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EXECUTIVE COURSE ON HEALTH DIPLOMACY AND MIGRATION

Organized by
Global Health Centre at the Graduate Institute 

September 4-6
Geneva, Switzerland
REGISTRATION
(Application Deadline – August)

 

Many different forms of migration exist and human mobility shapes global health, impacting on domestic and foreign poli­cies of sending, transition and receiving countries. The health of migrants is influenced by these different policies and legal frameworks but also by the practices surrounding migration. Yet, the act of migration alone does not cause any disease. Rather, the socioeconomic, political, cultural and environmen­tal conditions connected to the act of migration can impact on health and the vulnerability to disease. National health systems are often put under pressure to respond to large-scale movements and diplomacy comes into play to find cross-border, collective solutions. Health can serve as an entry point for these diplomatic actions and new governance mechanisms need to be negotiated to respond appropriately to migration crises.

Yet, the migration crisis interfaces with other crises, such as the ecological, financial, humanitarian, and health security crisis. This complexity requires a new awareness but also a fast response that recognises the synergies between them and addresses the distribution of power, money and resources. Decisive political action is needed to save lives, protect people and preserve dignity.

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Global Migration of HIV/AIDS

AIDS 2012 in Washington, D.C., is still a year away but a session at IAS 2011 brought to mind why the location of next year’s conference is so significant. It’s been 22 years since the U.S. hosted the conference, in San Francisco in 1990.  When President Obama lifted national entry restrictions for people with HIV that paved the way for organizers to bring IAS back to the United States.

Discriminatory policies, stigma and criminalization are just a few of the challenges facing HIV-positive migrants worldwide and those who face particular risk for infection. Migrants in Asia, Latin America and sub-Saharan Africa struggle with unique regional issues but they share common obstacles.  Whether people migrant voluntarily in search of economic opportunity or are displaced by military conflicts or natural disasters they encounter significant barriers in accessing health services.  Women are especially vulnerable when they suffer sexual violence, are forced into sex work for economic survival or have sex with men who have multiple partners. 

Security rather than human rights has been the focus in dealing with HIV/AIDS and migrant populations.  But as Rosilyne Borland of the International Organization for Migration pointed out, migration health is not the same as border health. Adopting mult-sectoral strategies to address migrant health and training migrants to be community health workers and peer educators were some of the responses identified as effective ways to address this critical distinction.

The focus away from security and toward human rights may shift with language in the latest political declaration on HIV/AIDS that came out of last month’s UN High-Level Meeting in New York.  The document calls for a commitment to address “the vulnerabilities experienced by migrant and mobile populations and support their access to HIV prevention, care, treatment and support.”  It also calls for a commitment of financial resources and evidence-based prevention measures to ensure that particular attention is paid to migrants and people affected by humanitarian emergencies among other key groups.

It may be a year until AIDS 2012 comes to Washington but it’s not too early to stress political will and honoring financial commitments as critical in addressing the realities faced by vulnerable populations.

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Treatment’s Obstacles: Education and Migration

The story of Mariana Bernofsky, a TB patient and mother, in Moldova

Mariana Bernofsky (video below) lives with her husband in Balti, a small town in Northern Moldova, in a house that has been passed through the family for generations. She stays at home with their young child while he works as a trash collector, earning less than $200 each month. Mariana is pregnant and is infected with TB. She expects to successfully complete her treatment in a few months and, after her child is born, will be able to get a final X-Ray that she hopes will show she has been cured of TB.

A few years ago, her father died of TB. It was the second time he had contracted the disease and the last time occurred while he was a migrant worker in Moscow. In this video, Mariana discusses her father’s illness. She touches on a few themes that are very important when discussing TB: how migration can influence TB incidence and how lack of education can complicate the treatment of TB patients.

[youtube=http://www.youtube.com/watch?v=CH2C2aku1sA&w=541&h=330]

Read the full blog on the Pulitzer Center’s website.

See David Rochkind’s article and multi-media piece Moldova: What Happens to MDR-TB Patients.

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Cancun: Climate Change, Displacement and Migration

All this week, Jade Sasser, policy advisor for the Public Health Institute, is guest blogging for Blog4GlobalHealth from the Cancun Climate Summit in Mexico. Her reports can also be seen at Dialogue4Health, the blog of PHI.

CANCUN, Mexico — Tuesday at the COP 16 climate change conference here, I attended a briefing on the topic of displacement and migration in the context of climate change.

Representatives from a range of United Nations departments highlighted evidence identifying increased mobility and migration as one of the most significant human impacts of climate change: according to some projections, as many as 150 million people could be displaced by climate-related phenomena by the year 2050. As panelists argued, predicting the long term impacts of increased mobility is particularly difficult, thus leaving the social, political and health effects of climate-induced migration an open question.

