Dr. Santino Severoni:

I thank the Vice Chairman and distinguished members of the joint committee for the invitation to appear before the committee today and giving me the opportunity to make a presentation on the work of the World Health Organization for Europe in the area of migrants’ health issues and to discuss the possibilities for further collaboration with Ireland. I am honoured to be accompanied by three Irish colleagues, partners of the WHO, from the mental health services of Cavan and Monaghan which have been collaborating with the WHO since 2001 in implementing major mental health reforms in the Balkans. I thank them for accompanying me.

We all know that the overall health of the population across Europe has improved in recent years, but we also know that these improvements have not been equally shared within and among the different European countries. Migration is a key factor in influencing these avoidable and unfair health inequalities. The main contributing causes of migration are natural and man made disasters and social, economic and political disruptions. An estimated 8% of the total population of the WHO European region, which comprises 53 member states, is composed of migrants, with women accounting for 52% of the overall migrant population. This influx represents an increase of 5 million people since 2005 and accounts for almost 70% of the population growth between 2005 and 2010 in Europe.

In this context, the project - Public Health Aspects of Migration in Europe, PHAME, - was created by the WHO regional office for Europe in 2011 to respond to the public health needs of migrants. It was precisely in 2011 that the crises in north Africa and the Middle East started posing significant challenges to the health systems of European countries in the Mediterranean, as a result of the large influxes of migrants arriving to Europe from across the sea. This WHO project on health and migration was defined with the aim of supporting member states in strengthening health systems to address the public health needs associated with migration, consequently improving the health of the migrant and resident populations. Its objectives are also to contribute to a productive debate on migrants’ health at all levels within and outside the government, sharing knowledge and increasing awareness throughout the European region.

With these same objectives in mind I am appearing today before this committee. The phenomenon of migration and its consequences in the health of the migrant and resident population affect the European region entirely, but manifest in different ways. For example, our region is characterised by three main challenges in dealing with migration, where the southern part of the region must confront undocumented migrants arriving across the sea. The member states of the eastern part of the WHO European region must confront increasing movement of labour migrants, while northern Europe is a major attraction for people requesting asylum and protection and governments face the challenge of integrating these asylum seekers.

In the southern Mediterranean region, WHO-Europe has already established collaboration with the ministries of Portugal, Spain, Italy, Malta, Greece and Cyprus. Health system assessments have been conducted jointly with the ministries of health in these countries and similar exercises are also under preparation with the ministries of health of Bulgaria and Turkey. These missions have the aim of supporting the work of policy makers, health planners, national, regional and local health professionals and all those responsible for providing quality health care to migrants. The final objective is to develop expertise and capacity and to identify and fill potential gaps in health service delivery, including services for the prevention, diagnosis, monitoring and management of disease, and to share best practice among member states. As a result of these exercises, several reports have been published indicating key findings and areas for future collaboration. These activities and publications have initiated a dialogue among southern European countries towards a common understanding of the phenomenon of migration and public health.

In order to address the complexity of migration health, it is important to raise awareness on migrant health and of the need to address the issue in an equal and inclusive way. In this regard, WHO-Europe is producing a number of publications that will contribute to bringing relevant stakeholders within and outside the health sector together and start a cross-sectoral and region-wide dialogue on migrant health. There is also a growing demand by member states to strengthen health information for decision making in the field of migration and health. Responding to this need, the European advisory committee on health research is currently working on the development of three reports to synthesise the best available evidence on the public health responses to migration and identify potential gaps in order to inform policy makers.

At this stage, anyone could ask himself or herself why I am addressing these questions to the Joint Committee on Foreign Affairs and Trade. The answer is that migrants’ health is an intersectoral issue that not only involves professionals working within the health sector, but also the ministries of foreign affairs, interior, employment, education or social affairs.

The diversity of actors involved in the process and the political sensitivities attached to this field of work make of migration a challenging field for public health. At the same time, the intersectoral nature of this area brings an opportunity for the health sector and governments to explore ways to work horizontally and transform migrants' diversity into greater health equality and sustainability in Europe. By promoting an intersectoral and intergovernmental approach to migration, the WHO project supports the implementation of the European policy framework, Health 2020, signed by all 53 European member states, including Ireland, and the implementation of the World Health Assembly resolution 61.17 on the health of migrants adopted in 2008 and also ratified by Ireland.

Migration is an international phenomenon which manifests in different ways but affects all countries regardless of their borders. As a consequence, there is a growing need for a more comprehensive and systematic approach, recognizing countries' specificities while identifying regional priorities and agreeing on a common strategy to address migration and public health. During the last WHO Regional Committee for Europe session, a technical briefing on health and migration was held - and attended by member states - by the standing committee of the WHO Regional Committee for Europe for the preparation of a European action plan on health and migration. This is a remarkable new initiative. While we have already engaged in discussion and consultations with southern and eastern European regions, we are looking now at the northern countries in order to add all voices to this regional dialogue on migrants' health. More specifically, we would like to strengthen our collaboration with Ireland in this area of work, following the example of the national strategy, Healthy Ireland, in which the objectives of the Health 2020 European policy framework have been successfully applied to the national context, aiming at the improvement of everyone's health with a focus on the most vulnerable through whole-of-government and whole-of-society approaches.

Ireland is a country with a huge experience of emigration and immigration which understands the challenges related to this phenomenon. Ireland also has great experience in the area of health inequalities and vulnerability. The WHO is looking for success stories and best practice approaches on migration health. Ireland could be a northern European champion in this regard. I thank the members for their attention.