Migration: implications for health inequalities

Health inequalities are integral both to factors which lead people to migrate and to the consequences of migration and are therefore an important focus of attention for social work and social development practice, research, education and policy making. Following the social determinants framework outlined in ‘Closing the Gap in A Generation’ (WHO 2008), the factors leading to migration, the process of migration, the social conditions into which migrants move and barriers to accessing services may all constitute cumulative inequalities, with threats to health, both physical and mental. One consequence of the disadvantaged situations from which migrants often leave and into which they arrive is that their health status may be poor or under threat. While migrants are also often those with the strength, motivation and resources which those they leave behind may lack (i.e. the “healthy migrant effect”), there is evidence of an accelerated health decline after emigrating to a new country. Most vulnerable are those migrants who leave because of physical and mental injuries caused by violence, including torture and rape; their health status may be a direct focus of concern. Others may bring disease requiring treatment and care with them. Harrowing and dangerous journeys may cause or exacerbate ill health. Host country or host area social attitudes and policies, together with limited resources and support mechanisms may constitute a further health threat. Migrants moving against their will, who are trafficked or sexually exploited, and unaccompanied children are especially vulnerable. Additionally limitations on rights and access to health treatment and care may exclude migrants from the help and support their health requires. Social exclusion and relative power imbalances are significant forces contributing to health inequalities. This paper will outline the key issues linking health inequalities with migration and their relevance for social work and social development practice and research. It is designed to introduce four other research based papers from Professor Varda Soskolne (Israel), Dr. Eva Moya (USA/Mexico), Dr. Blanca Ramos (USA) and Dr. Christa Fouche (New Zealand) which are being separately submitted.