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      Economic arguments in migrant health policymaking: proposing a research agenda

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          Abstract

          Welfare states around the world restrict access to public healthcare for some migrant groups. Formal restrictions on migrants’ healthcare access are often justified with economic arguments; for example, as a means to prevent excess costs and safeguard scarce resources. However, existing studies on the economics of migrant health policies suggest that restrictive policies increase rather than decrease costs. This evidence has largely been ignored in migration debates. Amplifying the relationship between welfare state transformations and the production of inequalities, the Covid-19 pandemic may fuel exclusionary rhetoric and politics; or it may serve as an impetus to reconsider the costs that one group’s exclusion from health can entail for all members of society.

          The public health community has a responsibility to promote evidence-informed health policies that are ethically and economically sound, and to counter anti-migrant and racial discrimination (whether overt or masked with economic reasoning). Toward this end, we propose a research agenda which includes 1) the generation of a comprehensive body of evidence on economic aspects of migrant health policies, 2) the clarification of the role of economic arguments in migration debates, 3) (self-)critical reflection on the ethics and politics of the production of economic evidence, 4) the introduction of evidence into migrant health policymaking processes, and 5) the endorsement of inter- and transdisciplinary approaches. With the Covid-19 pandemic and surrounding events rendering the suggested research agenda more topical than ever, we invite individuals and groups to join forces toward a (self-)critical examination of economic arguments in migration and health, and in public health generally.

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          Why inequality could spread COVID-19

          Pandemics rarely affect all people in a uniform way. The Black Death in the 14th century reduced the global population by a third, with the highest number of deaths observed among the poorest populations. 1 Densely populated with malnourished and overworked peasants, medieval Europe was a fertile breeding ground for the bubonic plague. Seven centuries on—with a global gross domestic product of almost US$100 trillion—is our world adequately resourced to prevent another pandemic? 2 Current evidence from the coronavirus disease 2019 (COVID-19) pandemic would suggest otherwise. Estimates indicate that COVID-19 could cost the world more than $10 trillion, 3 although considerable uncertainty exists with regard to the reach of the virus and the efficacy of the policy response. For each percentage point reduction in the global economy, more than 10 million people are plunged into poverty worldwide. 3 Considering that the poorest populations are more likely to have chronic conditions, this puts them at higher risk of COVID-19-associated mortality. Since the pandemic has perpetuated an economic crisis, unemployment rates will rise substantially and weakened welfare safety nets further threaten health and social insecurity. Working should never come at the expense of an individual's health nor to public health. In the USA, instances of unexpected medical billings for uninsured patients treated for COVID-19 and carriers continuing to work for fear of redundancy have already been documented. 4 Despite employment safeguards recently being passed into law in some high-income countries, such as the UK and the USA, low-income groups are wary of these assurances since they have experience of long-standing difficulties navigating complex benefits systems, 4 and many workers (including the self-employed) can be omitted from such contingency plans. The implications of inadequate financial protections for low-wage workers are more evident in countries with higher levels of extreme poverty, such as India. In recent pandemics, such as the Middle East respiratory syndrome, doctors were vectors of disease transmission due to inadequate testing and personal protective equipment. 5 History seems to be repeating itself, with clinicians comprising more than a tenth of all COVID-19 cases in Spain and Italy. With a projected global shortage of 15 million health-care workers by 2030, governments have left essential personnel exposed in this time of need. Poor populations lacking access to health services in normal circumstances are left most vulnerable during times of crisis. Misinformation and miscommunication disproportionally affect individuals with less access to information channels, who are thus more likely to ignore government health warnings. 6 With the introduction of physical distancing measures, household internet coverage should be made ubiquitous. The inequitable response to COVID-19 is already evident. Healthy life expectancy and mortality rates have historically been markedly disproportionate between the richest and poorest populations. The full effects of COVID-19 are yet to be seen, while the disease begins to spread across the most fragile settings, including conflict zones, prisons, and refugee camps. As the global economy plunges deeper into an economic crisis and government bailout programmes continue to prioritise industry, scarce resources and funding allocation decisions must aim to reduce inequities rather than exacerbate them.
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            The UCL–Lancet Commission on Migration and Health: the health of a world on the move

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              Making the difference in social Europe: deservingness perceptions among citizens of European welfare states

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                Author and article information

                Contributors
                nora.gottlieb@uni-bielefeld.de
                Journal
                Global Health
                Global Health
                Globalization and Health
                BioMed Central (London )
                1744-8603
                20 November 2020
                20 November 2020
                2020
                : 16
                : 113
                Affiliations
                [1 ]GRID grid.6734.6, ISNI 0000 0001 2292 8254, Department of Health Care Management, , Berlin Technical University, ; Berlin, Germany
                [2 ]GRID grid.7491.b, ISNI 0000 0001 0944 9128, Department of Population Medicine and Health Services Research, School of Public Health, , Bielefeld University, ; Bielefeld, Germany
                [3 ]Center for Health and Migration, Vienna, Austria
                [4 ]GRID grid.7489.2, ISNI 0000 0004 1937 0511, Department of Health Systems Management, School of Public Health, , Ben-Gurion University of the Negev, ; Beer Sheva, Israel
                [5 ]GRID grid.5254.6, ISNI 0000 0001 0674 042X, Department of Public Health, Center for Migration, Ethnicity and Health, , University of Copenhagen, ; Copenhagen, Denmark
                [6 ]GRID grid.10548.38, ISNI 0000 0004 1936 9377, Department of Public Health Sciences, , Stockholm University, ; Stockholm, Sweden
                [7 ]GRID grid.10548.38, ISNI 0000 0004 1936 9377, Centre for Health Equity Studies (CHESS), , Stockholm University/Karolinska Institute, ; Stockholm, Sweden
                [8 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, , University Hospital Heidelberg, ; Heidelberg, Germany
                Author information
                http://orcid.org/0000-0001-9199-2321
                Article
                642
                10.1186/s12992-020-00642-8
                7677743
                31898532
                5cc0bb7e-70ef-48fa-9b8d-06df274b945e
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 June 2020
                : 10 November 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010665, H2020 Marie Skłodowska-Curie Actions;
                Award ID: 600209
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001862, Svenska Forskningsrådet Formas;
                Award ID: 2016-07128
                Award ID: 2016-07128
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;
                Award ID: 01GY1611
                Award ID: 01GY1611
                Award Recipient :
                Categories
                Commentary
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                discourse analysis,economics,equity,health economics,health policy,health political science,migrant health,political decision-making,political economy,translational research

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