Migration and health: a continuous link crossing borders

Inez Roosen

Introduction

Migration has been a constant throughout human history and impacts different segments of the community. Since the beginning of the so-called refugee crisis, migration has received increasing attention. The global number of international migrants rose, reaching 258 million in 2017, comprising diverse populations with complex, transnational exchanges.

At their new destination country, migrants live within ‘transnational networks’ linking them with their family and friends who remain behind in their country of origin or elsewhere. These connections result in transnational exchanges from migrants to those who remain, and vice versa. These exchanges can include money and goods, but also information and social capital. Living in-between worlds often leads to the creation of migrants’ own ‘intercultural identity’, and influences the identity of migrants’ kin who have remained behind. For many, this means juggling between the global South and the global North to combine the best of both worlds, not entirely belonging to one or the other .ii,

While migrant health is high on the policy agenda, it still often focuses on the differences between migrants and native populations, which stresses the one-way ‘acculturation’ processes from migrants into their new host country societies, overlooking the importance of transnational social spaces in influencing health outcomes. Additionally, one often forgets the influence migrants can have on the health of their transnational network members who remained behind in their country of origin. Therefore, this article will elaborate on the impacts migrants can have on the health behaviours and related health outcomes of those who remained behind, acting as possible agents of development influencing their countries of origin.

Migrants as possible development agents

Understanding how migrants can act as development agents influencing health behaviours and health outcomes requires a clear understanding of migration and transnational life. When studying how migrants can contribute to the development of their home countries and their kin that remain behind, current research mostly focuses on the influence of monetary transfers (also known as economic remittances) on home countries. While focusing on economic remittances, the impact of the transfer of human and social capital between migrants and those who remain behind in their country of origin (also known as social remittances) on health remains largely unexplored. Some studies explored the influence of social remittances on the health of those transnational network members who stay behind; interesting examples are the studies of Beine, Docquier, and Schiff (2013) and Fargues (2006).

In their cross-country analysis of the influence of international migration on fertility norms (such as attitudes toward the use of birth control methods or perceptions regarding family sizes) in origin countries, Beine, Docquier, and Schiff (2013) argued that migrants observe social norms regarding fertility in their countries of destination. For example, depending on the destination country, migrants can be exposed to positive attitudes towards birth control use and positive social norms regarding smaller family sizes in their country of destination. Over time, the observed fertility norms at the destination country can consequently shape the perceived norms of the migrants. Depending on existing social norms in both origin and destination, fertility rates in the origin country may either increase or decrease in response to the norms migrants transmit. Changes in fertility rates were recorded by Fargues (2006), who researched how migrants destined for different host regions (namely the West or the Gulf) shaped birth rates in their countries of origin (Morocco, Turkey, and Egypt). In Morocco and Turkey, countries for which the majority of migrants resided in a developed country, birth rates were found to decrease among the family members of migrants who remained in the origin country following information and values (smaller family sizes) received from migrant family members. Birth rates were found to increase among Egyptians with migrant kin, which reflects the more conservative values migrants residing in the Gulf transmitted regarding family sizes.
When recognizing the potential of migrants as development agents, social remittances have been increasingly acknowledged as drivers of contemporary social and cultural (ex)change. These transnational exchanges even have the potential to reach sustainable and far-reaching effects on understandings and practices at individual and collective levels. Therefore, social remittances could be a more durable means of development than economic remittances.

Continuous links crossing borders: The influence of social remittances

Telecommunication technologies and affordable air travel allow migrants to communicate with family and other networks in their countries of origin. These connections facilitate the diffusion of ideas and information (social remittances) back-and-forth across international borders. These social remittances can entail new knowledge, skills, attitudes and social norms. Interestingly, these different types of information that the migrants diffuse are often related to health behavioural change, and considering this comes from a reliable source (a network member) who is able to tailor the information to the person he/she is talking to, stresses the power of this type of information exchange.

It appears that via social remittances migrants have the potential to influence individual health behavioural determinants such as the knowledge, social norms, skills/self-efficacy and attitudes of those individuals who remain behind. In addition, due to the often more prominent position of the migrant within the household and community as well as due to (unconsciously) tailoring the health-related information that they diffuse, migrants could positively contribute to changes in health behaviours and health outcomes of their transnational network members who remain in their country of origin. The diffusion of information and ideas, however, does not guarantee acceptance; they may be resisted, rejected or adapted to local contexts.iv,

To be able to establish a positive developmental influence of social remittances, such as on the health behaviours and health outcomes, several conditions should be taken into account. First, the migrant needs to have access to correct health-related information to diffuse to those who remain behind within their transnational network. Second, migrants need to have gained positive attitudes towards the retrieved health-related information, preferably obtained from positive personal experiences related to the specific information, supporting the transfer of normative structures (such as attitudes and social norms). Being part of the transnational network, the migrant can serve as a role model to those family members that stay behind, increasing the success of the health-related remittances. Third, frequent exchange of information within an established transnational network needs to occur to increase the chances that the migrant can successfully remit the health-related information.

