history of the current migration health paradigm migration health conference citizenship and...

CIC Medical Services - Services medicaux

StandardizationBegun in the 19th CenturyInternational Sanitary Conferences60 year processdiseases, vector control & standardsInternational Sanitary Regulations 1951


International Health RegulationsReplaced International Sanitary Regulationspurposeensure maximum security against international spread of disease with a minimum interference on world traffic


Article 84Migrants, nomads seasonal workers or persons taking part in periodic mass congregations, and any ship, in particular small boats for international coastal traffic, train, road vehicle or other means of transport carrying them, may be subjected to additional health measures conforming with the laws and regulations of each State concerned and with any agreement conclude between such States.


Challenges Post arrival follow upnot a part of classic quarantinemore relevant in todays worldcostlymajor gap


Traditional Approaches to Migration Health Immigration Medical AssessmentInfectious Diseases Quarantine Health

Fitness for EstablishmentImmigration Health


Photo: US National Library of Medicine


Traditional FocusBorder or FrontierPrimarily of interest to large receiving countriesLimited to arrival phaseLittle concern for integration into health systemsHomogenous populations



ApplicationOften applied under immigration legislationreference to national quarantine systemnational differences as opposed to international situationmovement from high to low prevalence areas


Immigration Health Screeningreflects national concernsgreat variabilityrelated to social policyemployabilityindependenceeugenicscontagious diseases


Why this is not already apparent to many Historic Canadian focus is inadmissibility screening focus limited to exclusion (few)limited attention on long term impacts of arrivals (TB good example)limited attention to forward looking issues of those who arrive


Policy is designed for Homogeneous Populations - Migrants VaryWhile the unifying factor may be being foreign born, other characteristics can be markedly different:HistoryEconomic statusEducationLegal statusLocal environmentAll of these characteristics can affect health outcomes


Pressures on the ParagidmPopulation flowsGlobalizationNew prevalence gapsEvolution of travel


Reduction of Interest in International Disease Control and RegulationLimited revision and modernization of legislationnational : quarantineinternational: IHRsRetention of antiquated regulatory instrumentswrong tools for the wrong place at the wrong time


The Lessons of History may not be Relevant


Reduction of the Impact of Infectious DiseasePharmacology (a drug for every bug)Improved control and reduction of disease prevalencein the developed worldLowered appreciation of threatDecreased appreciation of importance of Public Health


Evolution : DemographyMore people on the move for more reasonsdisplacementpost (natural / man made)More destinationsMore originsDifferent ages


Demographics@ 175 million persons live and often work outside of their country of citizenship@ 1- 2 more million migrate permanently every year @ 1 million others seek political asylumAdded to this are some 24 million refugees and millions of internally displaced individuals


DemographicsOlder and youngerBringing with them the health parameters of where they leftHealth care professionals may not be ready for previously geographically isolated diseases (SSD, Trypanosomiasis)


New Factors ContinuedSocial Increasing conflict/social/political unrestInternally and externally displacedGlobalized economyExchange of commerce and labour and merchandiseDietary patterns, pharmaceutical use globalContinued population pressuresSustained economic disparity


Geo-Biologic Boundariesconsequences of travel speed and availabilityincubation period less than journeyvectors in conveyanceshumanity as a vectorparasiticvaccine preventable



Prevalence Gapsmovement from local level to prevalence at destinationimplication for diseases that have mandated public health responsecosts and resource utilizationBioSafety IV diseasesmanaging small risks



New Factors ContinuedSpeed of Travelincubation period greater than travel timeFrontier focus requires reassessment



Forgotten Risk Groupsdescendants of migrantswho return to region of originconcept that citizenship provides public health protectiontravel medicine is generically applied to passport not riskchildren return to high risk environmentprophylaxis may not be taken


Risks of Rare or Uncommon Low Incidence Diseases In developed countries, certain groups of migrants can be expected to become high risk groups for diseases and illnesses controlled or eliminated in native-borne populations,

Craig AS, Reed GW, Mohon RT, Quick ML, Swarner OW, Moore WL, Schaffner W Pediatr Neonatal tetanus in the United States: a sentinel event in the foreign-born. Infect Dis J 1997 Oct;16(10):955-959


Distribution of reported TB cases by origin in Canada : 1980 - 2001Foreign bornCanadian born non-aboriginalCanadian born Aboriginall

Chart2

49.414.135.3

4814.837.1

4715.637.4

44.119.836

4615.638.4

43.91640.2

42.817.339.9

36.519.544

37.217.145.8

32.720.147.1

34.118.847.1

33.216.850

27.818.453.8

28.618.552.8

23.619.257.2

22.517.959

19.915.862.7

20.214.364.3

19.215.564.3

17.917.463.7

18.115.465

15.9718.162.4

Cdn-born Non-Aboriginal

Cdn-born Aboriginal

Foreign-born

Percent ofCases

Sheet1

Cdn-born Non-AboriginalCdn-born AboriginalForeign-born

198049.414.135.3

19814814.837.1

19824715.637.4

198344.119.836

19844615.638.4

198543.91640.2

198642.817.339.9

198736.519.544

198837.217.145.8

198932.720.147.1

199034.118.847.1

199133.216.850

199227.818.453.8

199328.618.552.8

199423.619.257.2

199522.517.959

199619.915.862.7

199720.214.364.3

199819.215.564.3

199917.917.463.7

200018.115.465

200115.9718.162.4

Sheet2

Sheet3

1http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1048001686696_114///?hub=Canada1March 18 BBC http://news.bbc.co.uk/2/hi/health/2859825.stm

1As well as monitoring of more specific trends

history of the current migration health paradigm migration health conference citizenship and...

Documents

international disease

additional health measures

international coastal

wrong place

exclusion fewlimited

arrival phaselittle

historic canadian focus

minimum interference