Biosocial Analysis of Migration and Health in Mexico, LAC and Beyond: Exploring the Right to Health for People on the Move Before, During and Beyond the COVID-19 Pandemic

Abstract

Introduction: If people have been on the move for over 200,000 years, why is it that migrant’s access to healthcare continues to be a challenge? Despite global commitments to ‘leaving no one behind’, governments and institutions continue to neglect the explicit inclusion of all migrants in healthcare systems and policies. Rather than chartering international commitments towards safe and orderly migration, many countries’ policies disrupt, fragment and jeopardize the right to health for migrants on the move, even during the ongoing global COVID-19 pandemic. This paper explores the syndemic and structural vulnerability of people on the move, emphasizing the structural, political, economic and social forces, both historical and emerging, that impact an individual’s decision to migrate, his or her health and the barriers to fulfil their right to health.

Methods: The present work introduces a series of case studies illustrating the many experiences faced by migrants when accessing TB care during the COVID-19 pandemic. The cases (some of them already published in the International Journal for Infectious Diseases) explore the right to access TB care for a circular Central American migrant in Mexico, internally displaced persons in Syria, impoverished Venezuelans in Peru, and labour migrants in South Africa.

Results: Leveraging from teachings within the disciplines of global health and social medicine, human rights and migration, and international law enabled a deeper understanding of evidence-based and comprehensive healthcare delivery strategies for people on the move. Likewise, exploring the retroactive impact of COVID-19 on global TB strategies towards people on the move enabled a deeper syndemic and biosocial analysis merged within human rights frameworks. The work underlined the commonly overlooked barriers migrants experience when attempting to fulfil their right to health around the globe.

Discussion: Migrant health is a dynamic and multidimensional experience that requires a complete understanding of the host, transit and origin context of healthcare systems and delivery. The accumulation of negative or positive health-seeking experiences is reshaped by the interaction between the individual and the local or national health governance. While this thesis highlighted and addressed the many limitations to assessing access to healthcare for people on the move; exploring areas of opportunity to improve service delivery mainly was limited to the supply side with scarce detail on the system’s overall user experience and interaction. By building from international legal frameworks (such as the AAAQ Framework described within the General Comment No. 14) and migrant and people-centered healthcare delivery. This work brought forward a revised approach for program and policy evaluation. The conceptual framework has been proposed to render opportunities for practical, human-rights and people-centered approaches to comprehensive healthcare delivery for accountability to ensure no one is left behind.