FFrontront CCover.aiover.ai 220/5/090/5/09 110:06:320:06:32 Health and Migration in the European Union: Better Health for All in an Inclusive Society Foreword by António Correia de Campos Editors: Ana Fernandes and José Pereira Miguel C M Y CM MY CY CMY K 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 1 Health and Migration in the European Union: Better Health for All in an Inclusive Society 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 2 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 3 Health and Migration in the European Union Health and Migration in the European Union: Better Health for All in an Inclusive Society Foreword by António Correia de Campos Edited by Ana Fernandes and José Pereira Miguel 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 4 Instituto Nacional de Saúde Doutor Ricardo Jorge Avenida Padre Cruz, 1649-016 Lisboa, Portugal Copyright © Instituto Nacional de Saúde Doutor Ricardo Jorge 2009 All rights reserved. First published: 2009 Title: Health and migration in European Union: better health for all in an inclusive society Authors: General editors: Ana Fernandes and José Pereira Miguel; Associate editors: Jorge Malheiros, Manuel Carballo, Beatriz Padilla, Rui Portugal Editor/Publisher: Instituto Nacional de Saúde Doutor Ricardo Jorge Date of publication: 2009 ISBN: 978-972-8643-41-6 Legal Deposit: 291173/09 This report was commissioned by the DG SANCO for giving insights to the Conference “Health and Migration in the EU: Better health for all in an inclusive society” to be held in Lisbon on the 27th and 28th of September, 2007, under the Portuguese Presidency of the EU Council. The content of the present work is the responsibility of the editors and of the authors of the good practices presented and not necessarily reflects the position of the Portuguese authorities. Produced for the Instituto Nacional de Saúde Doutor Ricardo Jorge by Pro-Brook Publishing Limited, 13 Church Street, Woodbridge, Suffolk, IP12 1BH, UK (www.pro-brook.com) Printed in the European Union 004 HEALTH AND MIGRATION IN THE EUROPEAN UNION 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 5 Contents Contents 07 Foreword – Health and Migration in the European Union António Correia de Campos Part I: Challenges for Health in the Age of Migration 13 Introduction 15 Chapter 1: Health and Migration in the European Union: Building a Shared Vision For Action Beatriz Padilla and José Pereira Miguel 23 Chapter 2: Conceptual framework Ana Fernandes, Barbara Backstrom, Beatriz Padilla, Jorge Malheiros, Julián Perelman and Sónia Dias 33 Chapter 3: Immigrants in the European Union: Features, Trends and Vulnerabilities Jorge Malheiros, Sofia Nunes and Dora Possidónio 53 Chapter 4: Communicable Diseases Manuel Carballo 71 Chapter 5: Non-communicable Diseases Manuel Carballo 83 Chapter 6: Migration and Health: National Policies Compared Milena Chimienti 91 Chapter 7: The Road Ahead: Conclusions and Recommendations Ana Fernandes, Beatriz Padilla, Manuel Carballo and José Pereira Miguel Part II: Good Practices on Health and Migration in the European Union 101 Health and Migration in the European Union: Good Practices Beatriz Padilla, Rui Portugal, David Ingleby, Cláudia de Freitas and Jacques Lebas 119 Transnational Case Studies 151 Country Case Studies 211 Portuguese Case Studies HEALTH AND MIGRATION IN THE EUROPEAN UNION 005 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 6 00-96 1st section:updated - portugal 1 20/5/09 09:55 Page 7 Foreword Health and Migration in the European Union he organisation of a conference on Health and Migration within both for the host and the origin countries. International experience the scope of the Portuguese Presidency of the European Union has shown that integration is key for societies and economies to Twas intended to address the political need to find and think benefit from the migration movements. about exchange platforms between Member States regarding the A person who decides to emigrate, is normally in good health, to economical, demographic, social and cultural challenges of migration. be ready to work. However, if being healthy is common for the Migrations, both into and within the EU, are an important migrant workers, conditions in which migration happens are challenge for social and health policies deserving co-operation traumatic: migrants are abused by illegal networks; they travel in among Member States to exchange expertise, learn from each overcrowded boats or in containers and railway wagons. In host others’ experiences and promote common strategic initiatives. countries, they are also a target for discrimination and exploitation: Health and access to healthcare are crucial factors for the they accept less appealing jobs, live in poor housing conditions, eat integration of immigrants. badly and find it difficult to access healthcare and other services. If In the last few years, the political debate over the demographic they are healthy to start with, they will find hostility and vulnerability aspect and its economic and social implications has become along the way. intense. Recent changes in the history of European population References to migrant populations in the health policies of most movements constitute a global phenomenon with two distinct host countries are not recent. For centuries countries have held tendencies: a definite decline in reproductive capacity and an control measures in place to avoid the spread of contagious increase in life expectancy. As a consequence, we experience slow diseases such as tuberculosis and tropical diseases. The growth in growth and population ageing with the corresponding social and mobility is mirrored by the complexity of migrant population economic impact. European Member States have some of the composition. Ethnic diversity is replicated on diversity in statute: world’s most ageing populations, with low reproductive capacity irregular migrant workers may include asylum seekers, trafficked and extended life expectancy. We are heading towards demographic people and those who have lost their legal status and become implosion, that is, more deaths than births. In some cases, the highly vulnerable. On the other end of the job scale, there is also a impact on natural decline can barely be compensated by new growth of specialised migrant workers, especially health migrant populations. The sustainability of health and social security professionals. The “brain drain” process or the emigration of systems is at stake with negative consequences in economic activity. professionals is now a global phenomenon. However, Europe represents a regional magnet because of its The need to address the provision of adequate care to culturally wealth. Despite some EU Member States’ attempts to restrict, diverse and increasingly vulnerable migrant population is a great control and select influxes, an increase in all types of migration is challenge to health policies. However the EU also faces difficulties in noticeable. managing access to healthcare. The illegal status and access to care Migration is part of the history of human populations. What is an important political debate still without solution. distinguishes this phenomenon in the era of globalisation is the The documents presented here are the preparatory working pace of mobility. There has been an increase in the number of papers for the conference on Health and Migration in the European people who move and there has also been an increase in the speed Union. Health and migration are related subjects. This research of these movements. The reasons are well known: the development involved the participation of experts in migration and in health and of an open system of communications and the low cost of migration to demonstrate the extent and impact of population travelling. Some European countries have been stunned by the mobility on morbidity and health and to identify some of the related extension and the increase in intensity of influxes of immigrants, policies in place up to now. from Eastern Europe, Asia, Africa and Latin America. Portugal, The challenges for health in the age of migration are due to the Ireland, Spain and Italy, traditionally emigrant countries, are now complex relations between health and migrations. We still lack receiving immigrants. The size and direction of the influxes depend, knowledge about migrations as a factor in health. Available data is mainly on the economic and political differences between regions scarce. This is an attempt to gather and systematise relevant and countries. However, an important reason can be attributed to information, which I hope can become an instrument for city growth and urbanisation. Globalisation increases trade and politicians, researchers and interested stakeholders in general. I interactions between countries and regions. The coming workforce is not enough to compensate the ageing of the population; it may just delay or slow down the process, giving countries the opportunity to create suitable policies to counteract the demographic change. António Correia de Campos It is important to understand costs and benefits of migrant labour, Minister of Health of Portugal HEALTH AND MIGRATION IN THE EUROPEAN UNION 007 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 8 00-96 1st section:updated - portugal 1 19/5/09 16:29 Page 9 Health and Migration in the European Union Part I Challenges for Health in the Age of Migration Associate editors: Jorge Malheiros and Manuel Carballo MIGRATION AND HEALTH