Author: Christiana Nöstlinger Posted on: 3rd February 2025
On November 14, the University of Antwerp hosted the 5th Seminar on Migration And Health, co-organized between ITM’s department of Public Health (more specifically the research unit on HIV and sexual health) and MIGLOBA, the network on migration and global mobility.
Our research group in ITM and what was once CeMIS - now MIGLOBA- started with this series in 2019, because we felt that it was important to bring academia, professionals in service delivery and civil society together to reflect on health issues relevant for the diverse groups of migrants and people with migration background.
Over these years, we have focused on different topics (such as e.g., inequalities in the COVID-response, mental health and cultural sensitive treatment, the sensitive use of data in migration and health research). These events rose interesting debates about terminology (such as “who is a migrant in the medical and public debate?”), data collection (i.e. “what kind of data on ethnicity/nationality should be collected and how to avoid stigma and labelling when using disaggregated data?”), and approaches to reach vulnerable populations in Belgium (e.g. outreach strategies, participatory approaches and community health workers with acting as a link between communities and public structures). The November seminar continued this tradition and was titled “Bridging the gap: healthcare in a superdiverse society.”
However, during the preparation of this year’s seminar some of our invited speakers raised the question whether a focus on migrant populations was really necessary for a seminar on access to primary health care. Would a focus on inequalities and vulnerable populations not be sufficient? After all, indeed the number of vulnerable people with inequitable access to health care In Belgium has been increasing, be they foreigners or not. In 2016, 8% of the lowest income population indicated having no access to the necessary care, while this was 1.4% in 2008.[1] However, Belgium underperforms in terms of equal access to healthcare and coverage of the most vulnerable groups, such as undocumented immigrants. Unmet health care needs differed substantially between first generation migrants from non-EU countries compared with those from EU countries and native Belgians (3.8 %, 5.6% and 2% respectively in 2016).[2]
In this blog, we would thus like to share our personal reflections on this debate, as in the current political climate it seems less and less obvious to address migrant health than when we started out six years ago with the series of annual seminars.
In what is to follow, we’d like to offer the reader a couple of arguments from different perspectives, that stress why we believe that today it is still or even more important than ever to address migrant health.
1.The Human Rights perspective
Every person, regardless of their migration status, has a right to healthcare. However, research has shown consistently that migrants, especially those in vulnerable or precarious situations, face substantial barriers to accessing health services, for instance, but not only in the field of HIV. In our own research we have that both on European and global level, migrants in destination countries have less access to HIV testing, treatment and have worse treatment outcomes when compared to the general population. [3][4] Barriers include, but are not limited to e.g. language problems, economic constraints and to a certain extent, also cultural barriers. But the greatest barriers are structural ones, such as laws and regulations that restrict access to health care and health insurance.
2. The scientific perspective
We must use all the available evidence to correct the biased and stigmatizing image of migrants as health threats or “disease carriers.” In a climate of persistent xenophobia and increasing evidence of racism and discrimination in health care, [5] we should foster open discussions, backed by accurate data, to counter such misconceptions.
Available data consistency has demonstrated that most health risks faced by migrants are due to intersecting social health determinants: factors like inadequate healthcare access, unsafe working conditions, or lack of social support.
3. The public health perspective
Migrant health cannot be separated from the overall public health landscape.
Ignoring migrants’ health needs can lead to increased healthcare costs, and further contribute to health inequalities. [6] Though this should never be the prevailing argument, there is an economic argument here: Ensuring migrants’ access to prevention and healthcare can contribute to reducing long-term health system burdens.
4. The policy perspective
Public health policies should be informed by the available evidence, not by normative arguments. The large evidence-base available should encourage policymakers to make inclusive health policies that improve access, yet tailored to migrants’ specific needs, and create safe spaces where migrants can receive care without fear and discrimination.
5. The societal perspective
A large part of health services that falls under “bridging the gap” – as we also heard at the seminar – is delivered by community based organizations. The incredible work done by them and community health workers fosters empathy and solidarity within and across communities. When the majority understands the challenges faced by minorities, it may build mutual respect and break down stereotypes, potentially leading to a more inclusive environment. In such an enabling environment, organizations working for improving migrant health should be recognized as equal partners.[7]
In conclusion, as we are facing the dual challenges of migration and political polarization on global and European level, addressing migrant health openly is not only ethically responsible but vital for promoting public health, social equity and human rights.
These perspectives set the scene for the 2024 ITM-MIGLOBA seminar and for the enticing research that was presented there by the following speakers.
Karina Kielmann (Department of Public Health, Institute of Tropical Medicine; Title: From cultural to structural competency: what can evolving approaches offer for super-diversity in European health care?)
contrasted two different approaches to enhancing health care providers’ ability to deliver health care services for individuals from migrant and other minoritized backgrounds. It drew on recent debates and concrete examples to offer comments on challenges and opportunities for improving provision of care in super-diverse contexts.
