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What impact does migration have on the health of societies?
When migrants were streaming off the fragile boats on the shores of Lesvos island in Greece, the look in their eyes was one of sadness and despair, tinged with hope. Disembarking were men, women, boys and girls from many countries, some fleeing war or political repression and others seeking safety from violence and abuse, while still others were looking for work.
They gingerly unwrapped their phones from their tight cellophane seal and, with tears in their eyes, they called their families to let them know they survived the treacherous journey that so many of their other fellow countrymen did not.
I was there on the shores, welcoming and supporting them in 2015.
Not all the greetings were warm - they also met with discrimination and exclusion. They were not just unwanted, but portrayed as disease-carriers and economic and social burdens. And now, a quarter of a billion people migrate each year across international borders, the vast majority from low- and middle-income countries.
This leads to some key questions - what impact does migration have on the health of societies? How do policies in countries receiving immigrants affect migrants' health?
The UCL-Lancet Commission on Migration and Health - on which we both were commissioners - was convened in 2016 to look at migration and health in the largest sense. The commission studied key evidence and impacts and has now released a new report to coincide with the adoption of the Global Compact on Safe, Orderly and Regular Migration in Morocco on Dec. 10 and 11. The compact is the first, inter-governmentally negotiated agreement to cover international migration in a comprehensive manner.
What we at the commission found was that evidence does not conform to the myths about migrants. On the contrary, the pervasive violations of the human rights of migrants lead to untold and needless suffering. Globally, most migrants are labor migrants and the movement primarily occurs within low- and middle-income countries. However, much of the media attention on migration focuses on movement of migrants from low- and middle-income countries to high-income countries, which has been increasing.
Here are some truths based on data: Migrants generally contribute more to the wealth of host societies, including high-income countries. In fact, each 1 percent increase of migrants in the adult population increases the gross domestic product per person by up to 2 percent.
Our study also shows that migrants don't impose significant health-care costs, as international migrants in high-income countries, on average, experience lower mortality than the local population.
This is likely because migrants seeking employment are generally healthier than those who do not migrate - the so-called "healthy migrant effect." The commission also found evidence showing that migrants do not a pose a significant risk of spreading infections, nor do they overburden host countries' health systems. Concerns about the fertility rates of migrants is also a myth - a study of six European countries found that fertility rates among migrant women were generally lower than that of the host population.
However, the commission also found that migrants, whether escaping conflict or coming for work, are often subjected to denial of basic human rights. They are discriminated against based on their health status.
For example, 35 countries deny entry of an individual testing positive for HIV. As we have seen so dramatically in the U.S., but is hardly unique, they are subjected to draconian border policies that criminalize entry without a visa, restrict the ability to apply for asylum and detain them not because they won't appear for a hearing or have engaged in a violent act but only to deter others.
These practices violate due process of law and deny them their basic humanity. The evidence shows that it also impairs their mental health.
The commission also reported on the widespread discrimination and exclusion that migrants face based on race, ethnicity, gender and migrant status. When they obtain jobs, migrants often work in dangerous occupations yet are denied occupational health protections and remedies. Employers wield power to prevent migrant workers from having job mobility, which leads to exploitation. And migrants are often denied fair access to health care except in medical emergencies.
These findings in their totality led the commission to call for a more holistic and inclusive approach to migration, one based on individual dignity and the promotion of global health. It calls for governments to respect migrants' human rights, improve their access to services and strengthen migrants' access to health. This call for action includes the United States, which thus far has opted out of the voluntary and non-binding compact, to re-engage.
We hope policymakers in the U.S. and globally will look closely at this report and see that our evidence-based findings should lead us to think about migrants differently - as human beings who not only deserve respect but who can also strengthen the societies and economies they join. These are the lessons and practices that we must learn from the migrants arriving on the shores of Lesvos island.
Paul Spiegel, MD, MPH, is the director of the Center for Humanitarian Health at Johns Hopkins University and professor of Practice at the Johns Hopkins Bloomberg School of Public Health. Leonard Rubenstein, JD, LLM, is director of the Program on Human Rights, Health and Conflict at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health.