Space and Global Health/Equity in Health Care/Migration and Health Inequity

Leave no one behind: Importance of Migration and Health data
The overarching, transformative promise of the 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs) is to ‘leave no one behind’. Migration is a cross-cutting issue that impacts most Sustainable Development Goals (SDGs). At least ten of the seventeen goals include targets and indicators related to migration and mobility.

The COVID 19 pandemic has brought to the limelight the vulnerabilities faced by various population subgroups, especially migrants globally and in India. Thus, migrants are one group that must not be left behind in any progress toward SDG. Migrants' contribution to the economy is a known factor in source or destination places. If migration is properly channelised and governments make an effort to incorporate migrants in SDG policy and programming design, the chances of fulfilling relevant SDG targets would be higher. On the contrary, excluding migrants from sustainable development interventions, on the other hand, obstructs the attainment of several SDGs. Involving migrants in programs helps accomplish the SDGs, and well-managed migration can help individuals and communities minimise social, economic, political, and cultural inequities.

Data is crucial to comprehend the positive relationships between migration and long-term development. The governments must urgently improve their data frameworks to identify individuals who may be in most need and reach the most vulnerable. The need for disaggregated data across sex, gender, age, disability, and migration status would ensure that vulnerable groups, especially migrants, are not left behind in the pursuit of the SDGs.

The primary source of migration data is the decadal Census, followed by National Sample Survey in India. However, Census and other surveys underestimate the volume of internal migration and have severe issues regarding the temporality of the available data. In India, during the Pandemic, it was clear that the government did not have the number of internal migrants in different states. Even the decadal Census did not happen to make the situation even worse. Now, Census need to be complemented with innovative and big data sources such as Mobile phone data, internet-based services and satellite-based services to understand migrant flows and drivers of migration. Newer data sources are not without drawbacks, and they have ethical and privacy issues, inherent bias and technical/legal challenges.

Even when we speak of conventional and innovative data sources, a significant data gap exists on less researched topics like migration policies, return migration and health of migrants. ‘Migrants health Research’ has been a neglected area except for screening for communicable diseases by health department/ health researchers and its implications in developed countries. Another reason for not prioritising migrant health is that policymakers/ experts working in the field of migration are people from varied disciplines where health is not the focus of attention, whereas livelihood and other issues are. However, there has been an increasing effort toward better migrant health in the last decade through World Health Assembly declarations, UN Assembly summits, WHO and IOM initiatives.

Various factors and conditions influence the migrants’ health at different levels of social determinants of health (SDH) and different migration phases. Migration itself is considered a social determinant of health. It can influence migration's health and conditions, fuel health inequities, and expose migrants to increased health risks and adverse health outcomes. Nearly eight out of 17 SDGs are directly or indirectly linked to migrants' health. SDG three directly addresses health, while other goals have specific targets to enable better health for migrants, mainly through the SDH. Governments and countries are encouraged to incorporate health into national plans, policies, and strategies. During this incorporation and monitoring, migration health data play a critical role.

The term “migration health data” can be broadly described as information about the health and social determinants of migrant populations and information about population mobility and health. They include quantitative data such as epidemiological profiles and disease burden and qualitative data that describes risk factors, health system factors and access to services.

Again, potential migration and health data sources would include population Census and Demographic health surveys, health records, and various disease control programs. In India, we have a few household surveys that provide insights into migration and health, like National Family Health Survey(NFHS), Indian Human Development Survey (IHDS), and Longitudinal Ageing Study in India (LASI). These surveys cannot estimate migration but can undoubtedly be used to extract migrants’ health outcomes. Each survey focuses on a different particular domain, i.e., NFHS focuses mainly on the health and nutrition of women and children, and LASI focuses on the elderly above 45 years.

Now non-traditional and agency based resources have been used with agencies making an effort to collect data on migration and health at the international and national levels. An example of this is the MIPEX index used internationally and the IMPEX, the national adaptation used in India.

Migration and health research is in its nascent stages. There is a lack of understanding and consensus among organisations working on migration and health on what data to be collected and how to collect it. The situation is likely to worsen in India, where we already struggle with routine health data collection. Newer methodologies need to be used to extract information from the existing surveys.

One practical solution is to incorporate a migration module in the NFHS survey, which is likely to happen every four years, rather than a migration specific survey which is not likely to happen soon. The NFHS uses the Census enumeration block for sampling. NFHS Migration estimates can be improved by selecting and oversampling high migration rate enumeration blocks.

It is now commonly recognised that being and staying healthy is a basic need and means by which migrants work productively and contribute to the social and economic development of their communities of origin and destination. Migrants' health needs to be coordinated throughout different migration phases, and receiving health systems must be responsive to their needs. Addressing migrants' health would be an ideal public health practice and having migrant health data is vital. In the long term, it would reduce health and social cost and contribute to economic development in both receiving and sending areas.