Whilst the migration process itself is increasingly recognised as a social determinant of health for migrants and their families once they arrive in the EU, the harsh reality is that the burden of migration remains with migrants. Newly arrived migrants and refugees often face severe barriers to access healthcare, in particular screening and immunisation programmes: lack of culturally-sensitive information and communication (EC/OECD 2007; Laverack 2018); different policy and regulatory systems for health care and social services across Member States (Pavli 2017; Migrant Integration Policy Index 2015); and poor understanding of migrants’ needs. In this respect, as widely emphasised by WHO Europe, migrants and refugees do not necessarily suffer from “infectious exotic diseases.” Conversely, their health problems are, in most cases, similar to those of the rest of the population, with regard to both communicable and non-communicable diseases.
In other words, better access to vaccination, screening, and treatment should not be based on the alleged association between migration and the risk of importation of deadly pathogens. There is an unmet need, rather, to respond to the growing vulnerabilities of migrants once they move to any Member State.
The interconnection between the digital single market and migrants’ health may not be obvious. However, it would be worthy to assess how digital services could help fill in the gaps of national health systems’ inconsistencies or inabilities regarding migrants’ healthcare coverage. In fact, an effective implementation of the digital single market could go far beyond its traditional objectives of ensuring a better competitiveness of the EU market and safer access of consumers to online business and services. New technologies and digital skills could create new opportunities to address most of the above mentioned barriers to access to healthcare:
-Cost-effective exchange of patients data across borders and different regulatory systems;
-Reduced cultural barriers through a tailor-made multilingual communication and healthcare provision;
-Evidence-based assessment of migrants’ needs through digital surveys and health status reports targeting migrants and refugees communities.
The REHEALTH project is a recent example of the successful use of technologies to address migrants’ integration into EU health systems via the digital collection of personal health records in one single document while complying with the data protection regulatory framework.
In April 2018, the European Commission issued a communication on the digital transformation of health and care in the Digital Single Market, mainly aimed at empowering citizens to take care of their health and become the first champions of prevention.
However, despite the multiple advantages of technology and the increase in digital skills, a few obstacles prevent the effective functioning of the digital single market for migrants’ health. Undocumented and irregular migrants are often left aside. Economic migrants, refugees and asylum seekers are not often targeted by model initiatives at national level. The French online platform MesVaccins, for example, proposes an electronic vaccination booklet which allows people to keep track of vaccines recommended and/or received. This platform has enormous potential for reaching out to migrants. Last, but not least, it can be observed that the regulatory framework across Member States is likely to entrust the management of many issues related to migrants, including health service provision and preventative care, to civil society actors via integration programmes. This approach keeps migrants’ health separate from the development and assessment of digital health services and practices provided at national level for the benefit of national public health – the 8 NGOs in 11 States project is an illustrative case (CHAFEA, 3rd Health Programme 2014-2020).
Some Member States made substantial progress in enhancing e-health and digital technologies to achieve the universal health coverage and reach out to less accessible population groups (Health 2020 policy). Leveraging e-health has been recognised as the ace in the hole that is able to make national health systems sustainable and effective (WHO Europe 2016). But tangible outcomes in favour of responsive political landscape that may adapt to migrants’ needs and ensure sustainable funding for e-health are more difficult to measure. Still there are too many questions on innovative strategies such as electronic health record systems and mobile health, and too few answers on how to adapt these strategies to migrants through national cross-cultural information campaigns.
Although e-health programmes and telehealth services have gained momentum in Europe since the issue of the 2004 eHealth Action Plan, standard policies and consistent impact assessment and evaluation should be further promoted to meet existing gaps in migrants’ health.
Is the digital single market breaking down or rather reinforcing barriers to the access to healthcare and health monitoring for migrants?