Among other factors, four key climate change-related phenomena are particularly associated with migration and displacement: intensified acute natural disasters; rising sea levels; intensified drought and desertification; and heightened competition for natural resources, leading to conflict and mass displacement. As a result, the most socially vulnerable, usually the poor, are most affected, and most likely to migrate. At the same time, displacement and migration is often associated with the disruption of social networks and access to health services, leading to an overall decline in human health. This is often worse for women, who are more likely to experience gender based violence in the wake of forced migration.

Of note is the panelists’ insistence that climate-related migration be seen as evidence of successful adaptation to climate change, rather than a failure to adapt. They argued that it usually results from a complex decision-making process in which the long-term effects of changes to the environment are considered in the context of livelihoods, means of subsistence, and overall quality of life. As a representative of the World Food Programme argued, these longer term changes have a far greater impact on environmentally driven migration than sudden onset natural disasters do.

Ultimately, climate change-induced migration is a matter of social inequality, as the poorest, most socially vulnerable and least resilient communities are most likely to have to migrate. In this context, panelists called for climate change adaptation strategies that include improved urban planning, disaster management, incorporation of a human rights perspective, and a focus on improving resiliency of the most vulnerable groups. In addition, more data is needed to develop evidence-based strategies to effectively understand migration decision making at the household level, as well as to develop services that effectively meet the needs of the most vulnerable, while working to improve their resiliency. These urgent needs provide a significant opportunity for members of the global public health community to take a leadership role in strengthening adaptation efforts at the local and regional levels.

The Public Health Institute is working through its Center for Public Health and Climate Change to support the public health and broader community to understand and respond to this critical challenge. We are working to equip the public health community with knowledge, skills, resources and tools needed to effectively address the health impacts from climate change- particularly among vulnerable populations. Join our community, track our work, and receive updates at www.climatehealthconnect.org

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South African Mining Industry Recognizes its Key Role in TB/HIV Fight

JOHANNESBURG, South Africa — You may think that the title says it all, “The Global Business Coalition Conference on TB, HIV/TB Co-infection and Global Fund Partnership,” but there’s more. Tuesday’s first session, “Lesson’s From the Mining Industry: Turning the Tide on TB/HIV” went deeper into the role of the mining industry in South Africa and the benefits of fighting tuberculosis to all companies and industries.

“How many investments have a ten-fold return?” is says in bold letters on the inside of the conference program. “Fighting tuberculosis is one of them,” it says. “Heavily affected countries get a ten-fold return or more — through increased economic productivity — on what they invest in tackling tuberculosis. Tuberculosis is slowing economic development in the countries with the most potential for rapid market growth. It makes good business sense to be part of the solution.”

Gavin Churchyard, CEO of the Aurum Institute took the audience back nearly a hundred years to the 1912 commission on TB in mines. He highlighted the increased risk factors — HIV and silicosis (a form of occupational lung disease caused by inhalation of crystalline silica dust, and marked by inflammation and scarring in the lungs), which substantially increase the risk of TB and are very much present in those who work in the mines. Miners are more susceptible to TB because of their age (25-33), gender (male) and behavior (smoking and exposure to silica dust in the mines), according to Thuthula Balfour-Kaipa, health advisor to the Chamber of Mines of South Africa.

Natalie Ridgard, migration health project officer at the International Organization for Migration, went a step further indicating that miners are a high-risk population due to structural, environmental and individual reasons. Miners are predominantly migratory males putting them at increased risk of unprotected sex with concurrent partners. The physical day-to-day dangers of their work leads many miners to have less concern for diseases they cannot see and ultimately these decisions they make or their lack of knowledge have lasting affects on their family members and the communities they are a part of.

But not all is lost, companies like AngloAmerican and AngloGold Ashanti are taking steps to implement TB control programs that are in line with national and international control regulations, isolate infectious employees and ensure their enrollment and successful completion of Directly Observed Therapy Short Course (DOTS).

The members of the mining industry represented on the panel and in the audience all recognized the importance of good TB control and good HIV/AIDS programs, and also acknowledged the importance of new technologies to reduce the amount of silica that miners are exposed to.  That being said, protective filtration masks are supposed to be worn by miners in the mines, but oftentimes they are not worn.

The same can be said for voluntary counseling and testing programs that many companies provide — what if your employees don’t want to know their status or have safe sex? Some may say this is out of the employers’ hands, but not Dr. Brian Brink chief medical officer at AngloAmerican who has shown a special interest in the funding, delivery and management of health care services, particularly HIV and TB, in Southern Africa and internationally. Dr. Brink passionately expressed his sentiments that “TB death is unacceptable; a death by TB is a failure.”  Even with the high incidence of TB in South Africa, especially in the mining industry, he sees no reason why the industry cannot have a positive impact to change cultural, social and business norms so that no death due to TB is seen as an acceptable loss.  Dr. Brink currently leads the Private sector Delegation on the Board of the Global Fund to fight AIDS, TB and Malaria.

If it wasn’t evident before today, let it be known that the mining industry’s commitment to stemming the TB and HIV epidemics is serious.

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