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Any erosion of Roe v Wade will have devastating health outcomes that are likely to widen existing healthcare inequalities, says Terry McGovern

With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.

Voters in Kentucky, a state with more Republicans than Democrats, rejected a ballot proposal that would have amended the state constitution to explicitly state it does not protect a right to abortion.23 The Kentucky Supreme Court heard oral arguments recently on challenges to the abortion restrictions. Voters in Vermont, California, and Michigan endorsed ballot initiatives enshrining state constitutional protection for abortion.4 The Michigan ballot measure, called proposal 3, broke state records for signatures and campaign donations.4 In Montana, a deeply conservative state, residents voted down the state’s “Born Alive” measure, which would have criminalised healthcare providers if they did not take “reasonable actions” to save an infant born alive, including after an attempted abortion.5 Voters around the country rallied behind candidates pledging to protect access to abortion. Anti-abortion lawmakers in Alabama and Mississippi have refused to expand Medicaid to extend postpartum care despite their states’ abysmal ratings for maternal and child health.6 And while anti-abortion politics are awash with rhetoric around saving the lives of infants and children, there is overwhelming evidence of dysfunction, neglect, and abuse in the foster care systems of Alabama and Mississippi, as well as in Louisiana, where at least three children have died in the past four months under the watch of the state’s Department of Children and Family Services.7 Courts in these states have found that the state programmes discriminate against young people with disabilities, provide unstable, unsafe care, and are responsible for extremely high rates of maltreatment.8910 In Oklahoma, Republican Governor Kevin Stitt has supported criminalising abortion but has not tackled some of the nation’s worst maternal and child health outcomes.

Better childhood health and nutrition, extensions to education, delays in family formation, and new technologies offer the possibility of this being the healthiest generation of adolescents ever. But these are also the ages when new and different health problems related to the onset of sexual activity, emotional control, and behaviour typically emerge. Global trends include those promoting unhealthy lifestyles and commodities, the crisis of youth unemployment, less family stability, environmental degradation, armed conflict, and mass migration, all of which pose major threats to adolescent health and wellbeing.

We propose that a stackable badged micro-credential system could increase academic programmatic agility, in turn helping university students cope with personal crises (illness, accidents, family emergencies), and societal-level crises (pandemics, natural disasters, geo-political events). We demonstrate how our proposed system would certify students’ mastery of several modules comprising a required graduate-level Strategic IS Management course. This proposed system will provide helpful structure (through a modular design and reliance on well-accepted faculty governance, including the traditional college registrar role), and temporal flexibility (enabling students to receive credit for course modules taken in different terms/semesters, and taught by the same or different instructors) and portability (given that micro-credentials provide valid evidence of specific skills or knowledge a student has acquired, regardless of learning modality or instructor). This stackable badged micro-credential system would help students during crises, by making it easy for them to temporarily drop out of a course when circumstances impede effective learning and making it easy for them to resume studies when they are ready and able to do so. We discuss technical challenges that university administrators may face in implementing micro-credentialing in IS classes, offer suggestions for pilot-testing the proposed system, and suggest possible future extensions of this idea.

Gender-based violence (GBV) policies and services in the United States (U.S.) have historically been underfunded and siloed from other health services. Soon after the onset of the COVID-19 pandemic, reports emerged noting increases in GBV and disruption of health services but few studies have empirically investigated these impacts. This study examines how the existing GBV funding and policy landscape, COVID-19, and resulting state policies in the first six months of the pandemic affect GBV health service provision in the U.S. This is a mixed method study consisting of 1) an analysis of state-by-state emergency response policies review; 2) a quantitative analysis of a survey of U.S.-based GBV service providers (N = 77); and 3) a qualitative analysis of in-depth interviews with U.S.-based GBV service providers (N = 11). Respondents spanned a range of organization types, populations served, and states. Twenty-one states enacted protections for GBV survivors and five states included explicit exemptions from non-essential business closures for GBV service providers. Through the surveys and interviews, GBV service providers note three major themes on COVID-19's impact on GBV services: reductions in GBV service provision and quality and increased workload, shifts in service utilization, and funding impacts. Findings also indicate GBV inequities were exacerbated for historically underserved groups. The noted disruptions on GBV services from the COVID-19 pandemic overlaid long-term policy and funding limitations that left service providers unprepared for the challenges posed by the pandemic. Future policies, in emergency and non-emergency contexts, should recognize GBV as essential care and ensure comprehensive services for clients, particularly members of historically underserved groups.

