Social, economic and environmental determinants

Background

People migrate largely due to wars, conflicts, political instability, armed violence, poverty, income inequality, and climate change. These crises, including wars, are not bad for everybody. In 2019, global military expenditure reached $1,917 billion. The United States continues to lead global military spending with a share of 38%, followed by China (14%), Russia (3.4%), and Saudi Arabia (3.2%).¹ The arms sales by the top 20 military contractors, “profiting the most from the war” has reached US$235.3 billion. ² Global spending on militarization is largely financed from public resources and goes to private corporations.

Pervasive violence is a major cause of emigration, especially in areas like the Northern Triangle of Central America (NTCA), a region with the highest violence rates in the world due to the increasing control of organized criminal armed groups. ^{3, 4} Extortion is another form of the violence in Central America. La Prensa, a Honduran daily newspaper, estimates that Salvadorans, Hondurans and Guatamalans together pay more than US$650 million a year in extortion fees. ⁵

Unfair trade agreements also contribute to increased flows of migration due to impoverishment. The North American Free Trade Agreement (NAFTA), for example, enables the U.S. to export massively subsidized corn to Mexico, which led to a severe drop in corn production in Mexico. As a result, millions of small farmers have left their farms, a good portion of whom migrated to the north in search of other job opportunities. ⁶

Income inequality is often associated with unequal access to education, health care, political participation, and political power. ⁷ Fajnzylber, et al. (2000) found a strong positive association between income inequality, the Gini index, and the incidence of crimes, both robbery and homicide types. ⁸ However, this correlation does not explain the increasing rate of organized crime in El Salvador despite the sharp reduction in poverty and the expanded income inequality. Poverty and income inequality may both contribute to the initiation of violent groups/gangs. Once formed, these gangs gain significant power which makes situation difficult to change even if the underlying causes of their existence are changed.

The World Bank predicts that Latin America, Sub-Saharan Africa, and Southeast Asia will generate 143 million climate migrants by the year 2050.⁹ Climate change increases the number of international migrants and internally displaced persons mostly through the increased frequency of extreme weather events. In early 2019, 146,000 persons were internally displaced in Mozambique because of Tropical Cyclone Idai.¹⁰ Literature has also associated an increase in aggression with higher temperatures. ¹¹

Objectives

1. Identify and discuss the co-influence of underlying political, economic, social, and environmental drivers of migration
2. Describe the forms and pathways for discrimination, social exclusion, and violence against migrants
3. Identify the research agenda to close knowledge gaps in addressing the determinants of migration
4. Identify best practices to reduce discrimination against migrants
5. Identify and discuss policy proposals to address the structural determinants of migration

Areas of focus

• Climate change
• Violence, conflicts, and political instability
• Poverty and inequity

Health care access, quality, and efficiency

Background

Migration, health, and management are rarely studied together. Management is generally defined as the process of using human, financial, and technical resources to achieve predetermined objectives.¹² Global health is "an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide."¹³ Migration management is "the establishment of a regime that is capable of ensuring that the movement of people becomes more orderly, predictable, and productive, and thus more manageable."¹⁴ Our review of extant scholarship suggests both a challenge and an opportunity to integrate these disparate but related bodies of literature.

The movement of population requires a globally synergistic response from health and other human services sectors. This proportion of migrants, refugees, asylum-seekers, and expatriates within the host population has been trending upwards in the past two decades. The 2019 report from the United Nations Department of Economic and Social Affairs (UN DESA) estimated 272 million international migrants.¹⁵ That same year, the Office of the United Nations High Commissioner for Refugees (UNHCR) reported that 79.5 million people are forcibly displaced worldwide. This complex phenomenon necessitates a critical, multi-disciplinary discourse.¹⁶

Health is a core component of migration management. The World Health Organization (WHO), in response to its member states and in cooperation with the International Organization for Migration (IOM) and non-State actors, is considering options to support "the development of recommendations and tools for the governance, management and delivery of health care services that address epidemiological factors, cultural and linguistic barriers, and legal, administrative and financial impediments to access, with the involvement of refugee and migrant health workers."¹⁷ Developments on the policy and practice fronts provide a fertile ground for empirical discovery and theoretical exploration which, in turn, leads to a critical and intertwined perspective of management, health, and migration management.

We invite abstracts that address either the demand side or the supply side of migration health management. On the demand side, we are interested in how individuals and families manage diseases. Migrants and refugees experience a delay, failure, or interruption in their health care. Specific reasons include a lack of legal status (i.e., nationality), stigma, discrimination, and language, cultural, and financial barriers to seeking care. On the supply side, we are interested in loci of care for migrants and refugees in biomedical settings, as well as non-traditional settings such as detention centers, prisons, and work sites. Migrants and refugees perform dangerous, difficult, and demeaning (3D) work to sustain their livelihoods. There may be variation in quality and/or efficiency of preventive interventions or treatment sought from non-traditional settings, but these may represent the only care outlets accessible to migrants and refugees.

Objectives

The objective of this track is to develop the concept of 'migration health management'. Thus, we welcome scholarly work that

• Occupies one or spans multiple levels of analysis (micro, meso, macro)
• Adopts an inductive, deductive, or abductive approach
• Uses qualitative methods, quantitative methods, or mixed-methods
• Is both driven by and seeks to extend social science theory
• Is situated in an empirical context, culture, and setting
• Holds public policy, labor market, and/or business implications

Areas of focus

• Access to preventive and curative health services
• Social determinants of migrant population health
• Other puzzles that involve examination on multiple levels of analysis (individual, household, organization, sub-national, national, supranational)
• Organizational policies and practices that produce inequality either within the migrant population or between the migrant and general population
• Cultural brokers who mediate between two or more cultures while providing services
• Approaches to health care and preventive interventions that are customized to maximize existing resources and meet the needs of migrants
• The socialization of health within immigrant enclaves and other transnational communities

We also welcome abstracts that cut across not only focus areas, but across the tracks (arts, social determinants of health, brain drain, detention) of this conference.

