European migration and implications in Physical and Rehabilitation Medicine
By: Resident Fellow Council
Tags: Rehabilitation, Physiatry In Motion, Migration, Physiatry, Medicine

M. Vaz, MD1*; E. Moreira MD1*; D. Coutinho, MD1*; B. Lopes, MD1*; N. Albuquerque, MD1*;; A. Torres MD2*; J. Caldas, MD3*

1 PMR Resident; 2 PMR Senior Consultant; 3 Head of Department; *Centro Hospitalar Tondela-Viseu

The increasing diversity of populations due to international migration creates new challenges for public health and health systems. Specific health needs are poorly understood, and there is a lack of information that physicians should be aware of. It is then pertinent to question the extent to which international migration should be considered in health care for physical and rehabilitation medicine (PRM). Which brings us the question, is physical and rehabilitation medicine prepared to respond adequately to this new reality?

Migration destination countries are victims of their own success. Improvements in living conditions, socioeconomic rates and the growth of the social state took place in Europe throughout the second half of the 20th century at the expense of high rates of economic growth. After the turn of the millennium, these high rates of economic growth have shifted to other regions of the globe such as China, India, Brazil, Indonesia and Nigeria. However, this growth is now always reflected in the well-being of these populations.

Due to its geographical proximity and political instability in the Middle East and North Africa, economic and political migration is a constant that the European Union has not been able to deal with. In 2019, more than 60 percent of all international migrants headed to Europe (82 million). After the initial care and reception of immigrants, characterization of the population and perception of their role in European society is necessary. Three out of four international migrants are of working age, and thus finding a job is crucial to their successful integration. Social support such as access to healthcare, and assistance for children, is equally important. With the aging of the old continent much has been heard about the future of Europe being in the unborn in Europe. Medical care for this population is neither an option nor an obligation, but a reality.

Concerning physical and rehabilitation medicine, there are common issues with other medical specialties and some specificities that we will try to develop a little further. In its relationship with health care, there are some intrinsic barriers, such as: (1) difficulty in accessing health care; (2) emergence of rare pathologies from destination countries; (3) communication difficulties due to linguistic and cultural differences; (4) specificities of the infectious pathology of each of the countries of origin; (5) low socioeconomic status.

Within the specificities of physical and rehabilitation medicine care, we can subdivide them in the short to medium-term and long-term ones. In the short to medium term, this population is expected to have an increased risk of occupational accidents. With the exception of refugee populations, this normally involves immigration of all social classes. The jobs offered to them are featured as 3D jobs (dirty, dangerous and demanding). Thus, they end up doing difficult work. The conjugation of a less educated population in high-risk jobs is certainly a risk factor to increased occupational accidents. Thus, it is foreseeable that there will be a growth in migrant patients within the group affected by occupational accidents, as well as an increase in the total number and severity of them.

Contrary to what we might expect, the immigrant population is characterized initially by better health indicators compared to the native population through a process called “healthy immigrant effect.” However, this trend is rapidly reversed as they become integrated into society. Those who integrate are more likely to consume unhealthy food (e.g. fast food), which is related to socioeconomic and educational status. Less health literacy predicts poorer eating habits and less physical exercise and the prevention of other risk factors, such as alcohol or smoking. Thus, in medium to long term, immigrant populations develop a greater propensity for cardiovascular events such as stroke, myocardial infarction or pulmonary embolism. Patients who experience these health conditions inevitably need specialized care in their rehabilitation process.

Rehabilitation programs should set goals throughout the rehabilitation process. At the end of a hospitalization, the functional status goal should consider architectural barriers, social and family support. This migratory phenomenon that we observe across the Mediterranean often involves one or few family members, so when disability arises, there is little to no familial support. There emerges a need for a destination after discharge that often will not exist.

This situation becomes more imperious with the severity of the disabling event. When the acute events are less serious and the healing or consolidation time is shorter, there is a possibility for these patients to resort to the private sector even though they may or may not have their documents and legalization process completed. Severely disabling events may lead to a long rehabilitation process. In severe cases, immigrants inevitably resort to the public health sector where, regardless of their legalization process, care should be performed; these are the cases in need of prolonged hospitalization in institutions with distinct levels of differentiation and care from multiple specialties. Among patients who will often present with some degree of permanent disability, these patients may find themselves in a void without usual socioeconomic supports.

Thus, there is a need for inclusive health policies and definition of concepts regarding immigrants. Physical and rehabilitation medicine should adapt to these patients and prepare for their inclusion, in order to improve the workforce that they will bring to the destiny societies. Regardless of the political decisions that may be taken, it is certain that physical and rehabilitation medicine, as a discipline of functionality, should enable these populations to enhance their integration into society and labor market.

Corresponding author contact information: marioferreiravaz@icloud.com, Twitter: @MariovazMd