Migration and Health: A Framework for 21st Century Policy-Making

With an estimated 214 million people on the move internationally and approximately three-quarters of a billion people migrating within their own country, there can be little doubt that population mobility is among the leading policy issues of the 21st century [1–3]. Human migration is not a new phenomenon, but it has changed significantly in number and nature with the growth of globalization, including the ease of international transport and communication, the push and pull factors of shifting capital, effects of climate change, and periodic political upheaval, including armed conflict. As a result, migrant networks that facilitate mobility and circular migration, in particular, have expanded in unprecedented ways [4,5]. Yet, there has not been commensurate development of coordinated policy approaches to address the health implications associated with modern migration. Internationally, policy-making on migration has generally been conducted from policy sector ‘‘silos’’ (e.g., international aid, security, immigration enforcement, trade, and labor) that rarely include the health sector and which often have different, if not incompatible, goals [6,7]. As discussions on ‘‘global migration governance’’ and ‘‘global health governance’’ expand, it will be increasingly important for policy-makers to engage in cross-sector coordination and move beyond narrow protectionist policy approaches, such as migrant-screening, and the simplistic view of migration as a one-way trajectory [8]. Health policy-making in the context of migration has generally been viewed either in terms of its ‘‘threats’’ to public health or from a rights-based approach that focuses on health hazards faced by individual migrants and the associated service challenges [9]. The former lens dates back to medieval quarantine measures and prioritizes public health security and communicable disease control, relying heavily on monitoring and screening (e.g., tuberculosis, pandemic flu). The rights-based perspective is more recent and grounded in medical ethics. It recognizes migrants’ special vulnerability to, for example, interpersonal and occupational hazards, social exclusion, and discrimination, and the importance of universal access and culturally competent health care services [10]. Although often framed as a ‘‘threat’’, human mobility is not inherently riskladen. However, poor policy coordination and contradictory policy goals, such as increasing foreign labor requirements while maintaining restrictive rights for migrants, can exacerbate risk conditions related to migration and pose health challenges [11,12]. This paper presents an introduction to the PLoS Medicine series on migration and health (http://www.ploscollections.org/ migrationhealth). It lays out a migratory process framework (Figure 1) that highlights the multistaged and cumulative nature of the health risks and intervention opportunities that can occur throughout the migration process, and points to the potential benefits of policymaking that spans the full range of migratory movement. Five subsequent articles in the series discuss in-depth the health impacts and policy needs associated with the five phases of this migratory process: pre-departure, travel, destination, interception, and return.