Mobility and Migration

Faculty Point of View

By Mark Dybul (C’85, M’92) and Susan C. Kim (MBA’13)

We are in an exciting, and challenging, time in global health. Progress has been made to shift the disease burdens of infectious and tropical diseases. Once deemed impossible, we are close to ending the epidemics of HIV, polio, tuberculosis, and malaria, and are making headway in the response to non-communicable diseases—the leading cause of death worldwide. But global health is at a critical inflection point. We are confronted by urgent trends that demand innovative response. One such megatrend is migration.

The movement of people and ideas is no longer limited by physical barriers, though political borders remain. The United Nation reports that last year 258 million people moved across borders, up by 85 million from 2000. While 26 million of the migrants were refugees, the vast majority had moved from their country of birth in search of economic mobility, hoping to improve their financial standing. To properly respond to issues of global health for all migrant populations, we must broaden solutions beyond short-term policies to more comprehensive, long-term responses in health systems, education, employment, and housing.

Moreover, global health security is inextricably linked to the issue of increased migration. Epidemic outbreaks can have catastrophic human and economic consequences, shattering the political and economic stability of affected countries, and creating shocks that reverberate throughout the global economic system. For example, in the aftermath of the 2014 Ebola crisis, the hardest hit countries of Guinea, Liberia, and Sierra Leone saw an ensuing loss of annual GDP growth around 90%. Similarly, the World Bank estimates that the potential global economic impact from a severe flu pandemic such as the Spanish Flu of 1918 could be close to $4 trillion today. Additionally, the future stability of fragile states could largely depend on health. For example, North Korea is combating a deteriorating health infrastructure, chronic malnutrition, and an epidemic of untreated drug-resistant tuberculosis, which may lead to health and migration challenges throughout the region and the world.

Artificially restricting the free flow of people, goods, and ideas has never been a tenable response to global health security. A better option is to embrace the inherent value of a more interconnected world and recognize that disease outbreak anywhere threatens people everywhere. As such, wherever people move, they must have good health services. The World Health Organization, through the International Health Regulations and Pandemic Influenza Preparedness Framework and current focus on universal health coverage, is helping build resilient health systems with effective monitoring and response capacities in the countries that need them most.

Expanding the mobility of ideas to keep pace with emerging innovations is equally urgent. The preceding decades in global health have led to significant progress in harnessing technology and data for improved knowledge sharing. The drive should be towards open-source, real-time (or near real-time) online tools.

One such project that our center is working on, supported by the Bill & Melinda Gates Foundation, examines how to help countries develop more effective systemic responses to their HIV burdens. Highly promising innovations occurring in discrete communities are frequently not connected to national policy, which leads to a lengthy implementation gap. Data challenges emerge when local contexts are not clearly understood, leading to over-collection, competing datasets, conflicting information systems, and duplication of efforts. Groups often do not focus on making data accessible or useful to decisionmakers and implementers. This leads to the failure to systematically review available data to develop programs with maximum impact, and the failure to generate data that intentionally directs policy.

To respond to these issues, our project: (1) links existing or new communities of practice across a health system—from the community level all the way through to the policymaker level, (2) has data tailored to the needs of each community of practice, and (3) uses human-centered design methodologies to facilitate innovation and capacitate links across a health system. We will be supporting country partners in Eswatini, Kenya, and Malawi to develop an overarching, more coordinated process for health impact—ultimately, a more community-led, human-centered, and better-connected system for health innovations and care should lead to sustained improvement in health outcomes.

In this time of economic and political change throughout the world, we have the opportunity to build on the success of the previous decades. But to do so, we must be bold, thoughtful, and strategic in developing solutions to confront the new challenges we face together in global health. n

Mark Dybul, MD, is professor of medicine and faculty co-director of the Center for Global Health and Quality at Georgetown University Medical Center. Susan C. Kim, JD, MPH, MBA, is an assistant research professor of medicine and executive director of the Center for Global Health and Quality.