Copyright 2001, The Guardian
The UK government has recently announced that migrants from at least 67 countries who intend to stay more than six months will need to have a TB test before applying for a visa. After years of progress in the global fight against TB, it has now clear that a major epidemic of the diseases again and the WHO predicts the situation will become worse in coming years unless steps are taken to improve better prevention and treatment of the disease.
TB is not a new challenge to Europe. TB was a major killer throughout the region and it has only been in the last 50 or so years that most (but not all) European countries have seen a major improvement in the prevalence of what is still a life-threatening disease. Rightly or wrongly, TB has also been typically seen as a disease imported by newcomers and most so-called “receiving” countries have instituted steps to assess migrants for their TB status. Some countries, such as the USA and Canada, have elected to screen people prior to their emigration or departure. Others have adopted on-arrival screening policies and practices.
Screening for any diseases is always costly and open to problems of sensitivity and specificity. Additionally, we believe that many of the screening policies and practices currently in place have not proved particularly effective. Pre-migration screening, for example, does not pick up cases of exposure to TB during the course of migration and on-arrival screening appears not to pick up a large proportion of all the people that go on to develop TB well after arrival. Screening for TB has also been associated with both real and perceived discrimination. Some countries in the Gulf, for example, refuse entry to people with TB and the USA, Canada and Australia require people who test positive for TB to complete a course of treatment before reapplying for a visa. The fear of being rejected entry as a result of TB has lead to considerable corruption around pre-migration screening and to various other ways of avoiding screening. The reality is that a significant proportion of all TB identified in migrants after entry is probably linked to the working and living conditions into which migrants in most parts of the world are directed. Migrants typically move into low-income neighborhoods, poor quality houses that are overcrowded and poorly ventilated. Many TB experts believe these are the prime conditions for transmission of TB. Low-income migrations also tend to eat poorly and invest less in health care, thus exacerbating the risk of TB. If TB in migrants is to be prevented and controlled, existing policies and practices on screening need to be reassessed and steps need to be taken to tailor screening to the realities of exposure and reactivation of latent TB. TB screening also needs to be presented much more forcefully as a nondiscriminatory practice and as one designed simply to identify those people who should be and are eligible for quality treatment.
A couple of weeks ago,we at ICMHD touched on the growing tendency for politicians to use the theme of migration in their campaigns and, more often than not, blaming migrants for many of the ills facing countries in this time of economic hardship. This diversion could easily cast a shadow on the numerous opportunities available for constructive national social and economic development and at the same time it could directly erode the health of the migrants populations.
In many ways Europe is at crossroads. Demographers and economists largely agree that falling fertility rates, a rapidly aging population, and the growing lack of interest of nationals in occupations they no longer see as financially or socially attractive is creating major challenges to development. At a time when fewer young people are available to the economic market place and when a larger proportion of national budgets will inevitably be allocated to the care of the elderly, Europe is increasingly finding itself unable to maintain its social security systems and economic competitiveness.
If Europe pragmatically is to prosper socially and economically it must take up this challenge and proactively develop policies and programs designed to attract, absorb and integrate people in ways that will maintain the social capital base the continent needs to achieve these goals.
To date most European countries have done little to integrate migrants. Few have provided migrants with incentives to learn host languages and even fewer have developed outreach programs to incrementally transition migrants to link with the history and values of host societies. Urban planning and housing schemes have rarely been designed to encourage physical integration and prevent the concentration of ethnic minorities in ghettos. Instead Europe has taken a laissez-faire approach to migration presumably assuming that with time newcomers are automatically absorbed into host societies.
Today many European countries are faced with ethnic minority communities characterized by poor socioeconomic profiles, limited educational and occupational mobility and poor health profiles and, increasinglysocio-political instability.
The response from many politicians has been to talk in sweeping ways about the negative impact of migrants and suggest that the answer is to radically cut the number of newcomers. Instead the time has come for European countries to step back and analyze what type of society they want and what they are willing to do to encourage and facilitate a true absorption and integration of the new people they so desperately need. Isolation is not a valid option in the world we live in today.
We would like to know your thoughts on the specific issue of how you view national European immigration policies and their effects on migrants’ health. Please feel free to share and comment!
Posted in Health, Health Systems, ICMHD, Migrants, Migration, Politics
Tagged Economic development, European Union, ICMHD, Immigration, Manuel Carballo, Minority group
©2012 Stock Connection and World of Stock.
Gestational diabetes mellitus (GDM) is a non-communicable disease caused by glucose intolerance. Despite the fact that it can pose serious threats to pregnant women and their babies, GDM has been late in attracting the type and extent of global attention it deserves. Typically seen as a disease that goes into remission at the birth of the baby, GDM can nevertheless present serious threats to the mother in the ten years following her pregnancy (risk of developing type 2 diabetes and developing GDM in future pregnancies) and to the young infant (Obesity, respiratory problems, and later type 2 Diabetes).
How widespread or common GDM is, remains relatively unclear. The absence of globally accepted standards for screening and treatment of GDM is one of the reasons for this, and even today there are still many countries that do not routinely screen for GDM as part of antenatal care. The persisting lack of real attention to, and investment in, maternal health in general, is another underlying factor.
At ICMHD we believe GDM is a growing problem that is affecting some populations more than others. Our research suggests that some ethnic groups are far more vulnerable to it than others, and we also believe that the process of migration can be a precipitating factor. In a world in which the number of women on the move is now beginning to exceed the number of men, the problem of GDM in migrant groups and ethnic minorities calls for urgent attention.
ICMHD has made GDM one of its priorities and is working to improve international knowledge about its incidence and impact in different parts of the world and among different populations. We believe every mother-to-be and her child has the right to a healthy life and we hope that by raising awareness about the problem we will encourage more countries and stakeholders to take it up.
By: Emily Hertel
Posted in forced migration, Gestational Diabetes Mellitus, Health, Health Systems, ICMHD, International Centre for Migration Health and Development, Migrants, Migration
Tagged antenatal care, Diabetes, disease, health, maternal health, Non-communicable disease, women, Women's health
Health G20: A briefing on health issues for G20 leaders
Health G20 has been created by the International Centre for Migration, Health and Development in Geneva, Switzerland and the Dasman Diabetes Institute in association with Pro-Brook Publishing. The ICMHD Executive Director, Dr Manuel Carballo, and the Director, Professor Kazem Behehani, are editors of the publication. Pro-Brook Publishing is a specialist publisher in the global healthcare arena.
The objective of Health G20 is to promote health and development on the G20’s agenda. Underlying all economies is a healthy population, Health G20 is there to brief world leaders on key disease areas, common problems and new developments to ensure that healthcare is not left off the agenda of this powerful grouping.
Health G20 could not have been published without the assistance of the Supporters. These Supporters range from healthcare NGOs, UN agencies, commercial companies and academic institutions (See Supporters)