Opinion of the European Economic and Social Committee on Health and Migrations
Date: 2007-07-11
Institutions: European Economic and Social Committee
Subjects: cooperation policy, health care, health policy, illness, migrant, migration, public health

27.10.2007

EN

Official Journal of the European Union

C 256/123

Opinion of the European Economic and Social Committee on ‘Health and Migrations’

(2007/C 256/22)

In a letter dated 14 February 2007 the upcoming Portuguese Presidency asked the European Economic and
Social Committee to draw up an exploratory opinion on Health and Migrations.

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the
Committee's work on the subject, adopted its opinion on 18 June 2007. The rapporteur was Mr Sharma,
the co-rapporteur was Ms Cser.

At its 437th plenary session, held on 11 and 12 July 2007 (meeting of 11 July 2007), the European
Economic and Social Committee adopted the following opinion by 109 votes to 3 with no abstentions.

1. Conclusions

monitoring and assessing problems and benefits on local,
regional, national and European levels.

This Opinion is about the links between health and migration
and as such is not a debate about migration per se. Migration is
important to the EU economy and is an ongoing process which
involves a significant and increasing proportion of the EU and
the global population.

It is important that the policies of the EU and Member States
provide a high level of health protection to migrants and their
families. This means action in a wide range of policy areas
including employment and health and safety at work, education,
social protection as well as health promotion and health care.

This Opinion has identified a number of health issues facing
migrants and implications for public health which require inter-
vention by Member States and the European Union.

1.1 Recommendations

The humanist (1)and fair (2) globalization must be based on
universally shared values and respect
for human rights and
respect for a high level of health and food safety for all popula-
tion groups,
in particular the most vulnerable; cultural and
linguistic diversity and sharing and dissemination of knowledge
amongst everyone.

With respect to universal human rights the EESC makes the
following recommendations:

1.1.1
Information and meeting points should be set up,
making it easier for immigrants to obtain information on health
and social care. The information should be provided by
members of
the same immigrant minority, working in the
centres, as well as provide a focal point of cooperation between
authorities, migrant NGOs and those of the host communities.

1.1.2
The Member States and the EU should step up coopera-
tion with international organisations on immigrant health and

(1) See the EESC opinion of 31 May 2007 on ‘The Challenges and Oppor-
(Exploratory
tunities for the EU in the Context of Globalisation’
opinion), rapporteur Mr Malosse and the co-rapporteur was Mr Staffan
Nilsson (OJ C 175, 27.7.2007).
(2) ILO. A Fair Globalization. 2004.

1.1.3
education taking minority cultures into consideration.

Introducing national public health programmes into

1.1.4
together with programmes
cooperation between host countries and countries of origin.

A Special Compensation Fund should be set up,
resettlement and

training,

for

Access to medical treatment and preventive care should
1.1.5
be provided as a human right to all persons living in the EU
regardless of their status,
in line with the Charter of Funda-
mental Rights which guarantees access to preventative and
medical care.

1.1.6
Confidentiality clauses between patients and medical
institutions should be introduced (where these do not exist) to
ensure that any information about a person's immigration status
cannot be disclosed to third parties and therefore should not
deter migrants from seeking medical help and treatment espe-
cially in case of irregular immigration.

1.1.7 Member States and the EU should cooperate to
improve data collection and research on migration and health
throughout the EU.

1.1.8
migration.

Health should be included as an essential dimension of

1.1.9
Health impact assessments should evaluate the poten-
tial impact on both health and non-health policies on the health
of migrants.

specialist
1.1.10 Member States
tropical medical services must offer their expertise to all EU resi-
dents and continue to undertake high quality research into treat-
ments for tropical illnesses, particularly malaria.

traditionally offer

that

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1.1.11
Improved mechanisms are needed to assess and
provide for the health needs of all categories of migrants as
soon as possible after arrival. Enhanced cooperation is required
the
between the EU and Member States
immediate needs of migrants arriving with urgent medical need,
particularly through the provision of interpreters.

to provide for

1.1.12
Health of migrants at work should be prioritised. This
should involve cooperation by social partners and the compe-
tent authorities to ensure that high standards of occupational
health and safety are maintained in sectors in which migrants
are commonly employed. Workplace based health promotion
programmes should also be further developed in cooperation
with community based services to help meet
the needs of
migrant workers and their families.

