The UCL-Lancet Commission on Migration and Health: the health of a world on the move.
The UCL-Lancet Commission on Migration and Health: the health of a world on the move.
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DOI：
10.1016/s0140-6736(18)32114-7
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发表时间：
2018-12-15
期刊：
影响因子：
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通讯作者：
UCL–Lancet Commission on Migration and Health
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文献类型：
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作者：
Abubakar I;Aldridge RW;Devakumar D;Orcutt M;Burns R;Barreto ML;Dhavan P;Fouad FM;Groce N;Guo Y;Hargreaves S;Knipper M;Miranda JJ;Madise N;Kumar B;Mosca D;McGovern T;Rubenstein L;Sammonds P;Sawyer SM;Sheikh K;Tollman S;Spiegel P;Zimmerman C;UCL–Lancet Commission on Migration and Health
2018年有10亿人在迁移或已经迁移，移民是全球现实，也已成为政治避雷针。虽然估计表明，全球移徙大多发生在中低收入国家，但最突出的对话几乎完全集中在从中低收入国家向高收入国家的移徙问题上。如今，民粹主义言论妖魔化了那些在原籍国和目的地维护经济、加强社会服务并为卫生服务做出贡献的人。那些掌握政治和经济权力的人继续限制或公开谴责移徙，以促进他们自己的利益。与此同时，民族主义运动主张所谓的文化主权，通过描绘一个美国与他们的修辞，创造一个道德紧急情况。为了应对这些问题，召开了移民和健康的UCL柳叶刀委员会，阐明以证据为基础的方法，以告知公共话语和政策。委员会进行了分析，并广泛征求了意见，收集了各种国际证据和专业知识，涵盖社会学、政治学、公共卫生学、法律、人道主义和人类学。这项工作的成果是一份报告，旨在呼吁民间社会、卫生领导人、学者和政策制定者采取行动，最大限度地提高移民对当地和全球卫生的好处，降低移民对当地和全球卫生的成本。我们的工作成果与我们贯穿整个报告的五个总体目标有关。首先，我们提供了关于移民和健康结果的最新证据。这一证据挑战了常见的神话，突出了现代移民的多样性、动态和好处，以及它与人口和个人健康的关系。移徙者对东道国社会财富的贡献通常大于其成本。我们的文章表明，高收入国家的国际移民平均死亡率低于东道国人口。然而，在某些情况下，在某些移徙者亚群体中，以及在留在原籍地的人口中，发病率有所增加（例如，贩运受害者和逃离冲突者的精神疾病发病率增加）。目前，在2018年，由于数据质量差，很难评估移民的全方位健康需求。例如，我们对无证移民、残疾人、女同性恋、男同性恋、双性恋、变性人或双性人（LGBTI）的健康状况知之甚少。其次，我们研究多部门的健康决定因素，并考虑目前的部门孤立的方法的影响。移徙者的健康在很大程度上取决于决定移徙动力、旅行条件和目的地的结构和政治因素。歧视、两性不平等和被排斥在保健和社会服务之外，一再成为对移徙者健康的负面影响，需要采取跨部门对策。第三，我们认真审查健康移徙面临的主要挑战。人口流动为移徙者及其所在社区带来了经济、社会和文化红利。此外，享有能达到的最高标准健康的权利，不论地点或移民身份如何，都载于许多人权文书。然而，国家主权问题掩盖了这些好处和法律的规范。对移徙的关注主要集中在安全问题上。当将健康和移徙这两个词结合在一起时，它要么侧重于社会和政策的小部分，要么被负面解读。《联合国移民全球契约》和《联合国难民全球契约》等国际协定是确保国际团结、统一意图和我们共同的人性战胜民族主义和排斥政策的机会，从而采取具体行动保护移民的健康。第四，我们审查获得卫生和卫生服务的公平性，并提供基于证据的解决方案，以改善移民的健康。应将移徙者明确纳入全民医保承诺。最终，未能实现健康包容性的代价可能比所需的适度投资对国家经济、健康安全和全球健康造成的代价更高。最后，我们展望未来，概述我们的证据如何有助于协同和公平的卫生，社会和经济政策，以及可行的战略，以告知和激励移民，政策制定者和民间社会的行动。我们的结论是，应将移徙视为21世纪世纪健康与发展的一个中心特征。对移民人口健康的承诺应在所有可持续发展目标中以及在执行《全球移民契约》和《全球难民契约》时加以考虑。该委员会提出的建议将人口流动视为全球卫生的一项资产，说明人人享有良好健康的意义和现实。我们提出了四个关键信息，为今后的行动提供了重点。
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.