THE Covid-19 pandemic has greatly undermined recent advances in healthcare, driven more people into poverty and food insecurity and also amplified health inequities.
Despite affecting all population segments, the worst hit by the pandemic are migrant workers due to them being outsiders in a foreign land.
Malaysia is home to at least two million documented migrant workers, and two to four million more undocumented ones who are mostly from Indonesia and Bangladesh.
Generally, they are expected to be in good health before entering our country, but the global rise in non-communicable diseases (NCDs) has dramatically increased the likelihood of them arriving with pre-existing chronic conditions that make them more likely to become severely ill and die from Covid-19 if they are infected.
Common health problems associated with migrants include psychological disorders, injuries, infectious diseases, and under-managed NCDs such as hypertension, diabetes and heart disease.
The circumstances surrounding their migration may also expose them to greater health risks, including those encountered during transit and in the destination country. For those with current or previously well-managed NCDs, this can result in life-threatening complications due to critical or prolonged interruptions in treatment or loss of medication.
This has led to the World Health Organisation (WHO) calling on governments everywhere to tackle NCDs in a bid to eliminate health inequities among foreign labourers.
In Malaysia, both documented and undocumented immigrants face multiple barriers to healthcare access due to language, immigration status, low income, poor education, perceptions of discrimination, transport problems, culturally based healthcare beliefs and values, and a complex Malaysian healthcare system.
What can we do to reduce the health inequities faced by these migrant workers?
The Ottawa Charter outlines five key priorities that we can look into:
1. Building healthy public policy by adopting a Health in All Policies approach to ensure policies within all sectors of government, not just the healthcare sector, promote the health of migrants;
2. Creating supportive environments by improving social services and the quality of physical and social environments in which migrants live;
3. Strengthening community actions by prioritising community-centred approaches that mobilise resources and assets within migrant communities, and building local capacities;
4. Developing personal skills by investing in language support and health literacy initiatives to develop migrants’ personal skills in their host country; and
5. Reorienting health services by promoting cultural and diversity-sensitive approaches to healthcare, and building a culturally competent health workforce that is responsive to the unique needs of migrant populations.
In conjunction with the year 2021’s theme for World Health Day, which is to “Build a Fairer, Healthier World” by eliminating health inequities, these reforms would be timely.
DR ALIA DANIELLA ABDUL HALIM
PROF DR MOY FOONG MING
and DR NORAN NAQIAH HAIRI
Centre of Epidemiology & Evidence Based Practice,
Department of Social & Preventive Medicine,
Faculty of Medicine,