Marc Schenker M.D., M.P.H.mbschenker@ucdavis.eduUniversity of California at Davis

Migration and Global Health: Historic and Current Trends

•••••Summer Institute on Migration and Health

•••••June 26, 2017

OutlineOverview of global migration

Migration demographics and economics

Health status and care for immigrants

Current and future trends

Conclusions

1. Migration has always been and will continue to be a natural phenomena for living species.

One seventh of the global human population is migrant.

Major Migration Flows (2000’s)

Top 20 countries with the highest % of international migrants, 2010

86.570.0

68.845.9

43.640.7

40.438.8

28.427.8

23.222.421.921.3

19.619.518.9

17.8

16.615.9

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

QatarUnited Arab Emirates

KuwaitJordan

Occupied Palestinian TerritorySingapore

IsraelChina, Hong Kong SAR

OmanSaudi Arabia

SwitzerlandNew Zealand

AustraliaCanada

IrelandKazakhstan

GabonLebanonGambiaCroatia

U.S.A: 13.5%

UK & France: 11%

Mexico: 0.8%

2. The major causes of global migration are likely to increase

in the future.

Natural disastersBiologic, geophysical, climate-related (hydrologic, meteorological)

Haiti, 1/13/2010

Philippines, 11/9/2013Indonesia, 12/26/2004

Dhaka, Bangladesh

Mexico: Migration to Cope with Drought and Disaster

Extreme EventsNot Enough Water

Too Much Water

Mexico:Migration to Cope with

Drought and Disaster

Number and Types of Natural Disasters1950 - 2012

Experts predict 50 million environmental refugees by 2020,

200 million by 2050

2. The major causes of global migration are likely to increase

in the future.

Environmental Change Political Change (refugees)

Refugees and Displaced Populations, 1964 - 2011

The UN High Commissioner for Refugees estimates there were 40 million refugees

and IDP worldwide in 2012

UN Estimates 60 Million Refugees Worldwide – June 18, 2015

31 May 2016 – At least 880 people appear to have died over the past week as their vessels capsized in the Mediterranean, bringing the total fatalities along the dangerous crossing route to 2,510 so far this year, the United Nations refugee agency said today,

Number of Refugees per 1000 Population

The major causes of global migration are likely to increase

in the future.

Environmental Change Political Change (refugees) Demographic and Economic

Disparities

Farmworker in Oaxaca earns (U.S.) $1.50/hr

Same farmworker in California earns $10/hr1 hr Calif =

1 day Mexico

Global Migration•232 million people live outside their country of birth (46 million in the U.S.)

•750 million internal migrants

• Demographics will make increased migration inevitable

•In 2016 there will be 87 entrants in workforce for 100 retirees.

• Only immigrants can make up this gap

• 342 candidates for every 100 jobs in developing countries.

New Legal Permanent Residents to US by Continent

US Dept. Homeland

Security, Office of Immigration

Statistics

Top Sending

Countries to U.S.

US Dept. Homeland Security, Office of Immigration Statistics

Changing U.S. Immigrant Sources1890 – 14.6% born abroad, mostly W & N Europe1930 – 11.5% born abroad, most common Italy, Poland, Russia2000 – Latin America and Asia

Ellis Island, 1902

Global Migration Money Flow• World Bank estimates $542 billion sent in remittances annually

• 3.8 times the combined global foreign aid budgets

• 60 countries receive > $1 billion

• 22 countries remittances are > 10% of GDP

• Western Union has 5x the locations of McDonalds, Starbucks, Burger King and Wal-Mart combined!

3. Migration can have negative impacts on health in the origin, transit and destination locations

Mental health Chronic diseases Occupational health Infectious disease ………etc

4. Social protections in health are reduced for the majority of

immigrants

Less workplace protection Less preventive (public) health care Migrants have less financial

resources Migrants may be excluded from

health care access (e.g. ACA)

Health Among Hispanics in the United States — 2009–2013

“Hispanics had better health outcomes than whites for most analyzed health factors, despite facing worse socioeconomic barriers, but they had much higher death rates from diabetes, chronic liver disease/cirrhosis, and homicide, and a higher prevalence of obesity. There were substantial differences among Hispanics by origin, nativity, and sex.”

MMWR, May 8, 2015

Social Determinants of Health among Latino Immigrants

• Health care access• Poverty• Education• Employment• Language• Violence/safety• Discrimination• Fear of authorities (for undocumented)• Access to healthy foods• Housing and environment

Immigration and Occupation

Fatality Rate and % of Fatalities to Foreign Born Workers in the U.S.

Occupation and Industry Injury and Fatality Rates, ACS

Variable Natives ImmigrantsIndustry InjuryRate* 140.5 148.7

Occupational Injury Rate* 108.8 139.7

Industry Fatality Rate+ 4.7 6.5

Occupational Fatality Rate+ 5.9 7.5

Orrenius. Demography. 46:535, 2009*per 10,000 workers+per 100,000 workers

New Operational Frameworks are Needed

Monitor and study migrant worker health Health systems sensitive to migrant

worker status Equal health and safety protection and

enforcement for all workers Multinational approaches for immigrant

workers

“Every ethnic minority, in seeking in its own freedom, helped

strengthen the fabric of liberty in American life.

Similarly, every aspect of the American economy has profited from the

contributions of immigrants.”

John F. KennedyA Nation of Immigrants (1958)

“We, the people of this continent, are not fearful of foreigners, because most of us were once foreigners. I say this to you as the son of immigrants, knowing that so many of you are also descended from immigrants...Nonetheless, when the stranger in our midst appeals to us, we must not repeat the sins and the errors of the past… We must constantly relate to others, rejecting a mindset of hostility….”

Pope Francis speech to US CongressSeptember 24, 2015

Migration and Health: A Research Methods

Handbook

Editors: Schenker

CastañedaRodriguez-Lainz

UC Presswww.ucpress.edu

2014

Thank you!mbschenker@ucdavis.edu

@migranthealth

http://mahrc.ucdavis.edu/