Alternatives to the Migrant Health Problem

¶ … Migrant Health Problems

Understanding the Migrant Health Problem

Currently access to health and social services for the majority of migrants is based on their legal status. Needless to say undocumented migrants have little or no access to health care services. One's legal status is one of the prerequisite conditions for one to receive sufficient care. Additionally, accessibility, availability, acceptability and quality of such services depends on various factors such as financial, gender, structural, linguistic, social, cultural and geographical factors. Furthermore, various beliefs and myths or knowledge about ill health and one's health status prevent migrants from engaging or getting into national health systems.

Causes of the Migrant health problem/Impact on communities

Low health literacy levels within migrant communities are a huge barrier and deter many migrants from wanting to engage health care professionals (Becker, 2003). This situation is the same within many migrant communities regardless of a migrant's socio-economic status or legal status. Also, the nature of migrant workers not to work for long in a single workplace makes it somewhat difficult for healthcare providers to adequately document their needs. Seasonal and temporary workers often favor delaying their need to engage health care services regardless of the urgency or criticalness of their need for treatment (Okie, 2007). Migrants' long working hours also deters them from having enough time to get sufficient care even during occasions when there are free and open public health services. The nature of mobility of migrants also affects follow-up treatment and long-term care, for example, this phenomenon has been directly observed in the treatment of tuberculosis (TB). Traveling causes a lack of access to care which makes it difficult for one to complete TB treatment; not completing the treatment of diseases can lead to the emergence of drug resistant viruses or bacteria and individuals not completing TB treatment leads to the emergence of multi-drug resistant tuberculosis (Huang, Yu, & Ledsky, 2006). According to CDC (Center for Disease Control) (2013), the high prevalence of tuberculosis among certain communities in the population is a known health disparity. The difference in prevalence levels may be due to several reasons such as geographic location, race, gender, ethnicity, socio-economic status or co-morbidity of health conditions.

Behavioral, reproductive, sexual, cultural and ethnic health practices are among some of the key health concerns for migrant communities, particularly the lack of adequate use of contraception and the practice of female genital mutilation among some of these communities. Some of these migrant health practices challenge or conflict the knowledge or beliefs of host populations. Recognition and management of reproductive and sexual health practices requires cultural competence among health care service providers, however, cultural competence is not currently part of medical education training in most parts of the globe.

Formal and informal power bases

Migrant communities are highly vulnerable in terms of health care and the manner in which such vulnerabilities continue to exist and increase present further challenges to national health care systems (Stanhope & Lancaster, 2013b). Despite the current dynamics of immigrants, host nations are better placed to intervene. Combinations of events and circumstances also present several difficulties for national healthcare systems.

The basic principles of public health approaches determine the formation of migrant priorities. A fundamental public health objective is to avoid or prevent disparities in terms of access to health care services and in the health status between host populations and migrant communities. Besides, this fundamental objective is closely linked to making sure that the health rights of migrants are taken care of. This involves removal of impediments that prevent migrants' access to preventive and curative in healthcare interventions as well as prevention of discrimination or stigmatization (Stanhope & Lancaster, 2013a). Other healthcare public healthcare principles associated with migrations from places of conflict and/or disaster involves the establishment of life-saving initiatives and other interventions to cut excess mortality and morbidity. Other fundamental principles encompass the minimization of adverse migration impacts that affect the health status of immigrants. These are just some of the principles that help define public health plans and health policy frameworks for migrants.

The majority of migrants these days living in foreign nations do not have any significant legal statuses. Such people are often living in conditions of abject poverty making the prospects of getting employed and their access to proper healthcare very difficult (Carrasquillo, Carrasquillo, & Shea, 2000). Undocumented migrants are often considered a burden in many host countries' populations. These types of migrants are also usually very poor. Undocumented migrants are also often not quite literate and do not have health care insurance bringing about a serious burden to national health services of host nations resulting in healthcare costs being absorbed by the host government or being shifted to other host populations resulting in increase in cost of health services (Huang, Yu, & Ledsky, 2006).

There is little or no access to health information and health services for migrant communities. Present health information systems are engaged in disaggregating data in such a manner that allows the investigation of major health concerns among migrants. Comparative epidemiological surveys and studies reveal that migrants have higher frequencies of adverse or negative health outcomes compared to host communities (Becker, 2003). Qualitative studies and surveys concentrate on various health seeking behavior approaches and health perceptions. This shows that qualitative studies complement quantitative health studies in several ways in spite of the existing limitations in relevant data.

