Italian National Focal point Infectious Diseases and Migration ISS 17.2. 2015 Migrazione e salute: l’impatto della crisi economica nelle politiche e nei sistemi sanitari della Regione Europea dell’OMS Dr. Santino Severoni MD. MHE Coordinator Public Health and Migration Division of Policy and Governance for Health and Well-being European Office for Investment for Health and Development WHO Regional Office for Europe Venice, Italy [email protected]http;//www.euro.who.int
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Italian National Focal point
Infectious Diseases and Migration
ISS 17.2. 2015
Migrazione e salute: l’impatto della crisi
economica nelle politiche e nei sistemi sanitari
della Regione Europea dell’OMS
Dr. Santino Severoni MD. MHE
Coordinator Public Health and Migration
Division of Policy and Governance for Health and Well-being
European Office for Investment for Health and Development
• European Region undergoing important demographic and epidemiological changes
• 214 mil International migrants • (3% of global population UNPD data)
• 740 mil. Internal migrants (UNPD data)
• 8% of the WHO European Region’s total population are migrants
• Political and communication sensitivity
The maps of European Parties against integration From Corriere della Sera 29-11-
2013
• Variation in GDP/person/year (2009):
- Tajikistan $ 1,900 [rank192]
- Luxembourg $ 104,000 [rank 3]
77 million migrants in WHO EURO Region, (36% of global migrants population)
WHO European Region
53 Member States,
886 million people
Migration associated with emergency situation
• Recurrent phenomenon in the WHO EURO Region
• The health risks related to migration process associated with emergency or crises situations are not fully studied/addressed despite the growing number and intensity of these types of events
• Main causes: conflicts, economic crises, natural and manmade disasters, climate changes
Increased migration
Belarus
Moldova
Ukraine
Armenia
Azerbaijan
Georgia
Kazakhstan
Population movements
Cambiamenti demografici
Migration and economic financial crises the pre-crisis period: migration as an asset for development
In the middle of the 2000s,
• Migration, asset for development, was elevated to the highest international level, becoming part of the United Nations agenda
• 2006, High Level Dialogue on Migration and Development under the auspices of UN General Assembly and Global Commission Migration Development
Migration as an asset for development
Over the two decades preceding the global crisis:
financial flows from migrants in developed countries to
• Most countries resorted measures to reducing inflow of migrants, restricting entry conditions and cutting the number of migrants
• Italy, UK, Spain, and Russia, lowering the quota for labour migrants was applied as a crisis containment measure
• Norway, Ireland, Czech Republic, employment procedures were revised to favour local workers
• Spain, Czech Republic, France introduced financial bonuses for migrants to return home ("pay-to go")
Switzerland, won the vote against
immigrants
The federal government
has said yes to the
referendum to limit
foreign workers
Population perception can influence public opinion and politics
the case of Venice….
Undocumented Migrants’ Access to Medical Care in
European
Access only to emergency
services
Austria, Bulgaria, Cyprus, Czech Republic,
Denmark, Germany, Greece, Estonia,
Finland, Hungary, Ireland, Latvia,
Lithuania, Luxembourg, Malta, Poland,
Romania, Slovak Republic, Slovenia
Greater access to some services
or for some categories of
undocumented migrants
Belgium, Italy, Norway, and the United
Kingdom
Full access under specified
conditions
France, Netherlands, Portugal, Spain^,
Switzerland, Sweden
Degree of access Countries
Why Health & Migration matter to public health Health system access
………Border control spending in Europe is 20
higher than spending for assistance to
asylum seekers…… Nils Muiznieks, EU Commissioner for Human Rights
Legal framework for health care access
• Key question is the legal provision of access to health care for
undocumented migrants
• Documented migrants are entitled to access the health care system, (with specific rules depending on their legal status as permanent settlers, temporary workers, refugees, asylum seekers, etc)
Health & Migration a multy-sector agenda
• Ministry of Interior
• Ministry of Labour
• Ministry of Social affairs
• Ministry of Foreign Affairs
• Ministry of Education
• Ministry of Health
Policy implications
Health Access Security
measures
Human Rights National
Regulations
Public Health approach
HEALTH ISSUES STEMMING from MIGRATION
• Migration policy and integration
• Access to health services and overcoming health system access barriers (cultural, social and linguistic)
• Health System capacity & Economic impact
• State of health of migrants: changing health profile, CD & NCD, re-emerging neglected diseases
• Health risk assessment, expose to hazards and public health implication for migrants and resident community
• Screening guidelines
• SOPs on immunization, TB continuity of care, etc
• Public health data collection/generation
• Health system structural setting
Public health data problem, collection/generation
Main challenges
•High mobility
•Undocumented persons
•Health system barriers
•Variety of health service providers (NHS, NGOs)
•No routine collection of data in NHS on migration
variables
•incompatibility of sources, as well as
conceptual and definitional problems
Denominator?
What actions are we taking
MIGRANTS HEALTH SYSTEMS
Address migrants’ special vulnerabilities and health-care needs
Services that are migrant sensitive
Financial protection mechanisms
Workplaces employing migrants provide basic occupational health services
To define minimum package of health services and goods
STRATEGIES FOR IMPROVING HEALTH OF MIGRANTS in the WHO REGION
Advocacy and policy development
Assessment, research and information dissemination