Impact of Inclusive Policies on Health and Clinical Outcomes of Noncitizen Migrants: A Systematic Review

Abstract

Background: Globally, authorized international migration and unauthorized border crossings are on the rise, especially from developing countries to More Economically Developed Countries (MEDCs). This surge in immigration has led to changing demographics, increased anti-migrant sentiments, and hostile policies towards noncitizen migrants within MEDCs. Receiving countries are instituting policies at multiple levels to restrict noncitizen migrants from accessing public benefits including health care. These exclusionary policies have been widely investigated and noted as a determinant of poor health and clinical outcomes amongst noncitizen migrants. However, migrant-inclusive policies geared towards mitigating the unintended and intended consequences of unequal access to public benefits (including health care) for noncitizen migrants are understudied. We defined key concepts and operationalized descriptors of migrant inclusive policies and policies to ensure access to publicly-funded health interventions for noncitizen migrants as inclusive policies. The purpose of this study is to comprehensively review the current evidence on the impact of inclusive policies on health and clinical outcomes of recently arrived and undocumented migrants in MEDCs. Methods: This Systematic Literature Review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, CINAHL and ECOHOST for English only peer reviewed publications conducted in MEDCs between 1998 and 2018. Three reviewers screened titles, abstracts and full texts using Covidence systematic review software. Data on study characteristics, outcome categories, policy type, direction of health impact and study quality were extracted. Results: We identified 8,318 potentially relevant citations from which 598 articles were retrieved for screening. Twenty-three publications were included in the final analysis (15 from United States, 6 from other countries and two Pan-European studies.) Of these, nine studies described maternal and child health outcomes, ten studies examined mental health and general wellbeing, three studies assessed chronic disease treatment outcomes and one study reviewed outcomes associated with early access to preventive services and routine care. At the policy level, only one study examined the impact of sanctuary cities on health and clinical outcomes of non-citizen migrants. In general, inclusive policies were associated with increased prenatal services utilization, reduction in mental health issues, improvement in self-rated health and reduction in socioeconomic vulnerabilities amongst non-citizen migrants. Concerns around health insurance interruption, problematic referral pathway, legacy of racism and social stress associated with inclusive policies were noted. Conclusion: Although most previous studies focused on the health impact of restrictive and exclusionary policies on migrants, this study synthesizes current evidence on inclusive policies. A consistent finding was that inclusive policies were positively associated with health and clinical outcomes of noncitizen migrants except in three out of the twenty-three included studies where they were found to have neutral or negative associations. Continuous investments in inclusive policies could be key in the achievement of the global vision of ensuring healthcare for all and furtherance of global health goals. Future studies on inclusive policies could benefit from innovative data collection strategies, incorporation of new inclusion and integration assessment tools as well as epigenetic and cultural intelligence studies. We anticipate that findings from this study will enhance inclusive policy efforts and help policy makers in designing appropriate supportive health interventions that target noncitizen migrants. Also, it could better inform various stakeholders in MEDCs as they deliberate on the future of existing inclusive policies. In all, with political commitment, progress towards ensuring a minimal global standard for migrant health that is right-based and rooted in the public health concepts of safety and equity is attainable. Public Health Implications: In view of the surge in international migration and apparently increasing exclusionary policies within MEDCs, innovative policies to ensure continued access to healthcare to all vulnerable groups including noncitizen migrants are vital to reducing the global burden of diseases, decrease the cost of healthcare and ultimately attain health equity goals.