Anales de la RANM

17 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 MIGRATION AND HEALTH INEQUITY Aagaard-Hansen J, et al. An RANM. 2025;142(01): 11 - 20 The social determinants of health, which encompass economic, environmental, and sociopo- litical factors, shape health inequity affecting the well-being of populations. All the three cases share characteristics at the levels of socio-economic context and position, differential outcome, and consequences. These are to a large extent related to the health care services. In the case of migrants, the inequity is exacerbated by structural barriers that limit their access to essential resources, such as adequate housing, stable employment, and proper healthcare. Adequate access to local health care services (in the broad sense of the word including availability, affordability, and accept- ability) for the migrants poses a challenge in relation to all three diseases. There is an important variability between countries regarding health policies and health-care access for migrants (8). As many governments find it hard to cater for the health care needs even of ‘their own’ stationary populations, the migrants from abroad are likely to face additional problems. This issue is closely related to how the national health authorities have organized the funding (socio-economic context and position). If the migrants fall sick in an environment where services are paid for directly by the patients, they may face situations of differ- ential consequences such as catastrophic health expenditures, and this apply to all three disease cases. In addition to the health inequity mechanisms mentioned above, there are additional issues at stake for the two infectious diseases (VL and TB). In these cases, migration often leads to increased risk of infection (differential exposure). For instance, migration populations may enter areas endemic for disease with which they are not used, or the migrants may introduce new pathogens to the stationary populations at arrival. In some cases, the migrants bring their domestic animals which may serve as reservoirs (e.g. dogs for VL) (47). In relation to exposure, the level of differen- tial vulnerability may also play a role due to either lack of immunity or co-morbidities with a propen- sity of reducing the resilience. Additionally, there may be a delay in diagnosis among migrants due to fear of losing their job, fear of stigma and discrimination, and their intention to protect their contacts and family (in the case of TB). This can lead to migrants hiding their symptoms and not going to a health center, increasing the risk of non-detection and transmission (48). To add further to the complexity, the local context plays a key role. Thus, the combination of local languages, ethnicities, traditions and religions make a major difference. Evidently, migration between two countries with very similar conditions reduce the challenges – everything being equal. However, many migrants may have experienced poverty, which could have conditioned their bodies to cope with hunger and scarcity. Poverty plays a central role in this process, functioning as a cross-cutting determinant that amplifies vulnera- bilities and restricts the ability of affected popula- tions to adopt preventive measures or access timely treatments. Consequently, when they move to new countries with environments conducive to weight gain, characterized by high-fat diets and low physical activity, they are particularly suscep- tible to an increased risk of conditions such as DM. Interestingly, once these migrants gain stability in their new communities, their children also often experience higher rates of DM. This is sometimes seen as a result of their families' adaptation to their new surroundings (49-50). At the other extreme, migrants with different languages and maybe even arriving among hostile populations with antago- nistic ethnicities and/or religions may aggravate the situation. From a global perspective, these challenges must be addressed within the framework of the Sustain- able Development Goals (SDGs), which emphasize the need to reduce inequalities (SDG 10), ensure health and well-being for all (SDG 3), and promote more inclusive societies (SDGs 1 and 8). Adopting an approach aligned with the SDGs allows for understanding health inequity not only as a consequence of migration and poverty, but also as a reflection of broader exclusionary structures that perpetuate unequal access to fundamental rights. 7. CONCLUSION A typology for population movement catego- rized the many varieties according to onset (slow or rapid), cause (human/political or natural), direction (unidirectional or circular) and motivation (voluntary or forced) (2). The CSDH applied an analytical framework, which distinguished between disparities at the levels of society, exposure, vulnerability, outcome, and consequences at which health inequity could come into play (3). Common for the two approaches is that they deconstruct the notions of migration and health inequity according to a more detailed set of variables and, as such, this paper contributes for a better understanding of the social determinants linked to migration to be considered for targeting the 2030 SDGs. This article does not aim to provide comprehen- sive reviews of these two main concepts. Instead,it illustrates how the juxtaposition of the two analyt- ical perspectives enables a more in-depth analysis of migration and health inequity. The aim is that this dual conceptual framework will guide future public health planning and research in their endeavor to navigate the complex challenges of global health inequities. ACKNOWLEDGEMENTS We are thankful to our many colleagues from whom we have learned over the years.