London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK.
School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Int J Equity Health. 2023 May 8;22(1):82. doi: 10.1186/s12939-023-01862-1.
For over a decade, the global health community has advanced policy engagement with migration and health, as reflected in multiple global-led initiatives. These initiatives have called on governments to provide universal health coverage to all people, regardless of their migratory and/or legal status. South Africa is a middle-income country that experiences high levels of cross-border and internal migration, with the right to health enshrined in its Constitution. A National Health Insurance Bill also commits the South African public health system to universal health coverage, including for migrant and mobile groups. We conducted a study of government policy documents (from the health sector and other sectors) that in our view should be relevant to issues of migration and health, at national and subnational levels in South Africa. We did so to explore how migration is framed by key government decision makers, and to understand whether positions present in the documents support a migrant-aware and migrant-inclusive approach, in line with South Africa's policy commitments. This study was conducted between 2019 and 2021, and included analysis of 227 documents, from 2002-2019. Fewer than half the documents identified (101) engaged directly with migration as an issue, indicating a lack of prioritisation in the policy discourse. Across these documents, we found that the language or discourse across government levels and sectors focused mainly on the potential negative aspects of migration, including in policies that explicitly refer to health. The discourse often emphasised the prevalence of cross-border migration and diseases, the relationship between immigration and security risks, and the burden of migration on health systems and other government resources. These positions attribute blame to migrant groups, potentially fuelling nationalist and anti-migrant sentiment and largely obscuring the issue of internal mobility, all of which could also undermine the constructive engagement necessary to support effective responses to migration and health. We provide suggestions on how to advance engagement with issues of migration and health in order for South Africa and countries of a similar context in regard to migration to meet the goal of inclusion and equity for migrant and mobile groups.
十多年来，全球卫生界一直在推动移民与卫生政策方面的参与，这反映在多个全球主导的倡议中。这些倡议呼吁各国政府向所有人提供全民健康覆盖，无论其移民和/或法律地位如何。南非是一个中等收入国家，经历着跨境和国内移民的高流动，其宪法保障了健康权。国家健康保险法案还承诺南非公共卫生系统实行全民健康覆盖，包括移民和流动人口。我们研究了政府政策文件（来自卫生部门和其他部门），这些文件在我们看来应与南非的移民与卫生问题相关，涉及国家和次国家各级。我们这样做是为了探讨移民是如何被主要政府决策者所框定的，并了解文件中提出的立场是否支持对移民有认识和包容的方法，以符合南非的政策承诺。这项研究于 2019 年至 2021 年进行，分析了 2002 年至 2019 年的 227 份文件。确定的文件中只有不到一半（101 份）直接将移民作为一个问题来处理，表明政策话语中缺乏优先考虑。在这些文件中，我们发现政府各级和各部门的语言或话语主要集中在移民的潜在负面影响上，包括在明确提及健康的政策中。这种话语常常强调跨境移民和疾病的流行、移民与安全风险之间的关系，以及移民对卫生系统和其他政府资源的负担。这些立场将责任归咎于移民群体，可能助长民族主义和反移民情绪，并在很大程度上掩盖了内部流动问题，所有这些都可能破坏支持有效应对移民与卫生问题所需的建设性参与。我们就如何推动移民与卫生问题的参与提出了建议，以便南非和类似移民背景的国家能够实现包容和公平对待移民和流动人口的目标。