1.1.13
School based health promotion programmes should
also be considered as a way of providing for the health needs of
migrant children. Health of migrant children is a particular
priority. Pre-school and school-based health services must meet
the needs of children from all backgrounds, including the chil-
dren of migrants, with particular emphasis on new arrivals.

1.1.14
Health care treatment and preventive services should
be developed which are culturally appropriate and sensitive
without making any concessions to the ban on female genital
mutilation.

1.1.15
Health professionals should receive ongoing training
and professional development to assist them to provide for the
changing health needs of migrant communities.

Consideration should be given to recruiting health
1.1.16
including an
professionals trained in developing countries,
return after a
element of co-development,
temporary stay or providing compensation to the country of
origin that provided the training. The Commission needs to
look at areas of good practice in ethical recruitment of medical
staff from Third Countries with a view to proposing an EU
Code of Good Practice.

facilitating their

The role of the authorities controlling public health
1.1.17
should be enhanced and the exchange of good practices should
be encouraged and here EU authorities should play a coordi-
nating role.

1.1.18
state of health and health care (3).

Enhancing intercultural dialogue — focusing on the

(3) See the EESC opinion of 20.4.2006 on the ‘Proposal for a Decision of
the European Parliament and of the Council concerning the European
Year of Intercultural Dialogue (2008)’ — COM(2005) 467 final —
2005/0203 (COD), rapporteur Ms Cser (OJ C 185, 8.8.2006).

1.1.19
The EESC re-emphasises its previous recommenda-
tions saying that the Member States should implement the ILO
conventions on migrants (4).

2. Background

2.1
The European Economic and Social Committee welcomes
the on-going interest of the Portuguese Presidency to investigate
the issue of public health and migration. The German,
Portuguese and Slovenian presidencies agreed that ‘the health
policy plays a crucial role as better prevention and cross-border
health care bring direct benefit to European citizens’ (5).

The three Presidencies committed themselves to actively pursue
work to address the existing inequalities affecting migrants in
terms of access to health services. It has also been agreed to
support a wide range of Community activities to contribute to a
high level of health for all citizens, focusing on health promo-
tion, disease prevention, innovation and access to healthcare.

The Committee has adopted a wide range of opinions
2.2
concerning the issue of regular and irregular migrations (6),
therefore this exploratory opinion will focus on health issues.
We invite the Portuguese Presidency and other stakeholders
involved to refer to our previous work in the field of migration.

(4) The International Convention on the Protection of the Rights of All
Migrant Workers and Members of Their Families, adopted in 1990,
came into force in July 2003. This complements the ILO Migration for
Employment Convention, 1949 (No 97) and the ILO Migrant Workers
(Supplementary Provisions) Convention, 1975 (No 143). Together,
these three International Conventions provide a framework for
addressing the rights of migrant workers and questions of irregular
migration. They operate within a broader policy context including
recently-adopted UN treaties that address trafficking, smuggling and
exploitation, such as the UN Convention against Transnational Orga-
nized Crime (2000), its Protocol to Prevent, Suppress and Punish Traf-
ficking in Persons, Especially Women and Children (2000) and Protocol
against the Smuggling of Migrants by Land, Sea and Air (2000), the
Optional Protocol to the Convention on the Rights of the Child on the
sale of children, child prostitution and child pornography (2000), as
well as the earlier 1951 Convention and 1967 Protocol relating to the
Status of Refugees. While relatively few countries and, where relevant,
regional economic organizations have ratified these conventions to
date (with the exception of the refugee treaties), these instruments
provide important elements for a more comprehensive agenda.

(5) Council of the European Union, 18-month Programme of the
Brussels,

Presidencies,

Portuguese

Slovenian

and

German,
21 December 2006.

