WHO European Region's public health response to refugee and migrant health
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1) The WHO European Region has seen increasing migration, with over 90 million international migrants in 2017 accounting for 10% of the population. Migrants make up a large portion of the labor force. 2) Migrant and refugee populations face higher risks for certain communicable diseases like HIV and tuberculosis. They also experience higher rates of mental health issues and poorer maternal and child health outcomes. 3) In response, WHO/Europe has established innovative programs in countries like Italy and Turkey to advocate for migrant health, develop policies, provide health information and training, and give technical assistance. They are also working on a global framework to promote refugee and migrant health worldwide.
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WHO European Region's public health response to refugee and migrant health
- 1. The WHO European Region’s public health response to refugee and migrant health Dr Zsuzsanna Jakab WHO Regional Director for Europe World Health Summit Berlin, Germany, 14 October 2018
- 2. Setting the scene: migration in the WHO European Region A mixed migration flow. The migration flow is composed of a heterogeneous population of diverse and overlapping groups such as refugees, asylum seekers, economic migrants and other migrants. 56.6 million labour migrants reside in the Region. The average labour force participation rate for the migrant population is estimated to be 73%, and around 12% of all workers in the Region are migrants. 1 out of 10 residents in the Region is a migrant. In 2017, there were more than 90 million international migrants in the Region, accounting for almost 10% of the total population of the Region and 35% of global international migrants.
- 3. Vaccine-preventable diseases (VPDs) and immunization • The highest-risk group for VPDs are refugee and migrant children. • Irregular migrants receive immunization services in very few countries. • Only a few countries with a national immunization programme are considering refugees and migrants. Health profile: communicable diseases and immunization HIV (2016) • The proportion of migrants among newly reported HIV cases in the Region is 21%. • In the European Union/European Economic Area (EU/EEA), this figure is 40%. Tuberculosis (TB) (2016) • The proportion of migrants among newly reported TB cases in the Region is 8.2%. • In the EU/EEA, this figure is 32.7%.
- 4. Health profile: NCDs, maternal and child health, mental health Mental health • Post-traumatic stress disorder, mood disorders and depression are the most frequently reported conditions among refugees and migrants. • Overall, drug and alcohol abuse seems to be lower among migrants than host populations. Noncommunicable diseases (NCDs) • NCDs are the largest contributor to the total burden of disease in the Region. • The duration of stay in the host country can be associated with the development of overweight/obesity, and increased risk of developing type 2 diabetes. • The most common health issues faced by labour migrants are musculoskeletal, respiratory and mental health problems. Maternal and child health • The risk of adverse perinatal and obstetric outcomes, including mortality, seems to be higher among immigrant women. • Compared to the host population, migrant children seem to have a higher prevalence of overweight. • Unaccompanied minors are a risk group.
- 5. WHO/Europe’s response Innovative approach leading to structural changes the migration and health programme (MIG) Italy, 2015 Turkey, 2017 MIG Advocacy & communication Policy development Health information, research & training Technical assistance
- 6. Creating evidence and knowledge Evidence and guidance • Health Evidence Network (HEN) reports • Technical guidance • Policy briefs • Multiagency technical guidance • The forthcoming WHO European report on the health of refugee and migrants Country assessments Knowledge Hub on Health and Migration Biennial Summit Policy dialogues Flagship courses/summer schools Webinars on health challenges faced by migrants and host populations Knowledge repository
- 7. The strategy and action plan for refugee and migrant health in the WHO European Region 9strategicareas
- 8. Towards a global framework on refugee and migrant health: WHO/Europe is playing a lead role WHO is committed to providing health leadership and technical assistance and to supporting the United Nations Refugee Agency (UNHCR) and the International Organization for Migration (IOM) in the development of the Global Compact for Migration and the Global Compact on Refugees • The Framework of priorities and guiding principles to promote the health of refugees and migrants • Development of a global action plan
- 9. There is no public health without refugee and migrant health. THANKS!
