Equitable Health Care for Migrants

Equitable Health Care for Migrants
There is no agreement in Public Health as to whether
a health care system based on a libertarian ( liberalism
and libertarianism), egalitarian ( egalitarianism)
or utilitarian ( utilitarianism) framework is the best or
the most fair.From the point of view of migrants’ needs, the objective of health care systems cannot be to produce equality in risk, but to care
for individuals’ needs in a fair way while respecting
their differences (see Frankfurt 1997). A person will
feel respected if his or her individual characteristics
and needs as an individual are recognised and attended
to. Respect, like equity, cannot be achieved by aiming
merely at equality: Treating all persons the same way is
not necessarily an indication of respect; it may simply
be a consequence of not knowing the specific needs and
wishes of specific groups (such as migrants). Equality
would then merely be the lowest common denominator
and an ideal “which must be implemented in the
absence of considerations showing that an alternative
is required”.In order to avoid the trap of the lowest common denominator, more research is needed on how migrants’ needs differ from those of
the majority population, and how these differing needs
can best be met within the constraints of an existing
health care system. The more knowledge there is about
the specific risks and needs of migrants and other social
groups, the more attention a health care system can pay
to these differences.
There are various, partly overlapping strategies to overcome
social inequalities that migrants are facing; if successful, such strategies would contribute towards improving migrants’ health. General social and economic measures such as transfers will not be discussed
here. Examples of strategies with a strong focus on
health and health care for migrants include:
• Diversity management; this is an approach on the
side of the health care providers; it takes advantage
of knowledge about differences between population
groups to establish just, fair and respectful health
services ( migrants, diversity management).
• Improving health literacy among migrants; this
approach requires active contributions from both
providers of services and from migrants themselves.
Its objective is to help migrants to increase their
understanding of all aspects of health and health
care, including body functions, preventivemeasures,
access routes to health care etc.
• Empowerment, which takes the idea of improving
health literacy a step further. The empowerment of
migrants seeks to enable them to identify the conditions
that determine their health status and to find
out how to change them. Attractive in theory, this
approach poses many practical problems; it may suffer
from low acceptability, especially among older
and “traditional” migrants.
Social inequalities among migrants usually, but not
always, show a negative impact on their health. Equity
in health risks and outcomes among migrants, relative
to the majority population, is a goal that may be difficult
to achieve. Health care services need to be more
responsive towards the needs of an increasingly diverse
population. This will help to ensure that migrants
and other minority groups are treated more fairly and
respectfully. Social and economic measures seeking to
improve the situation of disadvantaged groups in general
should be designed in such a way that they also reach
migrants, thereby contributing to better health of this group.