By Tara Chen
Tara Chen identifies as a global citizen (Canadian with Taiwan ancestry) and is a young public health professional working abroad to strengthen health systems by thinking beyond the traditional approach to health. Her current areas of focus are related to the SDGs, health systems, climate change, and health literacy.
Increased migration is a global trend and a cross-cutting image of globalization in today’s mobile world. Individuals are moving within the same country and across borders, driven by conflict, instability, insecurity and/or opportunities. The World Migration Report estimated the number of international migrants is approximately 272 million globally (3.5% of the world’s population)(1). Furthermore, migration is not a single unique event in time and space, proving to be difficult to measure, model and forecast. It has transformed racial/ethnic group’s representation data; evolving culture and civilization as they spread their various identities, languages, religions, customs and ways of life. The pressures of migration are becoming more acute, exposing unequal medical treatment opportunities and poor access to quality health care in their new settings. The design of health services are not uniformed with the needs of migrants, highlighting the importance of integrating patient-centered and intercultural approaches in the migrant health agenda. Health systems need to provide migrants the opportunity to become “health literate” to design their own health services to be optimally accessible and inclusive to their actual needs.
Migrants face inequalities in their health status, creating a global challenge for health systems. Research highlights that migrants are at risk of serious health disparities and significant poor health outcomes(1). This may be caused by integration barriers such as language — one of the most central aspects of health literacy. Without language, good communication cannot be obtained. Information on how to access health services may often be misinterpreted due to the poor translation of language or use of words. Language is a powerful approach based on cultural humility may provide the tool to emphasize informed consent, and shared decision-making which are part of the wider goals of communication(2).
Successful healthcare delivery for refugees and migrants can follow the 4 C’s Model (Figure 1), focusing on the individual (migrant). Delivery of care should incorporate an ongoing cycle of communication, culture, confidence and continuity of care, while adapting to the migrant’s social, setting and situational changes. By including these factors, obstacles such as limited rights to access of healthcare services and facilities, lack of local networks, unfamiliarity with the navigation of the local health system, and language/cultural barriers can be addressed earlier in the migration process.
International migration is an “age of change”. It enhances economic development and creates a more dynamic, open society but to realize its maximum potential, there needs to be a supportive health environment. Health systems need to prioritize the development of migrant health literacy to build a “trusted” community to address their delicate health needs. From simply understanding which doctor to go to, how to pay for fees, afford fees or get subsidies, it can be a significant barrier- contributing to the cycle of poor health. Health service providers need to break stereotypes and misconceptions about migrants being “lazy” or “unwilling” to change.
Interventions need to prioritize and/or include health literacy in the delivery of their services to empower migrants navigate the health system and improve their health behaviors. Figure 2 is a modeling framework that uses the analogy of “gears” to share how to improve systems-level action by strengthening migrant health literacy interventions. Migrants embody inclusion, resilience, and trust, fostering the baseline of a positive environment open to learn and adapt to healthier lifestyles(3). Interactions should not follow the one-size-fits all approach in order to go deeper to make meaningful connections to empower the migrant.
Five pillars suggested to be incorporated in health literacy interventions for migrants include:
Capacity of professionals
Reduction of access barriers(3)
Health literacy is a driver and enabler to improve migrant health. It is a tool that can be used to engage stakeholders from different settings to co-create health literacy interventions that are sustainable, and beneficial to migrants. By taking action to create and strengthen migrant health literacy-friendly settings, the new age of change has the potential to improve health for all.
1. International Organization for Migration. (2020). World Migration Report 2020. IOM UN Migration. https://publications.iom.int/system/files/pdf/wmr_2020.pdf
2. Brandenberger, J., Tylleskar, T., Sontag, K., Peterhans, B., Ritz, N. (2019). A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries-the 3C model. BMC Public Health. 19:755. 5–11. https://doi.org/10.1186/s12889-019-7049-x
3. Garad, RM. (2017). Health Literacy Driving Health Engagement in the Pluralist Context of Migrant Health in Australia. Deakin University. http://dro.deakin.edu.au/eserv/DU:30103702/Garad-healthliteracy-2017.pdf