The role of destination countries

The stated conditions, which are facilitating factors to contribute to a positive influence on the health of those who remain behind, also reveal the responsibility and the role of the destination country. Migrants need to have access to accurate health-related information. The normative content of Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), on the right to the highest attainable health, states that migrants should not only have physical access to health and health information, but that this access should also be affordable and non-discriminatory.

Furthermore, to successfully remit new health information, migrants should gain positive experiences related to the new health behaviour and health outcome to increase acceptance. Components that support the approval of new health-related information are respectful medical ethics, culturally appropriate health-related information and practice as well as respecting confidentiality.

The Migrant Integration Policy Index analyses policies concerning the integration of migrants in a number of developed countries and with regards to a diverse range of policy areas. Health is one of these areas; overall, when examining the health index, one can observe that there is not one developed country classified as being ‘favourable’ for migrant health. Researchers have not only observed large-scale differences in immigrant health coverage, but also in their access to health services. Developing countries often fail to consider health needs specific to different migrant populations.

Conclusion

Migrants can be health-related development agents, but the health information migrants receive, and remit will vary by destination country.
It is important to understand that migrants’ influences on the health outcomes of transnational network members that remain behind in their country of origin are not solely positive and depend on the health behavioural information and norms available in the new host society. For example, migrants transferring Western dietary habits, especially those of fast food, can have a negative impact on health outcomes, such as overweight, on those that remain behind; while the promotion of Western perceptions on birth control use can lead to positive health outcomes, such as birth spacing, that can positively influence the maternal and child health of those who stay behind. One should consider the role and responsibilities of the destination countries to enable migrants remitting health-related information that can lead to positive health outcomes for those that stay behind. Migrants need to be able to access affordable, good-quality, culturally-sensitive and non-discriminatory health care and information. The host society and its healthcare workers need to be aware that healthcare and health education and promotion programmes should not be considered as one-size fits all. Especially nowadays, in a multicultural society, it is essential to tailor health education and promotion programmes to the specific needs of the diverse subpopulations. This tailoring is not only crucial for possible further developmental influences on those who remain but also to create an equal impact of these programmes on the society as a whole, including all of its diverse members. Important to mention that even though there is a great potential for the role of social remittances with regards to health-related development in origin countries, it should not be considered as the sole solution for development.

Ph.D. Fellow at UNU-MERIT / Maastricht Graduate School of Governance

Main research interests: Migration, Health, Social remittances and Transnational

Notes

1. UNDESA (2017). International Migration Report 2017. Retrieved from http://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationReport2017_Highlights.pdf
2. Levitt P. (1998). Social remittances: Migration Driven Local-Level Forms of Cultural Diffusion. The International Migration Review, 32(4), 926-948.
3. Donnelly T.T. (2006). Living “in-between” – Vietnamese Canadian women’s experiences: Implications for health care practice. Health Care Women International, 27(8): 695-708.
4. Levitt P. & Lamba-Nieves D. (2011). Social remittances revisited. Journal of Ethnic and Migration Studies, 37(1), 1-22.
5. Beine M., Docquier F. & Schiff M. (2013). International Migration, Transfers of Norms and Home Country Fertility. Canadian Journal of Economics, 46(4),1406–1430.
6. Fargues P. (2006). The Demographic Benefit of International Migration: Hypothesis and Application to Middle Eastern and North African Contexts. Retrieved from: http://www.ssrc.org/workspace/images/crm/new_publication_3/%7B7b6f3712-3255-de11-afac-001cc477ec70%7D.pdf
7. Markley E. (2011). Social remittances and social capital: values and practices of transnational social space. Quality of Life, 22(4), 365–378.
8. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice (4th ed.). San Francisco, SF: John Wiley & Sons.
9. Castles, S., de Haas, H., & Miller, M. J. (2014). The Age of Migration: International Population Movements in the Modern World (5th ed.). London, LDN: Palgrave Macmillan.
10. OHCHR (2000). Economic and Social Council. Retrieved from: http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1AVC1NkPsgUedPlF1vfPMJ2c7ey6PAz2qaojTzDJmC0y%2B9t%2BsAtGDNzdEqA6SuP2r0w%2F6sVBGTpvTSCbiOr4XVFTqhQY65auTFbQRPWNDxL
11. Based on ICESCR General Comment No. 14: Right to the Highest Attainable Standard of Health (Art. 12) (http://www.refworld.org/pdfid/4538838d0.pdf)
12. MIPEX (2015). Health. Retrieved from: http://www.mipex.eu/health