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响应: 全球卫生与移民

Building Responsive Health Systems to Meet the Challenges Of Growing Migrant/Refugee Populations

Professor Jennifer Bouey, Georgetown University


The United Nations reported a 50% increase in international migration between 1990 and 2013, resulting in an estimated 232 million international migrants.  In 2015 alone, 1.26 million new asylum claims were made in European Union (EU) countries.   Domestic migrant populations worldwide are even larger, and a quarter of this total was accounted for by China’s 243 million rural-to-urban migrants. For these migrant and immigrant populations, the additional stress associated with an abrupt change in cultural and social environments and the loss of social support has negative health consequences. Migration poses one of the most formidable challenges to health systems and their development among national and international governing agencies.  Understanding how human mobility affects health is crucial to improving efficiency in health services delivery, achieving health equity for marginalized populations, and preventing the spread of diseases.

As social epidemiologist, I am particularly interested in behavioral and social determinants of health among migrants and immigrants. Rapid urban growth in many developing countries is accompanied by the spontaneous emergence of migrant and immigrant settlements at the cities’ peripheries and by a disorganization of these settlements in terms of infrastructure (e.g., crowded and poorly planned housing, limited access to education and health facilities, and clandestine relationships with local law enforcement agencies). The great danger is that these floating populations also exhibit high risks for illness and disease because of very low access to sanitary facilities and preventive care, as well as the high exposure to often hazardous working environments.  Health needs of migrants and immigrants are often poorly understood by the public health system, communication between health care providers and migrant clients remains difficult with or without linguistic barriers, and health systems are not prepared to respond adequately.

In theory, migrant and immigrant health service utilization would be predicted by various predisposing and enabling factors and the effects of perceived needs, including health and mental health indicators, personal and social resources, and a range of post-migration living difficulties. A recent Delphi consensus has highlighted that “as worldwide migration increases, the media, decision makers and stakeholders are recognizing the importance of building responsive health and other social systems. . . If policies and programs for a responsive health system can be developed, crises may be averted in the future.” Global health scholars are calling for actions to engage migrant communities, provide culturally sensitive health care, and prioritize data collection on demographic movement, health surveillance, and health services studies in order to build a responsive health system. Our health studies on African migrants in China and Chinese migrant workers in Africa aim to highlight the unique needs of these floating populations and help engage these communities and local governments in building responsive health systems.