. Peter Hotez, the Dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas responded to her with a reference to his book “Blue Marble Health” that the diseases she mentions are already widespread in Texas due to poverty, climate change and vaccine refusal.

While the systematic review and the meta-analysis did find that international migrants in high-income countries have reduced mortality, there are many adverse health effects of migration. The act of migration is itself dangerous as well as costly, especially for undocumented and illegal migrants from areas of conflict and violence. Migration also changes the risk profile of the migrants, where they either conform to the resident population, or to other migrants in terms of habits, diet and lifestyle that can lead to worse health outcomes for migrants. For example, migrant populations in Europe had an increased risk of perinatal mortality, preterm birth, low birthweight and congenital malformations. Another one of these issues is mental health. Persistent unpredictability and uncontrollability of their future, combined with fear of deportation, discrimination and targeted condemnation can lead to profound mental health consequences, as well as a lack of access to healthcare and other services. This can have economic consequences at the societal level, such as in Australia that lost 3% of GDP over 2001-2011 as a result of individuals experiencing some form of racial discrimination.

The authors emphasize that migrants, just as all other human beings, are equally entitled to universal human rights without discrimination, including to the right to the highest attainable standard of health, equal access to preventative, curative and palliative health care, in addition to the underlying social, political, economic and cultural determinants of physical and mental health, such as clean water and air and non-discriminatory treatment. These rights and obligations are obviously not being met sufficiently for migrants currently. The authors have concrete suggestions to improve leadership and accountability, such as the UN appointing a Special Envoy on Migration and Health, and for national governments to have a country-level focal point, enabling much needed coordination and inclusion. They also propose to establish a Global Migration and Health Observatory to develop evidence-based migration and health indicators to ensure better reporting, transparency and accountability on the implementation of the Global Compact for Migration and the Global Compact on Refugees. They also suggest that health representatives should be involved in high level policy making on migration. Racism and prejudice should be confronted with a zero-tolerance approach, just as Dr. Peter Hotez demonstrated so clearly. Finally, universal and equitable access to health services and all determinants needs to be provided to migrant populations.

I found the Commission on Migration and Health to be very useful, even though I could only scrape the surface of this vast topic in this blog post. The authors also provided videos and interactive materials to communicate the main messages, especially about dispelling the myths numbered above. I do hope that their recommendations will be headed and the evidence they collected will be widely distributed and help dispel these misconceptions and prejudices. A citizenship aware of these facts on migration are harder to be misled by the ‘fake news’ and the propaganda aimed to exploit their feelings for political gain.


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