About the Authors: Paul Spiegel * E-mail: pbspiegel@jhu.edu Affiliation: Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America ORCID logo http://orcid.org/0000-0002-6158-6661 Kolitha Wickramage Affiliation: Migration Health Division, The UN Migration Agency, Manila, Philippines Terry McGovern Affiliation: Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York City, New York, United States of America Citation: Spiegel P, Wickramage K, McGovern T (2020) Migrant and refugee health: [...]no matter how migration is portrayed at a specific point in time, it will inexorably continue. [...]the need to ensure the protection, health, and welfare of people on the move is imperative and provides the rationale for the accompanying PLOS Medicine Special Issue on Refugee and Migrant Health [1]. Seeking to raise awareness of the health inequities and different contexts faced by migrants and forcibly displaced persons, as well as to promote research, service, and policy innovation in this area, this Special Issue is devoted to migrant and refugee health in the broadest sense. Paediatric Emergency Department Utilization Rates and Maternal Migration Status in the Born in Bradford Cohort: a Cross-Sectional Study.

Nigeria has a plural legal system in which various sources of law govern simultaneously. Inconsistent and conflicting legal frameworks can reinforce pre-existing health disparities in sexual and reproductive health (SRH). While previous studies indicate poor SRH outcomes for Nigerian women and girls, particularly in Northern states, the relationship between customary and religious law (CRL) and SRH has not been explored. We conducted a state-level ecological study to examine the relationship between CRL and SRH outcomes among women in 36 Nigerian states and the Federal Capital Territory of Abuja (n = 37), using publicly available Demographic and Health Survey data from 2013. Indicators were guided by published research and included contraception use among married women, total fertility rate, median age at first birth, receipt of antenatal care, delivery location, and comprehensive knowledge of HIV. To account for economic differences between states, crude linear regression models were compared to a multivariable model, adjusting for per capita GDP. All SRH outcomes, except comprehensive knowledge of HIV, were statistically significantly more negative in CRL states compared to non-CRL states, even after accounting for state-level GDP. In CRL states in 2013, compared to non-CRL states, the proportion of married women who used any method of contraception was 22.7 percentage points lower ([95% CI: -15.78 --29.64], p<0.001), a difference that persisted in a model adjusting for per capita GDP (b[adj] = -16.15, 95% CI: [-8.64 --23.66], p<0.001.). While this analysis of retrospective state-level data found robust associations between CRL and poor SRH outcomes, future research should incorporate prospective individual-level data to further elucidate these findings.

Researchers have found three crucial effects of the policy: decreased stakeholder coordination and reduced discussion related to sexual and reproductive health and rights; reduced access to contraception with accompanying increases in unintended pregnancy and induced abortion; and negative outcomes beyond reproductive health, including weakening of health-care system functioning. Unsurprisingly, local health practitioners in Madagascar now report that many women are seeking care to treat the complications of unsafe abortions.2,3 This increase is in line with the finding that the policy increases a country's typical abortion rate by 40%, while reducing the use of modern contraceptives by 13·5%, which was reported by Brooks and colleagues in 2019.4 Unsafe abortion is directly linked to risk of death in childbirth: approximately 8% of maternal deaths worldwide are attributable to complications from unsafe abortion. By increasing the incidence of unsafe abortion—while simultaneously decreasing discourse, reducing access to sexual and reproductive health care, and disassembling health systems—the Protecting Life in Global Health Assistance policy makes a dire public health situation worse.