Migration and health in the EU

From both the perspectives of European integration and human rights, migrant health and access to health care are important elements of national health policy. However, many EU Member States have not addressed, or have only recently begun to address this issue. Relatively little is known about the health of migrants. Measurement is challenging for a variety of technical and political reasons. The data that is available gives rise to a complex picture; the health of migrants and access issues vary across space, time, age, gender, across different countries of origin and type of migration. Disease specific mortality rates for certain conditions are higher for immigrants. Despite the fact that most migrants originate from countries with a substantially higher mortality rate than Europe, many studies have found that immigrant groups have similar or more favourable total mortality rates than native Europeans. However, the health advantage is confined to specific diseases. Furthermore, in many contexts the advantage disappears in the second generation and with increased duration of stay. The possible reasons for inequalities in health care use between migrants and autochthonous populations are complicated. Data in some countries suggests that utilization of health services among migrants tends to be relatively low, with a greater reliance on emergency services. Particularly worrisome are the low rates of utilization of antenatal and paediatric care. Barriers to access are thought to include education, cultural differences, language difficulties, lack of complimentary voluntary health insurance and legal issues. The other major issue is quality of care and whether it is lower for migrants. Across EU countries, attempts to incorporate the needs of migrant workers, in particular from non-EU Member States, into welfare systems have remained scattered and uncoordinated, although to some extent diversity in policy is to be expected. A country’s approach to migrant health issues will depend on the type of migration and the overall welfare regime. Nevertheless, it seems there are many opportunities for learning across countries. In some countries (notably France), social analyses by ethnic origin are not routinely carried out both for cultural and administrative reasons. In others (such as Spain, Germany and Ireland), migrant health policy has only recently started to be proactively developed. In others (notably the Netherlands, UK and Sweden), policy regarding the health of migrants is already relatively developed. The EU could play an important role in facilitating the development and transfer of evidence and information on migrant health policy. Topics identified as theoretically central and/or under-researched include: methodological problems of migrant health research; children and youth, particularly in terms of psychosocial health; sexuality, reproduction and family life; older migrants; access of illegal/undocumented migrants to health services; user involvement in the design and provision of services; ‘linkages’ between sender countries and receiver countries; preserving the health ‘advantage’ of some newly arrived migrants; analysis approaches to preventing and controlling TB and HIV/AIDS among migrants; multi-sectoral policy; and sharing of knowledge and data, and the improvement of data collection. This Research Note has been produced for the European Commission by Philipa Mladovsky from the Health and Living Conditions Network of the European Observatory on the Social Situation and Demography. The views expressed are those of the author and do not necessarily represent those of the European Commission. THE LONDON SCHOOL OF ECONOMICS AND POLITICAL SCIENCE