An in-depth look at human migration and health care systems

President Julio Frenk delivers his keynote address on migration and health care systems. Photo: TJ Lievonen/University of Miami

By Robert C. Jones Jr. and Janette Neuwahl Tannen

President Julio Frenk delivers his keynote address on migration and health care systems. Photo: TJ Lievonen/University of Miami

An in-depth look at human migration and health care systems

By Robert C. Jones Jr. and Janette Neuwahl Tannen
University of Miami President Julio Frenk delivered the keynote address at a symposium on migration, global change, and policy hosted by the Institute for Advanced Study of the Americas.

They flood into the country by the thousands, seeking and receiving a wide range of medical treatments.

Their trips across the border are born of necessity, as most of them are either underinsured or uninsured.

This is not a description of immigrants from Mexico crossing into the United States to access health care, but the reality of hundreds of thousands of Americans traveling to that Latin American country each year for medical procedures that range from dental work to elective and non-emergency surgery.

That was one the facts University of Miami President Julio Frenk revealed Friday to an audience of faculty and graduate students attending the inaugural Initiative on Migration, Global Change, and Policy 2019 Symposium. 

Organized by the University of Miami Institute for Advanced Study of the Americas, the one-day forum addressed current migration issues, identified ongoing research projects on the topic, and cultivated a vision for migration-oriented scholarly activity at the University.

“We should always be very conscious about populations that are most at risk, and one of those populations is migrants,” said Felicia Knaul, director of the institute and a professor at the Miller School of Medicine. She challenged faculty at the forum to ask themselves how they are incorporating issues of migration into their research projects.

Frenk, a former minister of health of Mexico, delivered keynote address, dispelling some of the misconceptions about the movement of health care consumers across borders and focusing more attention on the seldom-discussed issue of the interaction between migrants and health care systems.

While precise numbers are hard to come by, of the 1.4 million U.S. health consumers who travel abroad for health services, some 500,000 to 1 million make the trip south of the border, said Frenk during his half-hour talk titled Human Migration and Health Care Systems.

Yet, most of the literature centers around the health conditions of migrants and the demands and risks they may impose on health systems and other populations.

They are mistakenly perceived as a burden, “the bearers of a health problem,” said Frenk.

Instead, more scrutiny needs to be placed on the health system side of the equation, he explained, noting the vast number of health care professionals who are migrating from developing countries to developed regions.

The United States is a magnet for such talent, with upwards of 40 percent of foreign-born physicians and nurses in OECD (Organization for Economic Cooperation and Development) countries practicing in the U.S., Frenk said.

And this can be a tremendous asset, he said, as foreign-born providers can be more attuned to the needs of migrant patient populations.

Frenk also discussed some of the barriers that impede migrants’ ability to access health care, from stereotypes and stigmas that discourage them from seeking medical attention to financial restrictions and legal status.

As such, he reviewed strategies to improve their chances of obtaining care. Among his suggestions: developing explicit policies and establishing entitlements geared specifically toward refugees and migrants; strengthening health systems; and establishing information networks to assess their health.

Frenk also identified opportunities, chief among them, the chance for researchers to study diverse populations and to better understand the determinants of health.

Faculty experts in law, political science, architecture, art and art history, and other areas also presented at the forum. 

Law and sociology professor Alejandro Portes said that the United States’ current policies on immigration, which promote temporary visas, were designed simply for economic gain, without compassion or long-range thought.

“In effect, the federal government is setting up a revolving door at the border by which ICE deports tens of thousands of people on one side, and at the other side they are admitting them as temporary workers,” said Portes a distinguished scholar of the College of Arts and Sciences, as well as a research professor at Princeton University.  “How much easier, less costly, and less painful would it have been to just regularize the situation of individuals already in the country?”

This was one of the issues that came up several times at the symposium.

“This is the first of what we hope to be many opportunities to integrate migration studies into the University’s core research mission,” said Justin Stoler, associate professor of geography and regional studies who studies water insecurity and the geographic patterns of health disparities and environmental influences on people’s behavior.

Stoler and Merike Blofield, a political science professor who studies family and gender policy, as well as socioeconomic inequality throughout the U.S. and Latin America, led the one day conference. The symposium was created to unite and engage UM’s faculty experts and graduate students examining migration, so that interdisciplinary projects and more informed courses can emerge in the future, said Leonidas C. Bachas, dean of the College of Arts and Sciences.

“We want to see how the expertise we have at UM can have an impact on this issue,” Bachas said, later adding, “These ideas need to be translated into public policy on migration. If they do not translate into policy, the information has a minimal effect on society.”

Becky Sharpless, an immigration lawyer and professor in the School of Law, described the difficult legal minefield that immigrants face in America today for gaining citizenship, and outlined ways that she and her students in the immigration law clinic are working to defend the human rights of immigrants. However, she said the current—yet unfounded— ear in America about immigrants as a danger to society is slowing lawyers from making headway. In particular, family separations that have been happening at the border for deportations violate international law guidelines.

“The U.S. is considered a leader in human rights, but in many ways we are out of step with international law,” she said.

Miami law professor and former White House adviser Caroline Bettinger-Lopez, who also runs the human rights law clinic, said there is a groundswell on campus of law students concerned with preserving the rights of migrants. This prompted her and Sharpless to start a series of events on family detention and separation issues, which have been dominating headlines.

“We have been feeling the push from students and faculty to focus on defending the human rights of migrants,” she said. 

Portes then shared some of his research about migration into the U.S. He said the latest figures show that more than 1 million immigrants were legally admitted to the U.S. in 2017, primarily coming from Mexico, Cuba, China, India, and the Philippines. Yet, the wealth and educational gap among migrants is sizeable, mainly because immigrants from Asia must have the financial means to travel here.

Exacerbating the problem is the fact that the U.S. government is making it harder for people to become legal citizens, Portes said. So, during the recession of 2008, when American companies needed a way to attract inexpensive labor from abroad, they began offering different types of temporary visas. This helped solve the economic issue, but never offered workers a path to full citizenship.

“Tacitly but effectively, the United States has started sourcing its labor needs at the high and low skill levels via temporary visas,” Portes said.  “This confines immigrants to permanent insecurity and vulnerability.” 

Now that the U.S. is leaning toward an isolationist philosophy, Portes said, Americans are missing out on all the positive contributions that immigrants have made to the country. That is why he said it is imperative that America comes up with a better pathway to legal citizenship.

If this does not happen, Portes said, “We are going to be a nation with no capacity for innovation, which has given the U.S. an intellectual, social and economic edge in the past.”