Migrants in a globalized world — health threats, risks and challenges: an evidence-based framework

Brian Gushulak,Jacqueline Weekers,Douglas Macpherson

doi:10.3134/ehtj.09.010

Abstract

International population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. These risks are often related, but not limited, to transmissible pathogens. Mobile populations can link zones of disease emergence to lowprevalence or nonendemic areas through rapid or high-volume international movements, or both. Against this background of human movement, other global processes such as economics, trade, transportation, environment and climate change, as well as civil security influence the health impacts of disease emergence. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, affect organizational and public awareness of events of potential public health significance. International regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement. The thesis that human population mobility is itself a major determinant of global public health is supported in this article by review of the published literature from the perspective of determinants of health (such as genetics/biology, behavior, environment, and socioeconomics), population-based disease prevalence differences, existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. This paper highlights some of the emerging threats and risks to public health, identifies gaps in existing frameworks to manage health issues associated with migration, and suggests changes in approach to population mobility, globalization, and public health. The proposed integrated approach includes a broad spectrum of stakeholders ranging from individual health-care providers to policy makers and international organizations that are primarily involved in global health management, or are influenced by global health events.

Highlights

Several current emerging threats and risks exposing public health vulnerabilities are linked to global processes, such as economics, trade, transportation, environment and climate change, and civil security
The flow of populations between locations with widely different health determinants and outcomes creates situations in which locally defined public health threats and risks assume international or global relevance. This fact is illustrated by the rapid awareness, detection, and response to the emergence of a novel influenza A/H1N1 virus in the spring of 2009.4,5 Global demographic predictions indicate that the forces promoting and supporting international migration will continue to do so, and may become stronger in all regions of the world as populations attempt to move up gradients of opportunity.[6]
Both the diversity (The term ‘diversity’ describes the dissimilarities between host and migrant populations relevant to the determinants of health; ‘disparity’ reflects the burden of inequalities present at both individual and societal levels, which affects the determinants of health.) and the nature of modern mobility and migration

Summary

Introduction

Several current emerging threats and risks exposing public health vulnerabilities are linked to global processes, such as economics, trade, transportation, environment and climate change, and civil security Many of these processes are influenced or affected by the migration and mobility of human populations.[1,2] International migration, which is a supporting component and a consequence of globalization, increasingly affects health in migrant source, transit, and recipient nations.[3] The flow of populations between locations with widely different health determinants and outcomes creates situations in which locally defined public health threats and risks assume international or global relevance. This fact is illustrated by the rapid awareness, detection, and response to the emergence of a novel influenza A/H1N1 virus in the spring of 2009.4,5 Global demographic predictions indicate that the forces promoting and supporting international migration will continue to do so, and may become stronger in all regions of the world as populations attempt to move up gradients of opportunity (such as economic, educational, security, health).[6]

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Conclusion