Legal immigrants, often have similar socio-economic statuses to those of minorities who live in poverty in host countries. These migrants have also been reported to delay or forego curative and preventive healthcare interventions, waiting until the situations become dire or dangerous. Furthermore, there is also the significant challenge of securing a space for migrants' equitable access to healthcare services. Making sure that migrants have equitable access to healthcare services involves different approaches that are of importance to the institutions and organizations that are funding health systems (Okie, 2007). The objective of these organizations is to bring about financial protection mechanisms and to prevent excessive expenditures existing among groups that are economically vulnerable. Weight has to be given to sustained health insurance coverage provision in various countries of origin, transit, return and destination especially for temporary migrants and irregular migrants (Stanhope & Lancaster, 2013a). Different nations insist on an immigrant having a legal status as a prerequisite for access to health services. Some nations especially on the eastern fringes of Europe have, of late faced a rapid influx of transit migrants in very short periods of time resulting in challenges to national health systems.

Public policy

There are several approaches that can be pursued to improve the health statuses of migrants. First, it is crucial to come up with mechanisms of advocacy and policy. The support and promotion of pro-migrant health policies will permit proper adherence to principles of public health. This widens migrants' health elements while at the same time advocating for their health rights. It also promotes access and protection of equitable health services provision, in addition to care for immigrants. The formulation of mechanisms in terms of healthcare services improves social protection for immigrants and also promotes international cooperation (Stanhope & Lancaster, 2013b). For the approaches and efforts that revolve around migrants' health to be effective such mechanisms must be implemented in the countries of origin, destination, transit and return.

Stakeholders

The participation of all concerned parties promotes cooperation in the formulation of health policies among civil society representatives, national and local governments. Executive branches of governments should take the lead in encouraging cooperation between foreign affairs and health departments and other concerned healthcare departments (Stanhope & Lancaster, 2013a). It is possible to strengthen international, regional, and interagency collaboration for migrants' health while at the same time accommodating the promotion of partnerships with other relevant alternative institutions and organizations such as UNCHR and IOM (International organization for Migration).

Other approaches include research, assessments and information dissemination Carrasquillo, Carrasquillo, & Shea, 2000). An evaluation of migrants' health and related trends enables the identification of service delivery gaps and the filling of those gaps. The objective of such an evaluation or assessment would be to determine the health needs of migrants and disaggregate health information by age, gender and origin and also by socio-economic and migratory status. The promotion of the production of migrants' health information surveys and studies triggers the revelation and reporting of best practices and lessons. Such studies and surveys are crucial to identifying and meeting migrants' health needs in transit, destination and return countries (Huang, Yu, & Ledsky, 2006). Dissemination of best practices enhances the promotion of pro-migrant health care services in many places around the globe.

Another addition to aforementioned approach would be to increase capacity-building efforts. Programs to increase awareness and to train the relevant health policymakers and stakeholders who are involved in migrants' healthcare in destination and transit countries result in increased gender, cultural, religious and linguistic sensitivity.

This is related to the migrants' health for the health service providers in addition to training health experts who tackle certain health factors like population movements (Stanhope & Lancaster, 2013b). The establishment of networks meant for the collaboration of centers and academic institutions in addition to other partners, promote additional research in the migrants' health and improvement of competence in technical cooperation. Another important issue is the training of health experts in relevant diseases in addition to various pathologies existing in the origin or the return countries.

On the other hand, the diseases existent in the destination nations and the migrants are transformed and returned to the origin or return nations. For instance, when immunization coverage stays slow in the origin nation and the inhabitants are at great danger until the coverage of such migrants reaches similar points of host populations, the raised prevalence of the communicable diseases persists and there is great possibility of the migrants getting affected by the conditions and being moved across the borders (Becker, 2003). Proof also insinuates that non-communicable diseases such as hypertension, diabetes, cancer and cardiovascular diseases are quite prevalent in the migrant populations. This inflicts increased demands on the health systems in the destination nations.

Migrant health problems bear considerable health implications. The migrants' move is accompanied by various epidemiologic profiles, such as degrees of exposure to certain infectious agents in addition to lifestyle linked risk agents. Additional problems are their culture -- founded health practices accompanied with their overall vulnerability to immediate situations. In addition, the problems involved carry along with them susceptibilities both in their current and their original nations.

The Kingdon Model Framework -- Realities and Application

In 1995, Kingdon started to reflect on the manner through which an issue is placed on a political agenda and is finally transformed into a public policy. As Kingdon realized, under various conditions, an opportunity is created and, an issue is noted, a solution exists, the political environment makes the time appropriate for transformation, and the limitations do not prevent action from being undertaken. Kingdon assigned 3 "streams" which established such an opportunity during which the policy creators are ready to seriously consider legislation which is concentrates mainly on improving a condition that surrounds an issue (Howie, 2009).

