The UN Recommendations on Statistics of International Migration define a long-term migrant as a ‘person who moves to a country other than that of his or her usual residence for a period of at least a year. There were an estimated 48.9 million foreign-born residents in the 27 countries of the EU in 2011, amounting to 9.7% of the total population; 32.4 million were born outside the EU and 16.5 million were born in a different EU country.
Migration and health is a European issue. Considerable increases in the number of migrants living in European countries were observed between 2005 and 2010, yet the scarcity of data on their health and their access to healthcare makes it difficult to improve the health of migrants in the EU.
To the extent that information is available across countries and migrant groups and it is possible to generalise, migrants are often comparatively healthy overall, a phenomenon known as the ‘healthy migrant effect’. However, migrants are a very heterogeneous group and some migrant populations seem to be more vulnerable to specific infectious diseases, occupational diseases and poor mental health. In terms of non-communicable disease, migrants to Europe seem to initially have a lower risk of cancer but a higher risk of diabetes and some other diseases, while the risk of cardiovascular disease varies among different groups. Migrants are also at higher risk of maternal and child health problems.
These differences reflect a complex set of factors including migration patterns, the demographic profile of migrants, experiences during migration, high-risk behaviour, patterns of disease in migrants’ countries of origin, the trauma that can be associated with the causes of migration, and access to health services in both the country of origin and host country. Health risks to migrants may also continue for many years after arrival in Europe as a result of travel to visit friends and relatives in countries of origin.
In addition, social, economic, cultural and legal factors in the host country can increase the vulnerability of migrants to infectious diseases as well as influencing health-related behaviour. Social factors include discrimination, stigma and isolation. Economic factors include poverty, poor living conditions and unemployment. Cultural factors include language barriers, religion, gender roles, health beliefs, practices and perceptions about health services. Legal factors include lack of entitlement to healthcare, particularly for irregular migrants.
The public health challenge of migration
The conference ‘Health and migration in the EU: Better health for all in an inclusive society’, in Lisbon in June 2007, was an important input to the Council Conclusions on Health and Migration in the EU. They recommended that the European Commission support action through the Programme of Community Action in the Field of Health 2008-2013 and invited Member States to integrate migrant health into their national policies and to facilitate access to healthcare for migrants. The Conclusion also called on ECDC to produce a comprehensive report on migration and infectious diseases in the EU to inform policy and public health responses.