In order to move beyond simply understanding migration and to better foster admission and integration, the narrative of migration needs to be transformed by evidence-based, reliable and sustainable data sets. A primary example in which migrant groups are often misrepresented is with regard to economic resources. Migrants are often perceived as a long-term drain on the economy, when in reality it is a short-term cost for long-term benefits. For example, whilst initial absorption may be costly, it has been estimated that in the UK, refugees are projected to grow the GDP more than two-fold (€126.6 bn) in the next 5 years, through the creation of jobs, increased demand for services and products, and also filling gaps in EU workforces [13]. Additionally, findings from Addressing the income gap of ethnic groups: impact of health on livelihoods conducted by the University of Economics in Bratislava demonstrated that proxies for migrant discrimination played a substantial role in explaining the poverty differences between migrants and nationals in the EU. Therefore, it remains imperative to change the narrative of migrants through the use of data, to support and promote the evidence on the positive effects of migration.
The inclusion of evidence-based tools also needs to be reinforced and adopted at country-level. In Italy, two guidelines, namely the Guidelines to control TB among migrants in Italy and Boarder checks kept in check, were developed in collaboration with the National Institute of Health, the National Institute for Health, Migration and Poverty, and the Italian Society of Migration Medicine to promote evidence-based guidance for decision-makers [14]. The guidelines were drawn from systematic and rigorous literature reviews, which aimed to draw recommendations and best practices focused primarily on infectious diseases, chronic-degenerative conditions, pregnancy and vaccinations [14]. Rewriting the true narrative of migration should be based on both values and human rights, in hopes of triggering further engagement and acceptance. Similarly, shaping perception is also part of the Global Compact, which as part of its framework, aims to “eliminate all forms of discrimination and promote evidence-based public disclosure to shape perceptions of migration” [15].
International frameworks and policy: Translating abstract concepts into sustainable action
Due to the political nature of migration and the implications for the economic and legal system, it remains essential that there are just and robust frameworks and policy to advocate for the human rights of migrant populations. In collaboration with the WHO framework of priorities and guiding principles to promote health of refugees and migrants, the Global Compact for Migration seeks to set out comprehensive and holistic guidelines for healthier lives of migrant and refugees [15]. Objective 15f in the Global Compact for Migration seeks to provide access to basic services for migrants and states the following:
Expand and enhance national health systems, incorporating the needs of migrants in national and local health care policies and plans, including by strengthening capacities for service provision, facilitating affordable and non-discriminatory access, reducing communication barriers, and training health care providers on culturally-sensitive service delivery, in order to promote physical and mental health of migrants and communities overall.
There is a clear link which exists between migration and development, not only demonstrated by the Global Compact acting as a response to the sustainable development goals, but also by the proliferation of universal health care for migrants and refugees in Iran. There has been an influx of Afghan refugees into Iran, which currently hosts 951,142 documented refugees and is estimated to also host 1.5 to 2 million undocumented refugees (see Fig. 2) [16]. In the case for documented refugees, insurance coverage for refugees is endorsed by Iran’s development programs, namely through the 6-year development plan (2016–2021; Article 70, number 5). Examples of free primary healthcare services in Iran include vaccinations, maternal and child health, family planning and psychological consultations [17]. Health is also a main pillar of the United Nations Sustainable Development Goals, as a healthier population will also reinforce greater financial sustainability.
Fig. 2
From: Critical reflections, challenges and solutions for migrant and refugee health: 2nd M8 Alliance Expert Meeting
Where refugees from the top five countries of origin found asylum (UNHCR, 2015)
According to Lee’s push and pull theory, there may be various push and pull factors which influence migrants’ choice of host destination, and access to medicines may be categorised as a pull factor to migrate to said host country [18]. However, pull factors may be extremely conditional at times, widening the gap between expectation and reality. For instance, in France, a health protection scheme for undocumented migrants was created in 2000, named the State Medical Assistance [19]. Whilst the scheme had a period of entitlement for up to one renewable year, the legitimacy of assistance for undocumented migrants has been subject to debate and regular criticisms. The reasons for this being the requirements needed to access the healthcare are not only were undocumented migrants expected to have lived in the territory for over 3 months, but also beneficiaries were expected to bring forward supporting documents such as proof of identity, address of domiciliation and administrative documents proving their 3-month presence in France [19]. These criteria increase the difficulty to actually access these services, with only 10.2% of eligible candidates gaining effective access to medicine and primary health care services [19]. This echoes the need to have clearer laws and regulations, and research also concluded that it might be more beneficial to reintroduce undocumented migrants into a common law system opposed to maintaining a specific defined system for undocumented migrants [19].