Migration of health personnel (Brain drain)

Background

Brain drain is the concept of highly skilled or educated people moving from one country to another in search of opportunity. Some countries see more people leaving than others.¹ The migration of specialists, in particular health workers, represents a considerable loss for the origin countries and results in worse training and working environments compared to the host countries.² In response to this workforce imbalance, the World Health Organization (WHO) has developed a Code of Practice on the recruitment of health personnel. ¹⁸ This Code seeks to improve the management of health worker migration flows, especially from origin countries with already fragile health systems.

Until the travel bans set up in response to the COVID-19 pandemic, international mobility had been getting easier. There is growing competition for talent and human capital retention between countries. ¹⁹ Namely, every country must identify ways to make itself nationally and internationally attractive to skilled professionals in many fields. Higher education, workforce management, economic development, and commerce must come together to address this issue. This track seeks high-quality studies that describe the characteristics, pathways, and consequences of the migration of highly trained professionals. This track is also interested in the assessment of global, national, and organizational policies relevant to such migration.

Objectives

1. Deepen the understanding of the brain drain phenomenon and its drivers, especially during the COVID-19 pandemic
2. Discuss the barriers to implement WHO's Code of Practice on the international recruitment of healthcare personnel and the limitations of the code
3. Identify policy proposals that seek to attract and retain healthcare personnel and compensate the countries of origin

Areas of Focus

1. Global shortage of healthcare personnel: magnitude, intensity, determinants, and solutions
2. COVID-19's disruption of employment and education in the health sector: who is on the frontlines?²⁰
3. Contextual and institutional factors to implement (or not) the WHO's Code of Practice
4. Multilateral or bilateral migration agreements (e.g., South-South Migration [SSM]) and their social and economic consequences
5. Social reintegration assistance for returning migrants

Migrant detention

Background

UNHCR (2014) reports that immigrant detention occurs across the globe, including asylum seekers, stateless persons, and refugees.²¹ The International Organization for Migration (IOM) defines migrant detention as "the restriction on freedom of movement through confinement that is ordered by an administrative or judicial authority."²² The movement restriction takes different shapes based on the country and the type of migrant. It varies from simply monitoring of movement to imprisonment.

We highlight this global phenomenon for several reasons. The unprecedented increase over the last decade in the number of migrants has been met with an increased rate of detention of migrants and asylum seekers. UNHCR (2014) reported that this practice had been used as a means for governments to control or dissuade certain types of migration into countries.²¹ There is no accurate global figure for detained migrants. However, the Global Detention Project reported that, during the last decade, over 100 countries across the globe had used no less than 2,000 facilities to limit the movement of immigrants.^{23, 24} In the U.S., the number of detained immigrants reached 510,854 in 2019 versus 396,448 in 2018, a 29% increase.²⁵ The group Freedom for Immigrants, which works with people who stay in detention centers for more than a month, found that 7% stay less than 6 months, 12% stay from 6 months to 1 year, 28% stay 1-2 years, 48% stay 2-4 years and 5% stay for more than 4 years.²³ In most countries, these detained migrants have few if any legal rights. Furthermore, the detention process has serious mental, physical, and emotional consequences both in the short-term and in the long-term.²⁶

In recent years, the world has witnessed an increase in the detention of children as well, which has led to particularly egregious human rights violations related to family separation. In fact, the migration and detention of children is correlated with significant psychosocial issues after release and later in resettlement.²⁷ The detention of children is forbidden by international law and not acceptable under any circumstances.²⁸

In addition to these tragic human costs to detention, the latest literature on migrant detention notes additional "civic and democratic costs" of migrant detention. "Studies have documented the various ways in which exclusionary and discriminatory practices within the criminal justice system inculcate anti-democratic values of governmental distrust and civic disengagement on a growing underclass of Americans."²⁶ Despite this, in 2019, the U S. Department of Homeland Security proposed $22.5 billion for migration control and enforcement, an increase of 22% from F.Y. 2017. These increased resources have a profoundly negative impact on already vulnerable migrant populations, which in turn perpetuates a vicious cycle of migration tendencies. ²⁹

We seek abstracts that help expand the general understanding of how migration and detainment interact in many parts of the world. We look forward to scholarly works that further inform the discourse and present viable methods toward an alternative migration process that facilitates a human rights approach to screening, processing, and integration of migrants. We also invite further discussion on the long-term consequences of dedicating increased law enforcement to administrative confinement of migrants. Overall, we aim for this track to emphasize the various underlying causes of many of these events, theories, and analysis of the possible consequences of continuing in this direction, and demonstrable alternatives that can be realistically implemented.

Objectives

We are looking forward to reviewing abstracts for scholarly work and artwork that:

• Discuss the social, political, and environmental factors that influence migrant detention
• Engage in policy examination of existing methods and processes surrounding migrant detention
• Explore the legal procedures required for immigration detention

Areas of focus

We hope to review submissions that address but are not limited to any of the following focus areas:

• Human rights violations in the detention process
• Detention-related health consequences
• Economic implications of detention
• Conditions in detainment centers and refugee camps
• The impact of COVID-19 on migrants in detention centers
• Child detention and family separation • Humanitarian alternatives to detention