Elsevier

Health Policy

Volume 93, Issue 1, November 2009, Pages 55-63
Health Policy

A framework for analysing migrant health policies in Europe

https://doi.org/10.1016/j.healthpol.2009.05.015Get rights and content

Abstract

Evidence suggests migrants experience inequalities in health and access to health care. However, to date there has been little analysis of the policies employed to address these inequalities. This article develops a framework to compare migrant health policies, focusing on England, Italy, the Netherlands and Sweden. The first issue addressed in the framework is data collection. All four countries collect migrant health data, but many methodological limitations remain. The second issue is targeting of population groups. Countries typically focus either on first generation immigrants or on ethnic minorities, but not both, despite the often divergent needs of the two groups. Another issue is whether specific diseases should take priority in migrant health policy. While communicable diseases, sexual and reproductive health and mental health have been targeted, there may be a lack of attention paid to lifestyle related risk factors and preventive care. Fourthly, decisions about the mix of demand and supply-side interventions need to be made and evaluated. Finally, the challenge of implementation is discussed. Although migrant health policy has been elaborated in the four countries, implementation has not necessarily reflected this on the ground. These experiences signal important policy issues and options in the development of migrant health policies in Europe.

Introduction

A growing body of studies suggests there are inequalities in health between migrants and local populations in Europe [1], [2], [3], [4], [5]. This is despite the fact that health services are (almost) free at the point of use in the EU and most countries grant full equality of treatment to third country nationals1 after awarding them long-term or permanent residence status. There is therefore increasing pressure at the European level to ensure migrants’ access to social services, including health care, reflected for example in the focus of the Portuguese Presidency of the EU in 2007 [6] and the MIGHEALTHNET project which aims to stimulate the exchange of knowledge on migrant and minority health [7]. In light of this, an important question is, to what extent should governments develop policies to reduce migrant health inequalities? Furthermore, if governments do decide to address migrant health, what types of issues and policies might they consider? The lack of systematic analysis of national migrant health policies means there is little information available to help answer these questions. This article starts to address this gap. First, important conceptual and technical issues in migrant health policy are identified in the literature and presented in the form of an analytic framework. In the second part of the paper, the framework is employed to analyse migrant health policies and programmes in four European countries; England, Italy, the Netherlands and Sweden. It is argued that the framework is a useful tool for the systematic comparison of national migrant health policies, a process which can in turn provide a set of guideposts for policy makers and highlight topics which merit further research.

In terms of the scope of the study, it is recognised that the definition of ‘migrants’ is not straightforward. This article employs as a starting point a definition of migrants as persons born abroad who are legally working, or permanently resident, in the country in question. Data and policies on illegal or irregular migrants and on asylum seekers are not discussed in detail in this paper since these are complex areas of policy which merit a separate in-depth discussion. Clarifications are made throughout where appropriate.

Section snippets

A framework to analyse migrant health policy

While there is a growing body of research into inequalities in migrant health and (to a lesser degree) access to health care [1], [2], [3], [4], [5], how to translate this information into health policy has been little explored in a systematic manner. As a first step, the literature was analysed in order to identify possible technical and conceptual issues in the development of migrant health policy. These issues are presented in the left-hand side of Table 1. Particular attention was paid to

Migrant health policies and programmes in Europe

In the second part of the study, a questionnaire on migrant health was sent to health policy experts from 15 European countries (Belgium, Denmark, England, Estonia, Finland, France, Germany, Ireland, Italy, Lithuania, Netherlands, Poland, Spain, Sweden, Turkey). The experts were asked to report on: national surveys that include health indicators and identify whether respondents are a migrant and/or ethnic minority; official reporting of information on health status and health care of

Discussion

This article has proposed a framework for migrant health policy analysis. Information from four countries with some of the most developed policies in Europe (England, Italy, the Netherlands and Sweden) was used to populate this framework. The results of the analysis suggest that each country has taken a very different approach and that there may be opportunities for learning across countries. Perhaps most important as a starting point for any migrant health policy is the development of

Conclusion

By organising policy information in an analytic framework the study has been able to identify some of the important issues and options in migrant health policy. The comparison of four countries’ policies through the analytic framework demonstrates that it can be used to for develop guideposts for policy makers. This process may assist countries to learn from each others’ experiences and may particularly benefit countries currently designing migrant health policies. As a next step, the analysis

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  • Cited by (0)

    The country policy information in this article was collected under the project ‘Health Status and Living Conditions’ (VC/2004/0465) for the European Commission, DG Employment and Social Affairs, under the European Observatory on the Social Situation. The author would like to thank the country experts for the information provided and Elias Mossialos for comments on drafts of the article. All the views expressed are the author's own.

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