According to Unti (2005), John W. Kingdon has described how politics and agenda setting are responsible for the process of legislation, particularly healthcare. He provides a framework via which policies like healthcare policies might be reviewed within a condition of contradictory values and the social surroundings of which these are a part, like the health issues of the migrants (Kubiak, Sobeck, & Rose, 2005). It is composed of three different streams; problems, policies and politics. The first is basically the recognized problem that relies on the available authoritative and current information. This is the manner through which a policy transforms into a problem like the migrants' health issues. The second is policy. Policy solutions are available options within the power of policy communities such as educators and bureaucrats for policy action. The awareness of an issue results into it being discussed, tackled in meetings and then processed by more formal methods. The third stream is politics. When an essential mass of the population thinks similarly and is mobilized, it can manipulate the trend of the policy makers. Once this takes place, policy options are established and might benefit several groups. These particular options are most likely to stay on the agenda of the policy makers. Finally, their principle is essential. Once their priorities are altered or once there exists a turnover, their agenda might be altered. According to Kingdon, coupling these three streams in the creation of opportunities for a favored solution, like the issue on the migrants' health, is recommended. These policy makers are capable of convincing other decision makers to support and make it practically implementable. This opportunity can be lost without such support (Kubiak, Sobeck, & Rose, 2005).

The Problem Stream

According to Kingdon (2006), certain representative mechanisms that reflect problem appearances like indicators, focusing feedbacks and events, are capable of setting governmental agendas independently. These mechanisms are so essential that they can easily lure the attention of government officials and reach into agendas. However, he also mentions that there are certain factors making these issues fall from a conspicuous agenda, even though problems have been in the agenda. Instances in this paper comprise governmental officials feeling like they have tackled this issue or failing to handle it; a particular mechanism for stressing an issue has changed in an opposite direction; people have been used to a situation or an issue; other things substitute those which ought to have been given more attention (Zhou & Feng, 2014).

The Policy Stream

This paper discusses how the policy stream can impact the options specification directly; the procedure of alternatives specification that are undertaken by policy communities are produced and narrowed in the policy stream. Policy communities that can are comprised of experts can relate with one another more closely and tightly, into meaningful significance. These experts can exercise their thoughts on and positively influence other individuals from the policy communities in order to make their preferred ideas and options concerned and welcomed by decision-makers (Zhou & Feng, 2014). Here, they aim to "soften up" the policy communities together with the larger public in a number of ways (speeches, forums, bill introductions and many more), obtaining more approvals of new ideologies and developing acceptances for new ideas. Moreover, Kingdon (2006) argues that this proposal to survive ought to satisfy a series of criterion, such as practicability, similarity to the values of community members and the anticipation of the prospective limitations.

The Political Stream

This paper puts forward that the national mood, arranged political forces, events in the government all make up key factors of the political stream; similar cases imply that a change of administration or an alteration of the top personnel in a governmental organization can change agendas significantly, and that the combination of an election and national mood can lead to a more powerful agenda compared to interest groups that have rich resources. It is essential to note that it is crucial to come to an agreement in the political stream for developing the chances of building governmental agenda. Nonetheless, the agreement of the political stream is developed via bargaining (Zhou & Feng, 2014).

Intervention Strategy for the Migrant Health Problem

There has been a rising international focus directed towards migrants' health, displaying recognition for the need of better health systems to adapt to the increasingly diverse populations. Nonetheless, reports from several health policy specialists in European countries imply that by the year 2009, only 11 nations in Europe, had come up with national policies which improve migrant health and go much further beyond the migrants' legal right to care. The objective of this essay is to evaluate policies of certain nations from around the globe that deal with migrant health and strategies to deal with the improvement of migrant healthcare and evaluate their strengths and weaknesses so as to develop a strategy which shall identify gaps in present policies and also provide a solution. The evaluation from the studies undertaken implies that the bulk of national policies that deal with migrant health aim for the migrant including the more dominant ethnic communities.

Nations ought to address the different needs of both groups, i.e. local residents and migrants. Those willing to alter and practice new policies could learn from successful intercultural health care programs in Netherland and Ireland. "Policy initiatives basically comprise of training the health care workers, offering interpreter services and/or cultural mediators', acclimatizing organizational culture, improving information collection and offering data to the migrants on health problems and services" (Mladovsky, Rechel, Ingleby & McKee, 2012, p. 1).

Few nations persist with their aim to increase migrants' health concerns and their participation in the development in addition to execution of policy. Open-minded migrant health policies might not all the time be maintainable as they might become destabilized once the political situation changes. The evaluation of the migrant health policies in Europe is still at its early stages and there is critical need to observe the execution and analyze the effectiveness of these diverse policies (Mladovsky, Rechel, Ingleby & McKee, 2012, p. 1).