Editor's Notes
- Slide 2: Setting the Scene The WHO European Region is a large geographical region consisting of 53 Member states having different types of migration flows. Demographic profile: The total population of the WHO Region is 919 million. Of this, almost 10% (90.74 million) are international migrants. The proportion of international migrants in the region has been increasing from 3.9% in 1990 to almost 10% in 2017. This translates to the fact the 1 in every 10 residents in the region is a migrant. One of the major groups of migrants is Labor migrants. Recent estimates (2013) estimate the number of labour migrants in the region to be 56.6 million. Although the migration pattern in the WHO EURO region could be categorized as listed above, the region experience a mixed migration flow.
- Slide 3: Health profile – Communicable diseases and immunization In general, refugees, asylum seekers and migrants do not pose an additional health security threat to host communities. Initial screening – not limited to infectious diseases – can be an effective public health instrument, but should be nondiscriminatory and non-stigmatizing and carried out to the benefit of the individual and the public. It should be provided on a voluntary basis, and with ethical attention to confidentiality. Most of the data that exists on refugee and migrant health is on communicable diseases. HIV and TB are the most widely studied topics. HIV The proportion of migrants among newly reported cases in the WHO EURO region is 21%. In the EU/EEA, this figure is 40%. There is emerging evidence that a significant proportion of migrants, even those originating from high HIV-endemic areas, acquire HIV after arrival in the WHO EURO region, particularly in the EU/EEA. It is important to ensure migrant-sensitive services for prevention and HIV testing, combined with policies which promote and ensure linkage and access to care. TB In the EU/EEA, in contrast to native TB cases, the number and proportion of TB cases among migrants has increased since 2014. Foreign-born patients may have been exposed to TB prior to their immigration to the EU/EEA or when travelling back to their country of origin. The proportion of migrants among newly reported cases in the WHO EURO region is 8.2%. In the EU/EEA the figure is 32.7%. Refugees, migrants, asylum seekers are considered as a vulnerable/at risk group. As with any other vulnerable group, it is essential to ensure good access to healthcare services for migrants. Immunization There is a high chance that refugees and migrants arriving in the WHO European Region may not be immunized, or may not have received all recommended vaccinations upon arrival, thus leaving them vulnerable to Vaccine Preventable Diseases (VPDs) in transit and destination countries. The highest risk group for Vaccine preventable Diseases (VPDs) are refugee and migrant children as the process of migration can interrupted their immunization schedule, meaning they have not received all recommended vaccines. Evidence from Greece suggests that nearly 80% of newly arrived migrant children between 2010 and 2013 had an undetermined vaccination status. Irregular migrants receive immunization services in very few countries because of inbuilt administrative barriers in the host countries related to their entitlement to free health services, including immunization The attached map shows countries having a National Immunization Programme (NIP) considering refugees and migrants in the programme.
- Slide 4: Health profile – NCDs, Maternal and Child Health, Mental Health Non-communicable diseases Non-communicable diseases (NCDs) are the largest contributor to the total burden of disease in the WHO European Region Evidence shows that the duration of stay in the host country can be associated with the development of overweight/obesity, especially among the North African migrants A recently conducted WHO STEPS survey among Syrian refugees living Turkey showed that half of the population had a medium and high risk respectively for NCDs. Migrants have an increased risk of developing type 2 diabetes. The development might occur at an earlier age than the non-migrant population. Diabetes prevalence is typically higher among female migrants than male migrants, with variations seen among different ethnicities. The majority of migrant groups are at higher risk of ischemic heart disease and stroke than the native population in western Europe. In particular, migrants originating in Eastern Europe, the Middle East and South Asia were at higher risk than the native western European population There is evidence suggesting that risk factors for Cardio Vascular Diseases (CVD) among migrant converges with that that of the host population as a result of duration of stay in the host country. The most common work-related health problems reported among labour migrants include musculoskeletal, respiratory and mental health problems. The risk of work related injuries is higher among labour migrants than in the non-migrant population, particularly for those without a work or residence permit. Mental health Mental health is an important aspect of migration as the migration process has a detrimental effect on different aspects of people’s lives and the social networks they live in. Post-traumatic stress disorders, mood disorder and depression are the most frequently reported conditions among migrants, mainly for refugees and recently arrived asylum seekers. Overall, drug and alcohol abuse seems to be lower in migrants compared with host populations, particularly in the countries of northern Europe. Evidence shows that post-migration stressors such as length of the asylum application process, unemployment or isolation are usually negatively associated with developing depression and other mental disorders. This underlines the importance of focusing on post-migration stressors. Maternal and Child health The risk of adverse perinatal and obstetric outcomes, including mortality, seems to be increased among immigrant women in general, although it is mainly seen among first-generation migrants. Unaccompanied minors or separated children are at high risk for exploitation and trafficking and lack the protection and support of a caretaker. Evidence show high rates of depression and post-traumatic stress disorder among unaccompanied teenage asylum seekers after resettlement
