Centre for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1018WV, Amsterdam, The Netherlands.
Health Policy. 2019 Sep;123(9):809-817. doi: 10.1016/j.healthpol.2019.07.015. Epub 2019 Jul 22.
This article uses the concept of 'policy scripts' to explore the aims and assumptions underlying policies on migrant and ethnic minority health. Firstly, it analyses the shift in health policies from 'downstream' approaches (emphasising health care for the sick and injured) to 'upstream' ones (emphasising health protection for the whole population). The field of migrant health has been relatively slow to move upstream. Two factors appear to have impeded this shift: (a) the reluctance of the 'social determinants of health' movement to regard migrant status and ethnicity as important causes of health inequities; and (b) the one-sided emphasis on short-term emergency health provisions for migrants arising from the recent increase in forced migration worldwide, in particular the sudden peak in mixed migration to the EU in 2015. The article contends that (a) the usual arguments against treating migration and ethnicity as health determinants do not stand up to critical examination; and (b) the overwhelming emphasis on unauthorised entrants which characterises current discussions of migration policy, including health, is out of all proportion to their volume relative to that of other migrants. Fortunately, recent policy initiatives at UN level have the potential to restore the balance between 'upstream' and 'downstream' approaches, as well as between unauthorised entry and 'routine' migration.
本文运用“政策脚本”的概念，探讨了移民和少数族裔健康政策背后的目标和假设。首先，它分析了卫生政策从“下游”方法（强调对患病和受伤者的医疗保健）向“上游”方法（强调为整个人口提供健康保护）的转变。移民健康领域相对较难向上游推进。有两个因素似乎阻碍了这一转变：（a）“健康决定因素的社会决定因素”运动不愿意将移民身份和族裔视为健康不平等的重要原因；以及（b）由于全球范围内被迫移民的近期增加，尤其是 2015 年混合移民突然涌入欧盟，对移民的短期紧急卫生规定的片面强调。本文认为：（a）反对将移民和族裔视为健康决定因素的通常论点经不起批判性审查；（b）当前对移民政策，包括卫生政策的讨论中对无证入境者的过分强调与他们相对于其他移民的数量不成比例。幸运的是，联合国最近的政策举措有可能恢复“上游”和“下游”方法之间以及无证入境与“常规”移民之间的平衡。