(6) See the following EESC opinions:

— 13.9.2006 on ‘Immigration in the EU and integration policies:
cooperation between regional and local governments and civil
society organisations’, rapporteur Mr Pariza Castaños (OJ C 318,
23.12.2006).

and

— 15.12.2005 on the ‘Communication from the Commission to
the Council
European Parliament: The Hague
Programme: Ten priorities for the next five years — The Partner-
ship for European renewal in the field of Freedom, Security and
Justice’ — COM(2005) 184 final, rapporteur Mr Pariza Castaños
(OJ C 65, 17.3.2006).

the

— 20.4.2006 on the ‘Proposal for a Regulation of the European
Parliament and of the Council on Community statistics on migra-
tion and international protection’ — COM(2005) 375 final —
2005/0156 (COD), rapporteur Ms Sciberras (OJ C 185, 8.8.2006).

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3. Introduction

4. Size and scope of the issue

3.1 Much has been written about migration and health and
this report draws upon the recent paper prepared for the Policy
Analysis and Research Programme for the Global Commission
on International Migration (Carballo & Mboup, September
2005). Other references are noted throughout the Opinion.

The World Health Organisation defines health as: ‘a state
3.2
of complete physical, mental and social wellbeing and not
merely the absence of disease or
infirmity’. This Opinion
contends that ‘health’ as defined, is a human right.

The health of migrants and refugees is important for

3.3
many reasons, including:

— Universal human rights and respecting human dignity

— The extent of loss of life, disease and risk to health experi-

enced by some, especially illegal migrants

— The health risks experienced by a wide range of migrants

moving to a new country

— Variable access to health and social care

— Risks to the wider population and

— Risks to the country of origin from loss of health profes-

sionals.

Internationally, it is estimated that more than 200 million
4.1
people move every year to find work and a better life; at least
30-40 (7) million of them are unofficial. The number of the
migrants worldwide would constitute the fifth most populous
country in the world (8). Women accounted for 49,6 % of
global migrants in 2005. There are between 7 and 8 million
undocumented migrants in Europe (9).

For

the purposes of

4.2
this exploratory opinion the
committee has considered migration and health issues mainly in
relation to third country nationals migrating to the EU. Presently
there are around 18 million citizens of third countries living in
the EU. There are also a significant number of foreign born citi-
zens and irregular or illegal migrants. The vast majority of
migrants entering into the EU entered legally.

4.3
Asylum seekers represent a relatively small proportion of
the migrant population as a whole and the number of asylum
seekers has fallen in recent years because of EU policy rather
than an overall decrease in the number of people requiring
protection.

2006

2005

2004

2003

2002

EU Asylum Applications

266 270

350 103

421 236

532 300

640 347

Number accepted

% accepted

38 857

46 742

35 872

41 823

59 705

22,71

20,55

13,36

12,4

14,73

In recent years, migration both legal and irregular, has increased
in a number of countries
including
Portugal, Spain and Italy. Many of these migrants come from
North or sub Saharan Africa, Latin America and Asia and the
CIS countries.

in Southern Europe,

— Additional risks in their country of destination

— Housing conditions.

4.4 Whilst migrants are generally healthier than people in
their country of origin,
they may experience more health
problems than average for their host community. This is due to
a variety of reasons, including:

— Psychological and social stresses (resulting from unknown
culture, illegality, change of environment, lack of knowledge
of foreign languages, lack of trust and information, mental
health issues)

4.5 Migrants from some areas have a higher incidence of
communicable diseases and long term conditions
such as
mental health problems, coronary heart disease, respiratory
diseases and diabetes are often more common.

— Risks acquired in their country of origin

— Poverty and working in risky conditions

— Poor access to health care and information about healthcare

services, health promotion and preventative services

4.6
Irregular migrants, including their families and especially
children, experience worse health problems than legal migrants
which can relate to the health risks taken gaining entry, worse
economic and social conditions and insufficient access
to
services.

(7) United Nations' Trends in Total Migrant Stock: The 2003 Revision.
(8) US Census Bureau, IDB — Rank Countries by Population,

http://www.census.gov/ipc/www/idbrank.html.

