London School of Hygiene & Tropical Medicine

Myths about migration and health, including that migrants are disease carriers and are a burden on services, are not supported by the available evidence and ignore the critical contributions that  migration makes to global economies, according to a new UCL-Lancet Commission on Migration and Health.

The report is the result of a two-year project led by 20 leading experts from 13 countries, including senior author Professor Cathy Zimmerman from the London School of Hygiene & Tropical Medicine.

In 2018, there were more than one billion people on the move, a quarter of whom were migrants crossing international borders. Public health protection and cost savings are often used as reasons to restrict migrants’ access to health care, or to deny them entry.

These myths are pervasive and harmful to individuals and society, and the normalisation of these myths in popular discourse has allowed governments to introduce hostile and restrictive policies in many countries around the world – including the detention of migrants at US borders, and the denial of treatment to migrants in the UK’s NHS.

Through new international data and analysis, the Commission report represents the most comprehensive review of the available evidence to date and shows that most common myths about migration and health are unfounded.

The report also includes the following recommendations to improve the public health response to migration:

•             Improving leadership and accountability. UN should appoint a Special Envoy on Migration and Health and a Global Migration and Health Observatory should be established.

•             International and regional bodies and states should re-balance policy making in migration to give greater prominence to health by inviting health representatives to high level policy making forums on migration.

•             Racism and prejudice should be confronted with a zero tolerance approach.

•             Universal and equitable access to health services and to all determinants of the highest attainable standard of health needs to be provided to migrant populations.

The London School of Hygiene & Tropical Medicine has conducted leading research on migration and health and pioneered research on vulnerable migrants for more than 20 years. In a 2011 PLOS Medicine review Professor Zimmerman called for ‘decision-makers from the migration and health sectors to sit at the same table with policy-makers from other sectors, such as development, humanitarian aid, human rights, and labor, to make migration safe and healthy for all’.

Professor Zimmerman said: “Governments around the world are well-aware that their economies depend on migrant workers, both for low-wage work in destination countries and for remittances in sending countries. Yet, states have done disappointingly little to assure the health and safety of migrant workers, or to stop the exploitation and human trafficking of millions of hard-working women and men who toil invisibly in every corner of the globe.

“Low-wage workers must stop being treated as disposable and be offered adequate numbers of work visas that are fair and not tied to employers or to extortionate labour brokers. Until States stop siding with employers over migrant workers, individuals around the world will remain vulnerable to 3D jobs: dirty, dangerous and demeaning.”

Some of the key findings of the Commission include that while high-income countries have seen a greater rise in the percentage of international migrants (from 7.6% in 1990 to 13.4% in 2017), they are more likely to be students who pay for their education or labour migrants who are net contributors to the economy. In advanced economies, each 1% increase in migrants in the adult population increases the gross domestic product per person by up to 2%.

A new, comprehensive systematic review and meta-analysis concludes that international migrants in high-income countries have lower rates of mortality compared to general populations across the majority of disease categories. There is no systematic association between migration and importation of infectious diseases, and the evidence shows that the risk of transmission from migrating populations to host populations is generally low.

Commission Chair Professor Ibrahim Abubakar, UCL, said: “Populist discourse demonises the very same individuals who uphold economies and bolster social care and health services. Questioning the deservingness of migrants for health care on the basis of inaccurate beliefs supports practices of exclusion, harming the health of individuals, our society, and our economies.

“Migration is the defining issue of our time. How the world addresses human mobility will determine public health and social cohesion for decades ahead. Creating health systems that integrate migrant populations will benefit entire communities with better health access for all and positive gains for local populations. Failing to do so could be more expensive to national economies, health security, and global health than the modest investments required to protect migrants’ right to health, and ensure migrants can be productive members of society.”

The Commission received funding from the Wellcome Trust, Rockefeller Foundation, UK National Institute for Health Research, the UCL Grand Challenges in Global Health, and the EU’s Health Programme.

Publication

Ibrahim Abubakar, Robert W Aldridge, Delan Devakumar, Miriam Orcutt, Rachel Burns, Mauricio L Barreto, Poonam Dhavan, Fouad M Fouad, Nora Groce, Yan Guo, Sally Hargreaves, Michael Knipper, J Jaime Miranda, Nyovani Madise, Bernadette Kumar, Davide Mosca, Terry McGovern,

Leonard Rubenstein, Peter Sammonds, Susan M Sawyer, Kabir Sheikh, Stephen Tollman, Paul Spiegel, Cathy Zimmerman. UCL–Lancet Commission on Migration and Health: the health of a world on the move. DOI:10.1016/S0140-6736(18)32114-7.