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Migration, Health and Inequality

Migration, Health and Inequality

Felicity Thomas | Doctor Jasmine Gideon


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Should migrants have the same rights as citizens to health care services? What do we mean by rights and by health? And how do we uphold such rights when diasporic networks provide a diversity of opportunities and constraints for people seeking to maintain or restore their health? Answering these pressing questions, this book highlights recent developments in the areas of migration, human rights and health from a range of countries. Looking at diverse health issues, from HIV to reproductive and maternal health, and a variety of forms of migration, including asylum seeking, labour migration and trafficking, this timely volume exposes the factors that contribute to the vulnerability of different mobile groups as they seek to uphold their wellbeing. Migration, Health and Inequality argues that we need to look beyond host country responses and biomedical frameworks and include both the role of transnational health networks and indigenous, popular or lay ideas about health when trying to understand why many migrants suffer from low levels of health relative to their host population. Offering a broad range of linkages between migrant agency, transnationalism and diaspora mechanisms, this unique collection also looks at the impact of migrant health on the health and rights of those communities that are left behind.
'Recent decades have seen a major increase in migration and global "flows", of peoples, populations and ideas. Against this background, this landmark volume sets out to examine fundamental questions of health and inequality. It provides essential reading for all interested in migration and health.' Professor Peter Aggleton, The University of New South Wales, Australia 'A collection of thought provoking and engagingly written selections, the book provides a nuanced, multi-layered examination of migrants' right to health in the context of shifting power relations under contemporary globalization. An important read for researchers, policymakers and service providers.' Dr Denise L. Spitzer, Canada Research Chair in Gender, Migration and Health, University of Ottawa 'This edited collection provides timely and thought-provoking insights into understanding migrants' physical and mental health status and their health-seeking behaviours. Going beyond a biomedical approach to health to consider alternative understandings of wellbeing and illness, as well as dimensions of inequality such as gender, socio-economic status and migrant status, this wide-ranging book represents an excellent source for understanding migrant health inequalities and the associated human rights challenges.' Katie Willis, Professor of Human Geography & Director of the Politics, Development & Sustainability (PDS) Group, Royal Holloway, University of London
Dr. Felicity Thomas is a lecturer at the University of Exeter and a research associate at the University of Sussex. Dr. Jasmine Gideon is a lecturer in development studies at Birkbeck College, University of London.

Table of Contents

Section Title Page Action Price
About the editors i
Title page iii
Copyright page iv
Contents v
Tables and figures vii
Acknowledgements ix
Abbreviations x
Introduction 1
Current migration patterns and processes 5
Global policy-making and implementation 5
Health, migration and vulnerable groups 6
Transnationalism, diaspora and health 7
References 8
1 | Context and perspectives: who migrates and what are the risks? 10
Introduction 10
The larger context: international migration today 10
Figure 1.1 Traditional and modern migration paradigms 13
Phases of the migration process and health effects 13
Returning to communities of origin 18
Policy frameworks affecting migrant health, and the role of international organisations 19
Needs and challenges 22
References 23
2 | Impact on and use of health services by new migrants in Europe 27
New migration to Europe 27
What are the implications for health services? 28
Barriers to healthcare and their influence on service use 31
Table 2.1 Key barriers to healthcare for new migrants 32
System and provider level barriers 33
Conclusions 38
References 39
3 | Do migrants have an enforceable right to healthcare in international human rights law? 44
Introduction 44
Is there a right to health? 45
Does human rights protection extend to migrants? 46
Equality arguments as a basis for migrants’ entitlement to healthcare 46
The ‘justification’ defence to discrimination against migrants 48
Protection for special groups as a basis for migrants’ entitlement to healthcare 49
Regional human rights protection as a basis for migrants’ entitlement 51
Migrant-specific human rights protection 54
Domestic law as a basis for migrants’ entitlement 56
Conclusion 57
Notes 58
References 59
4 | International health worker migration: global inequality and the right to health 62
Introduction 62
Human rights analysis 63
‘Source’ country governments and the right to health 64
Caveats in the right to health 66
Conclusion 74
Notes 75
References 76
5 | Socioeconomic vulnerability and access to healthcare among immigrants in Chile 79
Introduction 79
The Republic of Chile and the Chilean healthcare system 80
Immigration patterns in Chile 81
Legal rights to healthcare and policies to support access among immigrants in Chile 82
Demographic characteristics of international immigrants in Chile 83
Socioeconomic conditions of international immigrants in Chile 85
Healthcare provision among international immigrants and its association with socioeconomic status 86
Are international immigrants in Chile a vulnerable group and why? 89
References 91
6 | Unaccompanied young asylum seekers in the UK: mental health and rights 94
Introduction 94
Ontological security 94
Unaccompanied young people seeking asylum in the UK 95
Rights as instruments or moral claims 96
Methodology 97
Threats to ontological security 98
The limitations of a clinical response 102
Discussion 105
Conclusion 106
Notes 108
References 108
7 | Healthcare for trafficked migrants: UK policy 2000–10 and consequences for access 112
Introduction 112
Trafficked migrants’ access to NHS care: policy environment 2000–10 114
Impact of the NHS charging regulations on trafficked migrants’ access to healthcare, 2000–08 117
Implications of NHS access policies 2008–10 120
Conclusion 122
Notes 123
References 123
8 | Vulnerable migrant women and charging formaternity care in the UK: advocating change 126
Introduction 126
Charging for maternity care 126
Access to maternity care 128
Poor health outcomes 131
Political environment 132
Advocating for change 133
References 135
9 | Multiple medicaments: looking beyond structural inequalities in migrant healthcare 137
Introduction 137
HIV in the UK 137
Thinking beyond the biomedical 139
Interpreting and responding to ill-health 141
Treatment seeking following an HIV positive diagnosis 144
Conclusion 147
Notes 147
References 148
10 | Harnessing ‘diasporic’ medical mobilities 150
Mobilising ‘diaspora’ for development in the ‘homeland’ 150
Capitalising on structural inequalities 152
Claiming diaspora as the ‘natural’ market for cultural reasons 153
Using ‘their’ diaspora as a bridge to access new markets around the globe 156
Conclusion 159
Note 160
References 160
11 | Access versus entitlements: health seeking for Latin American migrants in London 163
Introduction 163
Latin American migrants in the UK 164
Migrants’ access to NHS services in the UK 164
Migration, gendered vulnerability and ill-health 165
Migrants’ access to healthcare services 167
The role of transnational networks and health seeking behaviour 167
The case study 171
Return to Latin America 172
Use of Spanish-speaking doctors in the UK 174
Conclusion 176
Notes 176
References 177
12 | Wellbeing and community self-help:Turkish-speaking women in London 180
Introduction 180
Post-migration wellbeing 181
Migration and women 181
Issues for migrant women 182
Community self-help and user empowerment in health services 183
Research with Turkish-speaking migrant women 185
Gendered empowerment experiences of Turkish-speaking women: findings from a quantitative large scale survey 185
Figure 12.1 Women’s health problems before and after their arrival in the UK 186
Table 12.1 Health and mental health problems 187
Figure 12.2 Percentage of women accessing health services for their problems 188
Findings from a small scale qualitative study with Turkish-speaking women’s self-help groups 189
Discussion 191
Note 194
References 194
Contributors 198
Index 201
About Zed Books 210