|Migrants' Right to Health (UNAIDS, 2001, 60 p.)|
|II. Setting the scene|
|III. Balancing international treaties versus States' rights|
|IV. Access to health|
|V. Promising approaches to explore/expand in the future|
|VI. Implications for policy-makers|
|Appendix. International instruments (and relevant clauses)|
One of the overall problems in the area of migrant health, in particular in regard to STI/HIV and reproductive health, is that attention has for the most part been limited, patchy and sporadic.
This paper has argued for a more comprehensive, and global, approach, with clear leadership requirements from a number of international agencies. However, whatever the influence of an 'international' or 'global' agenda, the locus of decision-making will remain the nation state. The challenge will be to ensure that nation states understand that their self-interest requires attention to STI/HIV among all peoples of the world. In addition, policy-makers will need to consider the spectrum of decision-making and ensure that migrant health does not continue to fall off the agenda at most points along the spectrum.
As Parsons116 has stated, "If we define decision-making as a process in which choices are made or a preferred option is selected, then the notion of decision involves a point or series of points in time and space when policy-makers allocate values. Decision-making in this sense extends throughout the policy cycle; for example:
· decisions about what to make into a 'problem'
· what information to choose
· choices about strategies to influence the policy agenda
· choices about what policy options to consider
· choices about what option to select
· choices about ends and means
· choices in how a policy is implemented
· choices about how policies may be evaluated.
116 Parsons W: Public Policy. An Introduction to the Theory and Practice of Policy Analysis. Edward Elgar Publishing Ltd, UK, 1997, p245
At each of these points decision-making is taking place. Some of these decisions involve the allocation of values and the distribution of resources by the formulation of a policy, or through the ongoing conduct of a programme. Decision-making thus takes place in different arenas and at different levels. At one level, there is a decision by high policy actors to make 'national' health or economic policy, at another there are the decisions of other actors who are involved in 'health' policy at the level of a hospital or local service."
International agencies may be able to assist countries by promoting best practice policies and arrangements addressing all points on the decision-making continuum in relation to migrants' right to health, particularly in relation to HIV/AIDS/STD and reproductive health matters. In addition, the numerous research publications in the area need to be 'translated' so that policy- and decision-makers have better access to the research and the policy implications of the research.
It must be acknowledged by policy-makers and planners that equity of access to information and to health service delivery often requires a number of different and additional strategies to ensure that all parts of a population, especially the hard-to-reach such as illegal immigrants, have real access. Too often, in industrialized countries in particular, statements are made that health care access is available for all, without reference or attention to practical and psychological barriers for sub-populations such as females, people speaking a different language, people from different cultural backgrounds, people from rural areas or outlying regions, people with limited financial resources in generally affluent settings, or people ashamed of having contracted a sexually transmitted infection.
This paper has argued for a number of changes to improve migrants' health (particularly in regard to HIV/AIDS, other sexually transmitted infections and reproductive health), at global, national and local levels. In summary, these include:
· acknowledgment of the right to the highest attainable standard of physical and mental health. In relation to migrant populations, this might require attention to the right to affordable and accessible health services, the right to healthy working and living conditions, and the right to appropriate health education.
· attention to, and compliance by all countries with international treaties and agreements to which they are a party, and to relevant international customary law. It appears that many countries sign international treaties/agreements but do not necessarily put in place the measures required for compliance with the letter and spirit of such agreements.
· general application of, and compliance with, the International Health Regulations.
· measures to ensure that major sending, transit and receiving countries have joint/tripartite health access programmes in place to address all time and place points on the moving continuum for citizens/migrant workers. Such points include pre-departure, the migration itself, the initial period of adaptation, successful adaptation, return migration, and re-integration into the original community.
· health care access programmes for travellers and migrant populations that move beyond emergency care, and address physical, mental and social well-being, particularly in relation to HIV/AIDS/STD and reproductive health.
· greater attention to prevention in health service policy and delivery for migrant/mobile populations, including widespread development and implementation of community-level interventions.
· for migrants and for mobile populations within countries, measures to ensure good access to health-related HIV/AIDS/STD/reproductive health prevention and care for all members of such populations. For example, appropriate health education may require the production of highly specific material in a range of languages.
· attention to the gender disparities often involved in migrant worker movements, both within countries and across borders, and to gender/power relationships which frequently govern women's access to information and health care.
· understanding by major sending countries that contributions to the Gross National Product by migrant workers sending money back to their families may be balanced by pressure placed on health and social services, if migrant workers return to their home country ill or disabled.