Globalization: Trade, Population Mobility, and International Security Thematic Cluster: Migration Flows and Their Management Globalizing Public Health Jacqueline Weekers, Nenette Motus International Organization for Migration Migration Health Services 8 th International Metropolis Conference Vienna, September 15-19, 2003

World Population and Migrant Stocks by Continent, 2000 source: United Nations (2000); IOM World Migration Report 2003 Total Migrant Per Cent PopulationStocks of Population (in millions)(in millions)(%) Asia Africa Europe Latin America/Caribbean North America Oceania-Pacific GLOBAL * * Does not add up due to rounding

Annual flow of migrants- between 5 – 10 million people (including undocumented migrants) 48% of all migrants are women (IOM, 2000) 700,000 to 2 million women and children are victims of trafficking (US DOJ, 1998) 1.2 million children are trafficked every year world wide (UNICEF, 2003) Basic Figures

To highlight changes and health implications of migration in context of globalization To illustrate significant health implications among migrants (specific attention to migrants with irregular status, other vulnerable groups ie trafficking victims) To outline several health determinants and key priorities in addressing management of migration health care Aims of the Presentation

>> > PACE - faster migration movement >>> move DIVERSE types of migrants Globalization >> ethnically diverse societies => a challenge for decision makers and service providers to plan and provide effective and culturally appropriate, responsive health services Changes

>> >Traditional medical screening for a certain fraction of permanent resettlers (focus on infectious diseases at time of exams) >>> Mobile populations = infectious diseases + non-infectious + psychosocial illnesses Changes

< No estimate per pop 300 or more The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2003 Estimated TB Incidence Rates, 2001

Total: 42 million Western Europe North Africa & Middle East Sub-Saharan Africa 29.4 million Eastern Europe & Central Asia 1.2 million South & South-East Asia 6 million Australia & New Zealand North America Caribbean Latin America 1.5 million East Asia & Pacific 1.2 million 42 MILLION (UNAIDS) Global Estimated Prevalence Rate HIV/AIDS, end 2002

An illustration concerning labor migrants: “ If you wanted to spread a sexually transmitted disease, you’d take thousands of men away from their families, isolate them in single sex hostels and give them easy access to alcohol and commercial sex. Then to spread the disease, you’d send them home every once in a while to their wives and girlfriends.” -- Mark Lurie, S African Medical Research Council, 1999

Irregular migrants referred to include : Victims of human trafficking Victims of people smuggling Some sub groups of asylum seekers Some types of economic/labor migrants  million migrant workers/dependents in countries outside their own, ILO 2002  No less than 15% - have irregular status

migrants exploited labourers sex workers TRAFFICKED PERSONS individuals experiencing violence, sexual abuse, child abuse, domestic violence, torture Conceptual Framework 2 Spheres of Marginalization and Vulnerability High Risk Populations with Limited or Problematic Access to Care (from draft, Health Chapter, IOM Counter Trafficking Manual, 2003)

19.6% 13.3% 1.3% 1.7% 10.3% 7.1% 4.9% 15.9% 15.4% 10.4% 0.0%5.0%10.0%15.0%20.0%25.0% Other conditions Endocrine & nutrition related Cardiovascular Genito-urinary & pregnancy related Psychological & neurological Gastro Intestinal Musculoskeletal Dermatological ENT & Dental Respiratory Individual assessed = 22, 759 Most Common Reported Health Complaints among Migrants in Nauru and Manus, 2002

Innate genetic make up Epidemiology from place of origin and experience of traumatic events prior to departure Social and economic status Knowledge of language of host community Similarities of cultural values between home and host communities Educational level Age Gender Legal status in host community Being alone or with family Health conditions of receiving community Existing policies, discrimination and attitudes of receiving community Key Health Determinants

Developing integration and prevention strategies Improving access to health care Strengthening of information and surveillance systems Capacity building and changes in education ( health care providers, policy makers, planners, medical educators) Supporting public health research Priorities in Addressing Management of Migration Health Care