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Gemma A. Williams, Anna Odone, Taavi Tillmann, Anastasia Pharris, Dina Oksen, Bernd Rechel, Philipa Mladovsky, Sabrina Bacci, Rebecca Shadwick, Teymur Noori, Andreas Sandgren Erika Duffell, Jonathan E. Suk, David Ingleby and Martin McKee

This chapter explores the burden of infectious diseases in migrant populations in the European Union and the European Economic Area (EU/EEA) by means of a comprehensive literature review and analysis of data from the European Surveillance System (TESSy). The available evidence indicates that migrants in the EU/EEA have a higher burden of some infectious diseases, including HIV, TB and chronic hepatitis B, than the native-born population, but are less affected by others, such as measles and rubella. The extent to which different migrant populations are affected by infectious diseases depends on the disease in question, the country of destination and the region or country of origin. For example, Chagas disease disproportionately affects irregular migrants from Latin America, the majority of migrant HIV cases in the EU/EEA are from sub-Saharan Africa and migrants with TB or chronic hepatitis B are mainly from Asia, Africa and other parts of the European region. However, it should be noted that it is challenging to reach strong conclusions on the burden of infectious diseases in migrants, as few surveillance systems capture reliable and complete data that identify migrants and their specific characteristics. Measures of migrant status that are collected also vary among studies and contexts, adding to the challenge of obtaining a clear picture of infectious diseases in the migrant population in Europe. Strengthening of European surveillance systems must be a priority to enable meaningful comparisons across migrant populations in different Member States and to inform the provision of appropriately targeted health services.

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Vivien Runnels, Corinne Packer and Ronald Labonté

All countries require a health workforce that is sufficient in size and skills and properly located geographically to respond effectively to their populations’ healthcare needs. Many low-income countries have very high burdens of disease and low health worker density. As a result of this combination, significant proportions of their populations have little, poor or no access to healthcare. When countries that can least afford to lose health workers experience staff shortages associated with the international migration of their health workers, it becomes a global ethical issue. This is especially so when health workers trained in low-income countries move to high-income countries that have lower disease burdens and greater capacity to build their own health workforce and address their own problems of shortages or maldistribution. This chapter highlights the ethical and health equity issues that come to the fore when disproportional numbers of health workers trained in low-income countries move for work in high-income countries. Health worker migration is also a human rights issue. As such, we explore how the rights of individuals to work, to fair working conditions and protection against unemployment, must be balanced with their right to health.

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Yuko Aoyama and Balaji Parthasarathy

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Kris Bezdecny and Kevin Archer

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Hans Keman and Jaap J. Woldendorp

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Meghann Ormond

Tapping into migrants’ diverse tacit healthcare knowledge can bring a range of stakeholders in countries of origin great insight, at both macro- and micro-levels, not only into how to improve on local healthcare delivery but also how to effectively respond to the needs and interests of ‘medical tourists’ and other types of travellers and migrants. This chapter reviews recent literature on migration and ‘medical tourism’ in order to look in greater detail at the role, first, of migrant patients and, second, of migrant health workers in the development of Global South destinations’ ‘medical tourism’ industries. It offers a series of lessons drawn from the many examples of migrant knowledge transfer and barriers presented.

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Yao Lu and Alice Tianbo Zhang

In this chapter, we discuss three major mechanisms underlying the relationship between migration and health by synthesizing existing literature and highlighting the empirical challenges in causal identification. First, we examine the extent to which individuals are differentially selected into migration by health conditions and how health facilitates or constrains individuals’ decision to return, as posited by the “healthy migrant” and “salmon bias” hypotheses. Second, we show that the impact of migration on the health of migrants is multifaceted and can be mediated through various socioeconomic and psychosocial pathways. Third, we demonstrate how migration is linked to the health of people left behind in origin communities and how the relationship operates through both economic resources (remittances) and psychosocial processes (family separation). We conclude by underlining knowledge gaps in the current literature and offering suggestions for future areas of research.