What is a migrant? How definitions affect access to health care

Migrant, immigrant, refugee, asylum seeker – these terms are often used interchangeably in popular parlance, as if the specific term makes no difference. Yet for the individual, the label assigned to them can be life-changing.

The latest Health Evidence Network (HEN) publication, HEN synthesis report 46, addresses the question, “How do variations in definitions of ‘migrant’ and their application influence the access of migrants to health care services?” The report demonstrates that variations of definitions used for different groups of migrants in different areas affect access to health care. It provides detailed annotations of its evidence sources, which include academic and grey literature. A total of 169 publications in English and Russian were analysed, covering 39 out of the 53 Member States of the WHO European Region. Some of these sources contain data from as long ago as 1990.

No universal definition

There is no universally accepted definition for migrant at an international level. The empirical studies analysed for the report reflected this in the wide range of terms used to describe study populations. The terms migrant and immigrant were used broadly and interchangeably without defined source references; the terms refugee and asylum seeker were more likely to be defined with internationally standardized references.

Legal status emerged as one of the most significant factors in determining whether migrants were able to access affordable and adequate health services. In some Member States, even migrants with legal status had restricted access to health care, depending on their length of stay and type of residence permit.

The tasks of identifying subgroups of migrants at risk of poor health outcomes, targeting public health interventions and conducting disease surveillance can only be tackled with a good evidence base. Yet the wide variety of definitions limits the comparability of routinely collected data in health information systems across the Region. This variation and its consequences create an obstacle to achieving universal health care, and are related to the multisectoral nature of migration. Intersectoral collaboration is needed to ensure coherence among definitions.

Policy options from the review

The review puts forward 6 main policy options for consideration by Member States:

  • the development of a list of preferred terms relating to migrants based on a shared understanding of these terms;
  • the involvement of migrants in the development of intersectoral systems that collect sensitive data on migration and for migrant-sensitive health services;
  • the initiation of routine collection in national health information systems of data on an agreed set of variables relating to migration, such as country of birth, length of residence, legal status, purpose of migration and previous country of residence;
  • the monitoring and analysis of data on access to and delivery of health care to migrants based on these migration-related variables and social determinants of health;
  • the provision of health care, free of charge, for the diagnosis and treatment of communicable diseases, including primary and emergency health care; and
  • the incorporation of the needs of migrants into all aspects of health services and provision for all migrants of the same access to health care as for the general population, regardless of the definition used.

HEN is an information service for public health decision-makers that provides policy options based on the best available evidence. HEN reports are published regularly on a broad range of topics and are discoverable via PubMed.