Mainstreaming migration into development planning: Addressing the needs of vulnerable groups and vulnerable migrants Dr Marcus Day, DSc MBE, Director, CDARI Caribbean Drug and Alcohol Research Institute

Vulnerability is result of complex economic, social and cultural drivers that create an environment of marginality

Vulnerable populations the economically disadvantaged, migrants – especially inadequately documented individuals racial and ethnic minorities, children from low-income households, the elderly, the homeless, unemployed youth PWHIV and those with other chronic health conditions, including severe mental illness

Also Others, due to legislative prohibitions are also considered vulnerable. Men who have sex with men People occupied in the sex work industry, People who use drugs, including young cannabis users

Compounding the issue The vulnerability of these individuals is further compounded when social factors, including poor housing, poverty, and inadequate education are present.

Health Domains The health domains of vulnerable populations can be divided into 3 categories: physical, psychological, social

Physical Domains: high-risk mothers and infants, the chronically ill and disabled, persons living with HIV TB, respiratory diseases, diabetes, Hypertension, heart disease Malaria, Hepatitis

Psychological domain those with chronic mental conditions schizophrenia, bipolar disorder, major depression, attention-deficit/hyperactivity disorder, history of excessive alcohol use or drug use, those who are suicidal or prone to homelessness from mental illness

Social Realm Persons living in abusive families, Those subjected to GBV The homeless, Immigrants and refugees

Compounding The needs of these populations are serious with poor health in one domain likely to be compounded by poor health in others. Those with multiple issues also face more significant comorbidities and cumulative risks of their illness than those experiencing a single illness.

Multiple Effect Multiple unmet health needs and delayed medical care serve to exacerbate these unmet needs,

Needs the needs of vulnerable populations are likely to be unmet, growing serious, often debilitating or life-threatening, and require extensive and intensive medical and nonmedical services. Current financing and service delivery arrangements are not meeting these needs.

Access factors Factors that contribute to reduced or inhibited access to healthcare: Low income, Criminalised behaviours Less educated Rural location Immigration status

Migrants are prone to harassment, discrimination, exclusion, violence and exploitation, hampering their own human development, that of their families, communities, countries of origin and destination.

Public Health People who engage in behaviours or activities that are criminalised, which include irregular immigration status, are less likely to present for care. When their health issue is an infectious disease, this then has a negative effect on the overall public health.

Protections The “STATE” as the enactor of legislation and policies has the power to reduce or increase vulnerability though laws that address the protection of basic human rights.

Laws Laws that increase vulnerability : restrict minors from accessing sexual and reproductive health services with out parental consent, “buggery” laws that seek to legislate private adult consensual sex prostitution laws that criminalise a financial transaction between a wiling buyer and a willing seller. Drug prevention programmes that do not include harm reduction programmes for people who use drugs

Actions Measures to promote and protect the human rights of all populations including vulnerable populations, migrants, migrants in distress; irregular migrants; and the rights of children in the context of migration

Such as access to Sexual and Reproductive Health services, protected from gender-based violence, diseases, and other threats to life. Access to essential public services that are not required to report on immigration status of service users

Thank You