(9) Migration Information Source,

http://www.migrationinformation.org/Feature/display.cfm?id=336.

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5. Different types of migration

5.3 International travel

5.1 Voluntary migration

5.1.1
Economic factors are the main driver for migration
into the EU with escape from conflict or persecution also
forming important reasons. People move and continue to move
for different reasons. Some move with the intention of settling
and beginning new lives, others with the intention of earning
enough to return home.

5.1.2
Some move with legal status to work for a period of
time, others move in unregistered way but find work and stay
for an indeterminate period. Both of these can present health
challenges often related to national policies and social attitudes
to migrants and the wider determinants of health such as educa-
tion, employment and housing.

5.1.3
Circular migration is increasingly being recognised as a
key form of migration (10) that, if well managed, can help to
match the international supply of and demand for labour,
thereby contributing to a more efficient allocation of available
resources and to economic growth. It can be an answer of the
need of the EU offering a credible alternative to illegal immigra-
tion.

5.3.1
The World Tourist Organisation reports that in the last
decade of the 20th century international tourism made up for
30 % of global service industries and estimated that interna-
tional
these
‘arrivals’ will exceed 1,55 billion by 2020. Of
0,4 billion will involve long-haul travel across ecological zones.

An estimated 14 million people a year travel

5.3.2
from
industrialised countries to the tropics in Africa, Asia, Latin
America and Pacific Islands. A significant number return with a
disease that needs treatment. Diarrhoea is the most common
problem, but malaria has become a common problem in terms
of diagnosis, treatment and cost to the countries that tourists
return to.

5.3.3 Without protection, tourists run the risk of Hepatitis A
infection and sexually transmitted diseases, including HIV.

6. The impact of migration on health and the public health

5.2 Forced migration

6.1 Policy

The health care implications of forced migration are
5.2.1
severe and far-reaching; each year people are forced to leave
their own countries and become refugees with UN protection,
millions are forced to leave their own homes and stay within
their own borders.

6.1.1 Many EU countries have policies regarding right to
enter, length of stay and when people must leave. On the whole
these policies are restrictive rather than permissive and make
migration complicated. This may create social and economic
environments that are detrimental to the health of migrants.

5.2.2
Often people have to pay large amounts of money to
be helped across borders causing financial hardship. Migrants
live in fear and are easily exploited by employers. For women
rape and sexual exploitation are not uncommon.

6.1.2
Approaches to public health and health screening vary
from country to country as does the approach to access to
health and social care. However there appears to be a lack of
comprehensive information comparing national practices.

5.2.3
Trafficking people is a crime that violates basic human
rights and destroys lives. Trafficking people is acknowledged to
be the modern form of slavery and each year it is estimated that
the total number of people living in some form of forced servi-
tude around the world (according to the ILO) is 12 million,
while more than 1 million people are sold as commodities into
prostitution or forced labour. US State Department data suggests
that 80 % are women and girls and up to 50 % minors. The
data also suggests that the majority are trafficked into sexual
exploitation.

6.2 Data

Few EU countries gather routine data on the health of
6.2.1
migrants and this makes providing reliable information on the
health experience and health needs of migrants difficult.
In
many countries health recording systems are not designed to
identify people by migration status.

5.2.4
Trafficking generates enormous profits for traffickers,
some estimates suggest that as much as USD 10 billion (11) is
made each year. (iii: UNICEF)

(10) COM on Circular Migration of 16 May 2007.
(11) The New Global Slave Trade, Ethan B. Kapstein, from Foreign Affairs,

November/December 2006.

6.2.2 While a few countries collect these data others focus
on region of origin or ethnic group. There can be a lack of
clarity about who is a migrant and who is a descendent of a
migrant. In some cases people are described by ethnic origin
alone and no distinction is made between for example children
who are migrants themselves, or who are children of migrants.

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6.2.3
There are also an unknown number of irregular and so
unrecorded migrants who may be reluctant to seek health care
when it is needed.

mented migrants, who are the people in most need of these
services.

