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On the move – the route to universal health coverage in a mobile world

Monday 19 June 2017

There are one billion people on the move globally - more than 244 million of whom have crossed international borders. From refugees to those with employment visas, this huge volume of people not only face increased health risks but can significantly impact on the health systems of countries they are travelling through or to. Failure to tackle this growing issue risks the goal of universal health coverage, so what can policymakers do?
Migrants crossing train track

2017 has brought unprecedented political attention to the issue of migration, including its impact and links to health and health systems. In February, a Global Consultation on Migrant Health took place in Sri Lanka. Member States at the recent World Health Assembly in Geneva also debated the issue, and requested the World Health Organization’s support in responding to the increased movement of people and resulting impact.

Increased focus and asking questions are a start – finding answers is the next step.

The challenges posed by migration and mobility for health and health systems are vast – how to ensure continuity of treatment, how to meet vast health needs arising from unsafe passage, and how to organise national health systems in a way that they can accommodate increasing movement of people. Yet little is known about how best to address them. Governance mechanisms to manage movement of people and the related health impact do not really exist. Countries are not sufficiently equipped to deal with the complex reality faced by people on the move.

Fieldwork in migration settings has highlighted the need for stronger evidence to improve health-system responses. In a Lancet comment article we propose core areas where action is needed to support the development of a global research agenda that could be a catalyst for change.

Research conducted in primary healthcare facilities in South Africa in 2015/16 showed that while frontline health workers were developing strategies to deal with internal and cross-border mobility of their patients, this was not considered as part of health systems planning. This had possible effects on continuity and management of treatment for patients, especially with chronic conditions such as HIV and hypertension. It also impacted on immunisation of children.

Moreover, categorisation of patients into a myriad of different and often overlapping groups, such as asylum seeker, ‘undocumented’, or people on student visas, in many instances created confusion about entitlements amongst health workers and patients. The challenges to accessing and treatment continuity were often similar, regardless of whether a patient had crossed a border or migrated internally, but the legal classification was very different. There is clear need for a nuanced and distinct classification on migration and health that captures the complexity of the issue, without reinforcing reductionist categories to describe migrant and mobile people.

In many countries, including the UK, migrants’ use of health services is often seen as a threat and reported negatively in media or public discussion. However, in reality very little is known about actual costs and the potential benefits to population health and health systems. This type of polarised debate has blocked the development of innovative policies across countries to deal with a new and global reality - more people, at all levels, are on the move than ever before.

We need new and improved methods to study and understand the complex interactions between migration, mobility and health. Support for this is crucial, as is the need for greater global collaboration.

A global research agenda on migration, mobility and health is a starting point to addressing these issues, and ensuring no-one is left behind in the realisation of universal health coverage and efforts to achieve the United Nations Sustainable Development Goals.

Publication

Johanna Hanefeld, Jo Vearey, Neil Lunt. A global research agenda on migration, mobility, and health. The Lancet. DOI:10.1016/S0140-6736(17)31588-X