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To rethink European Healthcare.

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Migration and health challenges: how can we find the right approach?

When we were assigned our topic, every member of the committee knew that we were being asked to work on issues that are as complex as they are urgent. The topic is both compelling and potentially confusing as the migration phenomenon can be addressed from many angles. How do we define migration? What type of migration should we include in our approach? How can we draft recommendations and design policies that would have a real impact on a multi-dimensional issue under which lies a long-lasting refugee crisis, currently dividing both the public opinion and the political sphere?

This topic calls for us to be humble: we cannot tackle every issue created by migration. We have to limit our approach and articulate it around measures that will have a real –be it limited – impact.

We decided to choose a specific focus and isolate ourselves from other considerations. How would we choose that one? In other words, what is our goal? What does “health challenges” encompass? Are we talking about health challenges for us, Europeans? Should we focus on the challenges migrants face? Admittedly, from a European point of view, migration could be seen as a threat from a health perspective: some argue that migrants can bring along communicable diseases - which has not been empirically proven - and for a part of our population, this is a real concern. However, looking at the problem from a defensive point of view does not address the real issue at stake: the integration of migrants (refugees, but not only) in our health care systems. Our leaders are legally and morally obliged to ensure that every human being living on the European soil have access to health care (Article 35 of the Charter of Fundamental Rights of the European Union). That obligation is certainly not self-fulfilling and there is a lot left to do. Nevertheless, this legal framework is binding and provides a solid ground for policy makers on which to build.

As shown in the above diagram, we have established an objective with four dimensions that will guide us in designing our policy proposal. We need to distinguish the needs of the refugees from those of economic migrants, for instance. While the screening process applies mainly to refugees at the point of entry, the rest of our approach is more global, even if we decided not to address intra-European migration. We also cannot limit our approach to screening and treatment at the point of entry. Access to healthcare must also be guaranteed in the country of settlement.

Of course, we are fully aware that there are 28 different healthcare systems in the European Union. We are not aiming at radically transforming national frameworks; we are aiming at specific ideas that could be applied to ensure access to healthcare while preserving national social security systems. In this vein, establishing new (minimum) standards applicable all across the European Union seems to be a judicious idea, among others. Of course, this is just a start on which we have to build.

Assuredly, the migration phenomenon does not only generate health-related challenges, it constitutes a multi-level crisis that has repercussions at the political, economic and social level. Member states have not yet agreed on long-term solutions: the refugee crisis, while remaining at the top of the political agenda, is far from being solved. Therefore, migration and the underlying refugee crisis can be seen as a multi-layered, highly intricate issue. How do we tackle only one facet of it?

We decided that the most efficient way to go was to focus solely on the one objective: providing quality, equitable and accessible healthcare to migrants, from the point of entry to the country of settlement, while preserving the sustainability of our current system. It does not matter to us if these migrants are legal, if they settle in the country they were supposed to settle under the so-called Dublin system, how and where they will find a job. This is not to say that we do not care, we are taking these factors into account.  We just want to free ourselves from unproductive political considerations, to avoid being caught in a debate that goes beyond health-related challenges. The bottom line is that we seek to find specific recommendations to ensure that migrants receive the care they need, regardless of the underlying political debate.

Julien Noël, for the Committee of Migration and Health Challenges

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