Furthermore migrants may be reluctant

to provide
6.2.4
information about
their migration status to health service
authorities in case it could be used to their disadvantage. This
compounds the lack of good quality information available.

6.2.5
Reluctant behaviour might be rooted at cultural and
religious reasons. Furthermore authorities and health services
providers also lack the appropriate knowledge and are not
prepared to meet their special needs. For these reasons there is
not enough information on migrants and their state of health.

6.5 Migration and physical health

6.5.1
All people have a health ‘footprint’ related to where
they come from and social environment they live in. In general
economic migrants tend to move from poorer to wealthier
countries and so a proportion of them will have health profiles
linked to poverty.

6.3 Migration and psychosocial wellbeing

6.6 Communicable diseases

6.3.1
For both legal and irregular migrants challenges such
as language, culture and policies are exacerbated by fear of the
unknown (v: Tizon 1983). Other issues such as:

— Separation from families, partners and children

— Exploitation by employers

— Sexual exploitation

— Anxiety and homesickness

— Lack of integration with local communities

— Impaired physical or mental health.

All affect the health of individuals and communities.

6.4 Migration and mental health

Research (12) has shown that some migrant groups in
6.4.1
Europe exhibit the highest rates of schizophrenia, the highest
suicide rates, high incidences of drug and alcohol abuse and
high risk of depression and anxiety. The research also suggests
that access to health and social support for these groups is not
adequate.

Some of the factors identified as contributing to the
6.4.2
mental ill health of migrants are: changes in diet, family and
social support; culture,
language and climate; hostility, racism
and xenophobia from the host populations; people fleeing war
with the attendant horrors of torture, loss of family and sexual
abuse.

refugees
6.4.3
The research suggests that
experience anxiety or depression and post
traumatic stress
disorder symptoms, such as nightmares and panic attacks which
are common.

two thirds of

6.4.4
Poor access to treatment, help and support for these
disorders is particularly poor for asylum seekers and undocu-

Support for migrants affected by HIV or TB is variable
6.6.1
and presents challenges in respect of culture, language and reli-
gion as well as the legal and economic status of migrants.
Young generation, women and girls are at greater
risk
contacting HIV/AIDS.

6.6.2
There are no consistent policies for screening and even
locally how pre-entry screening is carried out varies. Apocryph-
ally, local screening responses are widely different. Some services
report more than 50 % non-attendance for follow up appoint-
ments and service providers relate this to poor communication,
fear of authority and a lack of understanding about what might
be available. The EESC is aware that Commissioner Kyprianou
has asked the European Centre for Disease Prevention and
Control to provide an EU Action Plan on TB. The plan is to be
published in autumn 2007 and will take account of the situa-
tion in different Member Sates.

6.6.3
seen a
Between 1995 and 2005 the EU has
steady increase in reported cases of TB. The latest Epidemiolo-
gical report from ECDC points out that ‘cases of a foreign
origin’ accounted for 30 % of all cases reported in the 25 coun-
tries (vi: The First European Communicable Disease Epidemiolo-
gical Report, European Centre for Disease Prevention and
Control, 2007)). It must also be acknowledged that migrants are
often located in areas where housing conditions are poor with
crowded living and working accommodation, with the attendant
risk of the spread of respiratory infections. Migrants are also
likely to be over represented amongst the homeless.

6.6.4 With regard to HIV, the EU Report:
‘AIDS & Mobility
— HIV/AIDS Care & Supports for Migrants and Ethnic Minority
Communities in Europe’ (vii: EU — Edited Clark K & Broring G)
presents reports from countries on:

— National Policy

— Access to health and social support

(12) M.G. Carta, M Bernal, MC Harday and JM Abad: Migration and mental

health in Europe 2005.

— Care and support services.

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6.6.5
The report highlights the fact that the situation of
migrants (number of people, ethnic background and epide-
miology) and the responses of society vary greatly across
Europe.

