Migrant health is public health, and public health needs to be political
Authors: James Smith
Journal: The Lancet Public Health (2018)

"No public health without migrant health" was the title of The Lancet Public Health's June Editorial.1The Lancet Public HealthNo public health without migrant health.Lancet Public Health. 2018; 3: e259Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar Indeed, migrants are the public, and the public are migrants. Having reaffirmed the obvious interchangeability between migrant health and public health, it is important to further explore what is required of the public health sector to challenge the largely unnecessary distinction between migrant and public in public health policy and praxis. The perpetuation of a distinction between public health and migrant health has served to exemplify the health needs of migrants with mixed consequences. On occasion, academics and practitioners have used the opportunity to draw attention to inequities in access to health care and health outcomes for migrants, and politically mediated intergenerational disparities that persist within communities with a relatively recent history of immigration. Such intellectual and interventional engagement with issues of migration, ethnicity, race, and health speaks to the "quest for equity and social justice" that the editors of The Lancet Public Health wish to see define the discipline.1The Lancet Public HealthNo public health without migrant health.Lancet Public Health. 2018; 3: e259Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar However, other studies have served misguided narratives that see migration as generative of health insecurity, and specifically as a threat to communicable disease control.2Smith J Thinking beyond borders: reconceptualising migration to better meet the needs of people in transit.Int J Public Health. 2016; 61: 521-522Crossref PubMed Scopus (10) Google Scholar Notably, the dependence of some public health institutions on funding from the very right-wing states that promote a narrative that intentionally others and demonises migrants, has drawn such institutions into the generation of so-called evidence for a predetermined policy purpose.3Grove NJ Zwi AB Our health and theirs: forced migration, othering, and public health.Soc Sci Med. 2006; 62: 1931-1942Crossref PubMed Scopus (258) Google Scholar All stages in the generation of evidence and the production of knowledge are political.4Barnes A Parkhurst J Can global health policy be depoliticised? A critique of global calls for evidence-based policy.in: Brown GW Yamey G Wamala S The handbook of global health policy. Wiley Blackwell, Chichester2014: 157-173Crossref Scopus (26) Google Scholar Who funds what research? Who designs the questions and shapes the methodology? Who interprets the data and determines whether findings will be disseminated publicly? To call for an evidence-driven agenda for migrant health, as was articulated at the May, 2018 World Congress on Migration, Ethnicity, Race and Health, runs the risk not only of oversimplifying the policy process by overlooking the many ways in which evidence-informed decision making for health is inherently political,4Barnes A Parkhurst J Can global health policy be depoliticised? A critique of global calls for evidence-based policy.in: Brown GW Yamey G Wamala S The handbook of global health policy. Wiley Blackwell, Chichester2014: 157-173Crossref Scopus (26) Google Scholar but also sees a technical, data-guided response as central to improved social policy outcomes.5Parkhurst J The politics of evidence: from evidence-based policy to the good governance of evidence. Routledge, Abingdon, Oxon, UK2017Google Scholar What if evidence suggested that migrants do not make a net positive economic contribution in the UK? How then would public health advocates seek to challenge racist, anti-migrant sentiment? If the public and policy makers were made aware that 13% rather than 32% of the UK population were immigrants (data that inadvertently still problematises the presence of migrants1The Lancet Public HealthNo public health without migrant health.Lancet Public Health. 2018; 3: e259Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar), would the UK Government suddenly opt for more inclusive, pro-migrant health and social policies? What is needed is not more evidence; frontline organisations, who have for decades witnessed and documented the negative health effects of oppressive, anti-migrant regimes, are aware of this point and are increasingly political in their public positioning. Instead, courageous public health advocates, unafraid to be political and to defend those political claims, not on the basis of evidence but on the basis of a moral commitment to solidarity and compassion, are needed. I declare no competing interests. No public health without migrant health1 billion people in the world today are on the move. There are an estimated 244 million international migrants (3·3% of the world's population)—an increase from 155 million in 2000. Internal migration is most prevalent, with more than 740 million people who have migrated within their own country of birth. According to the International Organisation for Migration (IOM), the UN migration agency, we are facing the highest levels of forced displacement globally recorded since World War 2, with a dramatic increase in the number of refugees, asylum-seekers, and internally displaced people across various regions of the world. Full-Text PDF Open Access