The UCL-Lancet Commission on Migration and Health: the health of a world on the move

Abstract

With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency.

In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report.

First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move.

Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses.

Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants.

Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required.

Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.

Figure 1. The migration cycle

Figure 2. International migration globally

(A) Global map of the total number of international migrants in 2015. (B) Percentage of population that were refugees by the World Bank Income group (1960-2017). Analysis done with data from the World Bank. Interactive online version available.

Figure 3. Weighted percentage of men and women using modern methods of contraception by migration status^–

No data available for Kenyan women.

Figure 4. International migration by migrant subgroup^,,

Percentage of all international migrants that were refugees, asylum seekers, and labour migrants, 1960–2017. Labour migration estimates only available for 2013. Refugee numbers are for those under the UN High Commissioner for Refugees’ mandate and therefore do not include individuals under the UN Relief and Works Agency for Palestine Refugees in the Near East’s mandate as data are not available back to 1960. Analysis done with data from UN High Commissioner for Refugees. Interactive online version available.

Figure 5. Total annual new displacements as a result of conflict and disasters globally

Interactive online version available.

Figure 6. Estimated refugee numbers under the UN High Commissioner for Refugees’ mandate by region, 1951-2015

Historical data in this figure do not include 5·4 million Palestinian refugees under the UN Relief and Works Agency for Palestine Refugees in the Near East’s mandate in 2017, as historical data for this group are not available. Interactive online version available.

Figure 7. Weighted mean number of years of education by internal migration status^–

Figure 8. Historical evolution of the migration and health agenda: selected international instruments and events

IOM=International Organization for Migration. OCHA=UN Nations Office for the Coordination of Humanitarian Affairs. UNGAHLD=UN General Assembly High-level Dialogue on International Migration and Development. WHA=World Health Assembly.

Figure 9. A health systems framework for migrants’ access to health and social protection

Factors on the supply side can affect demand and vice versa. Adapted from Levesque et al, 2013. *Social and cultural ability.