6.6.6
There is a possibility that people from parts of the
world with high HIV rates are likely to bring the disease with
them. In fact, between 1997 and 2005 47 % of all heterosexu-
ally transmitted HIV infection in the EU was diagnosed from
countries with high HIV prevalence.

6.6.7
Conversely, migrants from countries with a low preva-
lence of HIV do not appear to be at any greater risk (and may
be at less risk) than nationals in the host country.

6.7 Non-communicable diseases

is

an

inherited

Thalessemia

6.8.2
of
Mediterranean origin found in the UK amongst ethnic minori-
ties of Middle Eastern and Cypriot origin and there is evidence
that it may be common in people from Pakistan, China and
Bangladesh.

disease

blood

6.8.3
ling services which are not always available.

These diseases require specialist diagnostic and counsel-

6.9 Occupational diseases

6.9.1 Migrants tend to secure lower skills jobs that have
become unattractive to the local population. Some of these jobs,
such as mining, asbestos, chemical industries, or heavy manufac-
turing involve health risks. In the agricultural sector exposure to
pesticides and other chemicals has been associated with high
incidence of depression, headaches and in women miscarriage.

6.7.1
Long term conditions such as Coronary Heart Disease
(CHD), Chronic Obstructive Pulmonary Disorder (COPD), stroke
and diabetes present a great challenge to health services in most
parts of the world and account for about half of the deaths that
occur each year.

6.9.2
In the case of highly educated, skilled or ‘brain-drain’ as
well as circular migrants work-related stress appears very often,
as they have worse conditions than the employees of the host
countries (different rights, etc.); however, they have no choice
due to their economically dependent status (13).

6.7.2
CHD is the leading cause of mortality and has the
most impact in terms of treatment, cost and impact on indivi-
duals, carers and communities. CHD in migrant communities
can be related to ethnic pre-disposition, diet and stress. In the
UK, Asian men appear to be more prone to CHD than others
(viii: Baljaran & Raleigh, 1992; McKeigue & Sevak, 1994,
BMJ 2003)

Both men and women of South Asian origin have 30-40 %
higher CHD mortality rates than others (ix: Balajaran, 1991).

Data from the UK suggest

6.7.3
that migrants from the
Caribbean have an incidence of stroke, twice that of the ‘white’
population (x: Stewart 1999). In Sweden high rates of obesity
and CHD have been reported amongst Finnish migrants linked
to diet and alcohol consumption (xi: Jarhult et al 1992).

6.8 Inherited diseases

6.8.1 Migration of people from different parts of the work
can also mean the movement of genetic diseases. Sickle-cell
anaemia and thalassemia have become more apparent as a result
of migration from Africa, the Caribbean and the Mediterranean.
Sickle-cell anaemia is
relatively common in the EU and
estimated to affect 6 000 adults and between 75 and 300 babies
in the UK each year (xii: Karmi 1995). A high prevalence of
sickle-cell anaemia has also been found in migrants in Portugal
(xiii: Carrerio et al, 1996).

6.10 Accidents

In Germany, accidents

Occupational accidents are approximately twice as
6.10.1
high amongst migrant workers in Europe. (xiv: Bollini & Siem,
1995).
tend to be high amongst
migrants, particularly those working in industries with poor
health and safety measures (xv: Huismann et al, 1997). Data also
from Germany suggests that immigrant children in the 5-9 year
old
traffic
accidents and other injuries than German children of the same
age (xvi: Korporal & Geiger, 1990). In the Netherlands children
of Turkish and Moroccan origin appear to be at more risk of
domestic accidents, including poisoning and burns, as well as
road traffic accidents (xvii: de Jong & Wesenbeek, 1997).

are more

vulnerable

group

road

age

to

6.11 Reproductive health

Some groups of migrants such as men separated from
6.11.1
their spouses have a higher incidence of sexually transmitted
diseases. In many EU countries pregnancy-related morbidity is
higher in migrant women than in local women. Termination
rates tend to be higher in migrant women. In Barcelona requests
for induced abortion are twice as high amongst migrant woman
than Spanish women. An ICMH survey in Geneva reported the
abortion rate amongst illegal migrant women was three times
higher than national women of comparable age (xviii: Carballo
et al, 2004).

