A framework for analysing 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
References (72)
- et al.
A nationwide survey of CPR training in Sweden: foreign born and unemployed are not reached by training programmes
Resuscitation
(2006) - et al.
Profile of the hospital case mix of the immigrant population in Barcelona, Spain
Gaceta sanitaria/S.E.S.P.A.S.
(2002) - et al.
Health care and illegality: a survey of undocumented pregnant immigrants in Geneva
Social science & medicine
(2005) - et al.
Effect of ethnic background on Danish hospital utilisation patterns
Social science & medicine
(2002) - et al.
Pharmacy-related health disparities experienced by non-English-speaking patients: impact of pharmaceutical care
Journal of the American Pharmacists Association (Wash, DC)
(2005) - et al.
Sociodemographic characteristics and use of health services by the immigrant population residing in a district of the Community of Madrid
Atencion primaria/Sociedad Espanola de Medicina de Familia y Comunitaria
(2000) - et al.
International migration and health: a paper prepared for the Policy Analysis and Research Programme of the Global Commission on International Migration
(2005) - Ingleby D, Chimienti M, Hatziprokopiou P, Ormond M, De Freitas C. The role of health in integration, in social...
- MacKay L, Mcintyre S, Ellaway A. Migration and health: a review of the international literature. Medical Research...
- Mladovsky P. Migration and health in the EU Research Note produced for the European Commission as part of the Health...
Is research into ethnicity and health racist, unsound, or important science?
BMJ
The Mosque Campaign: a cardiovascular prevention program for female Turkish immigrants
Wiener klinische Wochenschrift
Online cancer education and immigrants: effecting culturally appropriate websites
Journal of Cancer Education
Older immigrants: language competencies and mental health
Canadian journal of community mental health
A review of ethnicity, health and nutrition-related diseases in relation to migration in the United Kingdom
Public health nutrition
Ethnicity and variations in the nation's health
Health Trends
Patterns of mortality among Bangladeshis in England and Wales
Ethnicity & health
Nutrient intake trends among African-Caribbeans in Britain: a migrant population and its second generation
Public health nutrition
Mortality among non-western migrants in The Netherlands
Nederlands tijdschrift voor geneeskunde
The healthy migrant effect: role of selection and late entry bias
Gesundheitswesen
Mortality of migrants from the Caribbean to England and Wales: effect of duration of residence
International journal of epidemiology
Unhealthy assimilation: why do immigrants converge to American health status levels?
Demography
Obesity among US immigrant subgroups by duration of residence
JAMA
Sexually transmitted diseases, cervical cytology and contraception in immigrants and refugees from the former Yugoslavia
Venereology
Access to Danish health care by immigrant women. Access to hospital care among immigrant women with breast cancer compared with Danish women
Ugeskrift for laeger
Interventions to improve uptake of breast screening in inner city Cardiff general practices with ethnic minority lists
Ethnicity & health
Health situation of and health service provided for adult migrants—a survey conducted during school admittance examinations
Gesundheitswesen
Inequality in the access to preventive health care: the case of immigrants in Belgium
Archives of public health
Access to and use of out-of-hours services by members of Vietnamese community groups in South London: a focus group study
Family practice
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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.