Solution for Policy Gap in Migrant Healthcare

Migrants experience hardship in finding sufficient healthcare in the nations to which they migrate. This is because the nation might have difficulty in speaking the language of the migrants, understanding their culture, and treating the migrants who do not have health insurance. The solution hence lies on raising cultural awareness and developing communication among the migrants and the medical staff. Nurses are the first in line of care when the patients enter the medical facility and should, hence, be well trained in communication and cultural awareness. Another option is employing migrant volunteers who are bi-lingual and can assist in translation and encouraging confidence and trust.

Migrant health issues are greatly ignored in several nations, with gaps identifying the need for more data on the health status of the migrants. Nonetheless, as the population of the migrants increases, health care policies ought to adapt to satisfy the increasing demands of the changing populations. In the adult population, migrants make up 57.8% and 40.5% in St.-Laurent du Maroni and Cayenne respectively. Majority of them had been dwelling in French Guyana for over 10 years. A huge population possessed precarious legal status or were not documented (Jolivet et al., 2012, p. 53).

Many migrant workers move to countries such as China and Saudi Arabia to get jobs to provide for basic needs for their families. Some of these workers get jobs at SMEs (small and medium --sized enterprises). Little or no use of health services among migrants working in small sized enterprises could be linked to the "healthy migrant" effect. However, when such workers compared against other workers in SMEs the underuse of health services by these workers was discovered to be the result of poor health awareness. Enhancing risk perception and incorporation of general and occupational health service is vital to improving the health statuses and use among migrants who work in SMEs (Zou, Zeng, Chen & Ling, 2015, p. 189).

Since there are communication and linguistic barriers between migrants and the host communities in the countries, migrants may be somewhat afraid to go to physicians when they are suffering from an illness or when they experience pain. These are amongst the several reasons why nurses are the best channels for building effective communication. Nurses are the healthcare professionals, best known for building trust and confidence among people and best equipped to do the same for migrant communities. When migrants feel sufficiently comfortable to go to medical service providers, they will be able to not only increase their perceptions of potential health issues but also be able to get medical care if the situation dictates.

A quantitative study done by Sirilak et al. (2012), investigated the deployment of migrants themselves as health care volunteers in a migrant healthcare program. The study enlisted migrants, who volunteered to serve within their communities. The study examined the characteristics of the migrant volunteers and how they connected to the management of the project in addition to their attitudes to the project. The study also investigated the impact of the migrant volunteers, from both healthcare professionals' and migrants' perspectives. The study was conducted in two provinces Samut Sakhon and Tak (Central Thailand and Northern Thailand). Primary and secondary data was gathered. The study assessed 260 volunteer migrants in addition to 446 migrants. The results revealed that not more than 5% of migrant volunteers were selected by the community. Most of the volunteers were assigned or given the role of health communicators with only 4 of the volunteers revealing they did nothing, however, most of the volunteers had positive attitudes. Most of the surveyed migrants reported that they found the volunteers work quite useful. The study concluded that the program actually helped with migrant health concerns. However, there was a recommendation that the management of the healthcare program ought to be closely considered if future programs are to achieve more effective outcomes (Sirilak et al., 2012, p. 658).

Obviously, this kind of program could do with several other recommendations. First would be giving the migrant communities more authority or space in choosing volunteers among themselves. Second would be encouraging the migrant communities to have more interactions with nurses during preliminary migrant patients' assessment phases. Third making sure that none of the volunteers is left unassigned or under-assigned and with no work as this would be a waste of valuable time and effort.

It is crucial to evaluate the issues in the management of migrant health concerns. Even though most host nations may not wish to be involved in assisting sick migrants, the migrants health problems may escalate to reach such a level that conditions or diseases brought about by the migrants start affecting the entire host nation. One such disease would be malaria. Many migrants are from countries or territories that have high malaria prevalence rates.

Migration is such a crucial international matter since poorly managed migration can result in several problems, including increased transmission of diseases such as malaria. Moreover, there is increasing evidence backing the fact that malaria is not as much a forest-dependent disease as was widely thought, since it can be principally affected by population movements, especially to agricultural areas. Even though internal and international migration has different legal implications in most nations, both types of migration occur for the same care and economic motives. While the act of migrating does not, in itself increase the risk of illnesses such as malaria, several factors linked to it can put both migrants and host communities in vulnerable situations. Factors such as development, infrastructure, political environments, natural disasters, farming push or pull migrants in or out of areas that are malaria endemic. Thus understanding the rapidly changing socio-environmental circumstances in addition to migration and the related risks for malaria infection is crucial for the containment, control and elimination of malaria. Initiatives to address these matters should entail mapping exercise, advocacy and expanded surveillance (to include migrant health information) (Jitthai, 2013, p. 306).