(13) ‘Who Cares? Women Health Workers in the Global Labour Market’,

edited by Kim Van Eyck, PhD, 2005.

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and post-natal mortality

6.11.2
In the UK babies of Asian mothers tend to have
lower-birth weights than other ethnic groups and their risk of
perinatal
to be higher.
Babies of women from the Caribbean also have higher than
average post-neonatal mortality rates. In Belgium and Germany
high perinatal and infant mortality rates are reported in migrant
women from Morocco and Turkey. Low birth weights and
problems in delivery are experienced amongst women from
sub-Saharan Africa and Central and South America.

tends

6.11.3
of preventative services such as immunisation.

Children of migrants may have lower rates of uptake

6.12 Barriers for migrant's access to and effective use of health care

systems

legal,

experience

psycho-social

6.12.1 Migrants
and
economic problems in accessing health care. Language barriers
are an obvious problem, so too is the cost of health care where
even very small co payments for a migrant on a low income
provides a significant barrier.
Irregular migrants and asylum
seekers waiting for their applications to be processed face legal
barriers to care in many countries.

6.12.2
In addition the public health services are often not in
a position to cater for the specific health problems of migrants
and lack the sensitivity and skills needed to deliver health are
successfully to people who may have significant differences in
their concepts of health and differing attitudes towards illness,
pain and death, as well as other ways of voicing symptoms,
coping with illness and expressing expectations towards the
physician.

Furthermore the complexity of the highly developed
6.12.3
and differentiated health sector of Member States may further
complicate this situation.

6.12.4
The organisation of disease prevention and health
promotion for migrant populations is often inadequate. This is
not only true for prenatal examinations, but also for vaccination
programmes and other kinds of prevention and early detection,
including screening. So far, prevention programmes have rarely

Brussels, 11 July 2007.

used culture-sensitive approaches to reach the various migrant
groups.

6.12.5
The high prices of certain healthcare services and the
cost of medicines are a heavy burden for most migrants. These
factors may result in treatment not being sought early enough
or prescribed treatment measures not being followed or medi-
cines not taken. This causes an incalculable increase in indivi-
dual human suffering and the overall economic costs to society.

6.13 Health professionals

6.13.1
The growing tendency for health professionals from
poor countries to be actively recruited by EU and other devel-
oped countries constitutes another growing challenge. If it were
to continue unmanaged, it would become a major detriment to
the health developments in the sending (and ‘losing’) countries
and make medical and nursing education in these countries less
sustainable The exodus of trained health care professionals from
resource poor countries is a significant loss of investment in the
training of health professionals (14). New solutions will have to
be found to respond to this problem, such as Special Compensa-
tion Fund, training and resettlement. The United Kingdom's and
Ireland's example of ensuring that the National Health Service
engages in ethical recruitment practices are widely acknowl-
edged as good practice. Member States must ensure that such
practices are adopted and that they are applied to health recruit-
ment agencies and private sector health facilities, as well as to
public services.

nurses

(especially

Healthcare

professionals

6.13.2
and
doctors) play a key role in maintaining and improving the
health care of migrants. Member States must ensure that health
care professionals are able to meet the migrants' healthcare
needs and understand the cultural, religious and lifestyle related
factors that influence the health habits of these specific groups.
This is necessary to ensure that migrants have access to appro-
priate and culturally sensitive healthcare services.

The President

of the European Economic and Social Committee

Dimitris DIMITRIADIS

(14) Kim Van Eyck ed., 2005. Who cares? UNISON UK: PSI.

C 256/130

EN

Official Journal of the European Union

27.10.2007

APPENDIX

to the opinion of the European Economic and Social Committee

The following amendments, which received at least a quarter of the votes cast, were rejected in the course of the debate
(Rule 54(3) of the Rules of Procedure):

Point 1.1.8

Delete point:

‘1.1.8 Introducing national public health programmes into education taking minority cultures into consideration.’

Voting

For: 44

Against: 51

Abstentions: 11