- Slide 5: WHO EURO response to the public health challenges of refugees and migrants Innovative approach leading to structural change -The Migration and Health Programme (MIG) WHO EURO region is the first WHO office to establish a fully-fledged programme on migration and health to assist Member States to respond to the public health challenges. Through the programme the Regional office has taken the lead in addressing the health challenges of the migrant and host population at regional and global level. The programme operates under the umbrella of the European health policy framework Health 2020, providing support to Member States under four pillars: technical assistance; health information, research and training; partnership building; and advocacy and communication. The programme promotes a collaborative intercountry approach to migrant health by facilitating cross-country policy dialogue and encouraging homogeneous health interventions along the migration routes to promote the health of refugees and migrants and protect public health in the host community.
- Slide 6: Create evidence and knowledge There are several activities through which the Regional office supports the Member States and promote refugee and migrant health. One of the key ways through which MIG does this is by creating an evidence base. MIG has so far produced 9 Health Evidence Network (HEN) synthesis reports on various topics related to refugee and migrant health. The HEN reports collates and synthesize existing evidence and presents in a format that is accessible and user friendly for policy makers. The latest HEN report provides on strategies that are in place in the WHO EURO region to address communication barriers faced by refugees and migrants. For the first time, WHO EURO is producing a report on the health of refugees and migrants in Europe. The report will be published later this year. In addition to producing evidence, MIG also provides guidance. Later this year MIG will produce 7 technical guidance (child health, elderly health, health promotion, mental health, mother and newborn health, noncommunicable diseases, immunization) Another pillar guiding the work of the programme is advocacy and communication. Knowledge Hub on health and migration is one of the several means through with the programme communicate and conduct advocacy. 7 webinars, 2 WHO schools on refugee and migrant health, repository of latest evidence on refugee and migrant health. The recently concluded WHO school was attended by more than 80 participants from nearly 20 European countries, North and South America, Africa and East Asia. Nearly 35 of the world’s leading experts in the field of refugee and migration health served as faculty. MIG also conducts country assessments using a unique tool developed by WHO EURO in collaboration with UNHCR and IOM. The aim of the assessment, in close collaboration with the relevant ministries, is to assess the national health system’s capacity to respond to the public health challenges of large influx of refugees and migrants
- Slide 7: The strategy and action plan for refugee and migrant health in the WHO European region This is the first ever WHO strategy and action plan focusing entirely on the health of refugees and migrants. This plan was adopted by all the Member States during RC 66. A survey to monitor the implementation of the strategy was carried out in early 2018. The survey results are promising showing positive developments in the region and the Member States are implementing the action plan. The survey will be repeated every 2 years until 2022. Progress has been made in including refugee and migrant health in national health policy, strategy and/or plan of several Member states, almost half of the Member states have contingency plans in place for large arrivals of refugees and migrants.
- Slide 8: Towards a Global Framework on refugee and migrant health WHO EURO playing a lead role Being a pioneer among the WHO regions in promoting refugee and migrant through strategy and action plan, WHO EURO has actively lead and contributed to developing a global agenda and framework for refugee and migrant health. The WHO Global Framework of priorities and guiding principles to promote the health of refugees and migrants was inspired by the WHO EURO Strategy and action plan The WHO EURO office is overseeing the consultations with all WHO Member States to finalize the Global Action plan for Refugee and migrant health. The Regional office is working closely with the Head Quarters to ensure that health of refugees and migrants is a core aspect and properly reflected in the forthcoming Global compacts (Global compact for safe, orderly and regular migration AND The Global Compact on Refugees)