Liesbet Meyvis (City of Antwerp; Title: Access to health(care) in Antwerp)
provided an overview of the (health)care access in Antwerp the city of Antwerp efforts to improve access to care, health literacy and community-based interventions in vulnerable neighbourhood and for a diverse population. Some of these initiatives included halt2diabetes, a diabetes risk detection and prevention program, and the growing up healthy program which promotes holistic well-being for families.
Maaike Van Overloop (Eerstelijnzone Antwepen; Title: Streamlining access to primary health care in Antwerp city)
focused on the multidisciplinary and context-sensitive primary health care model developed for metropolitan settings and implemented in Antwerp, catering for people with complex health and welfare needs, including those related to migration-specific stressors. The model was also developed in reaction to the current shortage of primary care providers including general practitioners (GP) in Antwerp, and for people who have troubles finding a GP.
Ella Van Landeghem (Department of Public Health, Institute of Tropical Medicine ; Title: Access to Emergency Care, a Case Study of Access to HIV prevention and PrEP for uninsured migrants)
examined access to HIV prevention and sexual health services for migrant populations in Belgium. The presentation highlighted key findings and insights from a recent PrEP implementation study conducted in Belgium.
Hilde Bastiaens (Faculty of Medicine and Health Sciences, University of Antwerp); Title: The Health Kiosk: ‘A community health literacy hub with low-threshold access to health information’)
presented the experience of the Health Kiosk: a community health literacy hub with low-threshold access to health information. This initiative was set up using participatory approaches and community involvement to respond to the need to increase health literacy, and ultimately health and well-being among vulnerable target group. It showed how embedding such initiatives well in the neighborhood can be an enabler for health promotion and prevention.
Emilie Op de Beeck, Laura Vroonen (Faculty of Medicine and Health Sciences, University of Antwerp; Faculty of Social Sciences, University of Antwerp; Title: Taking a community-oriented approach to improve access to primary healthcare within diverse communities of Antwerp)
focused on the preliminary steps to implement the COMPASS intervention. This aims to improve access to primary healthcare thanks to the activities of community health workers. The study is adopting a randomized controlled trial design to evaluate the intervention’s effectiveness. The community health workers also briefly introduced themselves.
Amina Yakhlef (Faculty of Social Sciences, University of Antwerp ; Title: Medical Decision-Making Challenges among Migrant Populations in Belgium: A Focus Group Study)
presented an interdisciplinary research (i.e. the MEDIMIG project involving medical, sociological and law sciences), which aims at tackling inequalities in healthcare by shedding light on the main preferences and challenges during the medical decision-making process among people with a migration background.
Anneleen De Maeyer (Médecins du monde, MdM; Antwerp ; Title : Theoretical versus effective access to care for undocumented migrants)
illustrated the MdM project in Antwerp, highlighting some of the main barriers refugees, irregular migrants and simply people without an address face when trying to access care. These barriers make it difficult for many to get the medical help they need, and this project is focused on breaking down those obstacles.
We would like to thank all presenters for their efforts, and the audience for their active participation!
Christiana Nöstlinger (also on behalf of the organizing team)
Contact and more information:
Imane Bendra – Doctoral Researcher MIGLOBA- Imane.Bendra@uantwerpen.be
Christiana Nostlinger – Senior Researcher ITM - cnoestlinger@itg.be
Milena Belloni – Research Professor MIGLOBA -milena.belloni@uantwerpen.be
[1] De Ridder R. Goed Ziek: Hoe we onze gezondheidszorg veel beter kunnen maken. Kalmthout: Van Halewyck; 2019. p. 276.
[2] European Social Policy Network. Thematic Report on Inequalities in Access to health care. Belgium 2018. Accessed on 08/01/2025 at: https://www.unia.be/equality-datahub/espn-thematic-report-on-inequalities-in-access-to-healthcare-belgium
[3] Nöstlinger C. , Coseart T., Van Lendeghem et al. HIV among migrants in precarious circumstances in the EU and European Economic Area. The Lancet HIV. 2022 Jun 1;9(6):e428-37
[4] Kamenshchikova A, Peters CM, Nöstlinger C, et al. Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis. The Lancet HIV. 2024 Dec 1;11(12):e873-84.
[5] Hamed S, Thapar-Björkert S, Bradby H, et al. Racism in European health care: structural violence and beyond. Qualitative health research. 2020 Sep;30(11):1662-73.
[6] Vidal EM, Wickramage KP. Tracking migration and health inequities. Bulletin of the World Health Organization. 2024 Feb 2;102(2):143.
[7] Nöstlinger C, Van Landeghem E, Vanhamel J, et al. COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium. International Journal for Equity in Health. 2022 May 16;21(1):67.