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2017年3月10日

Responding To: 全球卫生与移民

中美间在全球健康与移民上的合作

Professor Elanah Uretsky, George Washington University

请注意:中英文网站上发表的教授日志均为英文。

More people are on the move today than at any other time in history. According to the International Organization for Migration (IOM), a total of 244 million people resided in a country other than their country of birth in 2015. This is the highest recorded number of migrants ever.  To put this into perspective, the IOM recorded 76 million migrants in 1960. This increased to 214 million in 2010 before reaching its recent high of 244 million.  This increase in movement around the globe has also placed migrant health at the center of global health concerns. 

The main focal point of international migration and migrant health has historically been placed on people from developing countries drawn by economic opportunity to developed countries.  The host countries where they settle often have policies and infrastructure in place to aid the settlement of migrants.  This includes institutions that help to respond to the unique situations that frame migrant health.  Increasingly, however, South-South migration, or migration across developing countries is defining patterns of international migration. In 2015 over one-third of international migration occurred across developing nations.  One of the emerging trends in South-South migration is occurring between China and Africa.  China invests heavily in African infrastructure, building, for example, roads, dams, railways, and hospitals.  This has led to a large influx of migrants who work for the Chinese state-owned companies that are leading this infrastructure development. This is accompanied by a separate wave of independent migrants not supported by the infrastructure of a large company.  In the opposite direction we have seen a growing trend of migration from Africa to China but at a lesser level of recognition because this wave of migration happens at a lower tier of globalization. Approximately 500,000 Africans reside in China. The bulk of these migrants are itinerant traders who either reside in China’s trading hub, Guangzhou, or travel back and forth between Africa and Guangzhou.

The challenges to these populations are many.  The institutions and infrastructure that often
exist to help migrants to developed countries are non-existent in developing countries that have typically served as sending and not host countries for migrants.  This holds true for health as well. Access to health care for migrants among the global south is virtually non-existent because of a lack of infrastructure necessary for accepting immigrants into these countries. The African migrants to China are invisible to a local health care system that caters to its own citizens. This, compounded by fear, language barriers, and different health care expectations creates a vacuum capable of nurturing new global outbreaks of disease.

The implications that this new trend of international migration may have on global health are not yet known and will not be known until we can begin to break through the barriers posed by the lack of infrastructure, institutions, and policies needed to accommodate international migrants.  What is known is that China, as a new player on the global health stage, is well poised to respond to these problems. There is also great potential for China to partner with the United States in combatting and perhaps getting ahead of some of the new health problems that may result from this new wave of South-South migration, particularly the part of this trend that is connecting China and Africa through international migration. 

This potential stems from the individual experiences that China and the United States have in combatting health problems in Africa.  The complementary skills and resources they bring to this table can only benefit partnership and collaboration in these efforts. China’s engagement in African health dates back to 1963 when the government sent its first health emissaries to aid in African health care. Between 1976 and 1997 China dispatched medical teams to 25 African nations. They have also built hospitals and health centers, trained doctors and nurses and provided malaria treatment as well as malaria treatment centers. [1] U.S. involvement in public health in Africa, began with smallpox eradication programs in the 1940’s.  More recently we have seen implementation of major government-funded programs like PEPFAR and the President’s Malaria Initiative (PMI) as well as the many U.S.- funded and based international NGOs that implement health related programs in Africa. China and the United States also both provided assistance to West Africa during the recent Ebola crisis.  Both countries have also sailed hospital ships to aid Africa.

While China and the United States have contributed greatly to the public health needs in Africa, much of this has been done in parallel to one another.  With the increase in migration between China and Africa and the complementary sets of skills and knowledge that the United States and China have to offer each other in the global health arena, the time has never been more right for increased U.S.- China collaboration in Africa for the purposes of responding to needs on the continent as well as the needs of the transnational migrants moving between China and Africa. 

The cooperation may begin in Africa where, for example, China is valued and appreciated for the doctors and nurses it sends to fill critical gaps in health care.  Their efforts are often constrained, however, because of language and other practical barriers that can be addressed through U.S. collaboration.  This type of collaboration can also be nurtured in the many multilateral settings in Africa where China and the United States can cooperate on malaria projects, water and sanitation projects, and in building health centers.  In these situations, China can often provide the raw materials while the United States provides training.

This work is further strengthened by the increased dialogue and exchange China is having on global health with U.S. universities, including Harvard, the University of Washington, and Georgetown.

This increasing collaboration between Chinese and U.S. universities will bring together the expertise needed to address global health problems occurring in areas where Chinese perspective is necessary to complement Western skills, theories, and approaches often used in global health settings.

China has already realized the importance of engaging in local health issues in Africa but now needs to think at a more global level as the health threats commonly associated with Africans begin to affect Chinese on both Chinese and African soil as the two populations migrate between the two continents.  This will require China to change its focus from domestic public health and international health to one of global health that considers the global forces that act upon health transnationally. This includes consideration of how the experience of migration from home to host country affects the health of migrant populations.  Partnering with the U.S. government and other U.S. institutions including universities dedicated to studying global health will go a long way toward integrating China into the field of global health. It will also provide the necessary services and programs that will be needed to respond to the health problems that will inevitably arise as a result of this emerging trend of migration between China and Africa.

 [1]  Xiaoqing Lu Boynton (ed.) China’s Emerging Global Health and Foreign Aid Engagement in Africa.  A Report of the CSIS Freeman Chair in China Studies and the CSIS Global Health Policy Center


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