By Sarah Green, BA Medicine, Health, and Society & History, Expected 2020
In 2015, the term “refugee and migrant crisis” was coined to refer to the ever-increasing number of asylum seekers in Europe. The number of refugees immigrating to countries in the European Union (EU) from non-EU member states reached over two million in 2017. Geopolitical tension, violence, climate-change related natural disasters, economic inequality, and diminished freedom across Africa and the Middle East prompted this mass migration. With more immigrants comes increased pressure on EU member states to accommodate the influx of people. Nationalist leaders, who have gained footing across Europe since the start of the decade, have blocked proposed common migration policies for European countries. By analyzing healthcare policy in Europe through the lens of migration, it is easy to see where disparities exist.
According to many European laws, especially Article 12 of the International Covenant on Economic, Social, and Cultural Rights, all individuals in Europe have the right to healthcare, regardless of citizenry. However, immigrants often slip through the cracks, as many are unable to pay the fees for care beyond emergency treatment. A phenomenon called the “healthy migrant effect” (the perception that immigrants are strong and healthy) undercuts immigrants’ often traumatic journey, their pre-existing conditions, and potentially, the underfunded healthcare systems in their country of origin. Immigrants from non-EU member states might only be familiar with emergency care, as the country they left might not have had primary care institutions. Lengthy office visits and poor understandings of migrants’ experiences contribute to substantial barriers to care. A bad experience at a European health care center can even turn immigrants away from seeking healthcare at all in Europe. Furthermore, language barriers can lead to poor medication adherence and noncompliance with treatment. Mass immigration poses significant challenges to healthcare providers too— navigating different understandings of healthcare, unfamiliar disease profiles (many migrants come from countries in epidemiologic transition), and unfamiliar languages and cultures can contribute to frustration between doctors and patients, and ultimately, form barriers for immigrants to access routine health exams and treatment.
Of course, immigration is so nuanced and complex that a solution to provide equitable citizenry, and therefore healthcare, for all those in Europe will not appear overnight. However, training healthcare providers in cultural competency— how to work effectively with people across different cultures— is a starting point to ensure positive healthcare experiences for migrants that will not deter them from seeking routine care. A 2018 case study from South Africa indicated that emphasizing cultural competency in the medical curriculum with more community-based research and increased language instruction improved healthcare delivery for minority populations. These improvements are general enough to be applied more broadly. Investment in language instruction is also critical to European healthcare providers, not only to increase cultural competency, but also to increase the number of translators available and doctors who can speak multiple languages with emphasis on languages spoken outside the EU. Additionally, the establishment of community health centers focused on immigrants’ care could be beneficial to both healthcare providers and immigrants.
In Europe, there exists a notion of a shared identity called the “European Idea,”  enforced by political unions such as the EU which sustain the concept of European-ness . Although the European Idea emphasizes unity, independent European nations have their own notions of citizenry and nationhood. Most European countries today exercise an assimilationist model, where immigrants who pursue citizenship accept their new country’s culture as their own and automatically become just as much a citizen as anyone born in that country. However, this égalité is more of a starry-eyed ideal, because in the face of mass migration, institutions like healthcare are put under so much pressure that they cannot adapt to serve vulnerable immigrant populations, especially refugees, who, being excluded from the basic rights guaranteed to Europeans, find it difficult to assimilate into their new country’s culture. It is also important to note that between 2016 and 2017, although immigration of people from non-EU member states to EU member states was 2 million, the number of people granted EU citizenship decreased by 17 percent. In conjunction with a recent rise in European populist voices critical of the EU gaining political traction, migrants’ freedoms and rights are on the line. Only one month ago, Susanna Ceccardi, the far-right anti-immigrant mayor of Cascina, Italy, described immigrants as exploitative “invaders” at an event for her campaign to earn a seat in the EU Parliament. Ceccardi became a right-wing star in Italy, premising that immigrants take jobs from Italian youth, who are facing unemployment rates of 30%. Sentiments such as Ceccardi’s further ostracize immigrants from citizenry-based rights in Europe.
It is difficult to say what the future holds for immigrants in Europe. The anti-immigrant politicians gaining traction now might lose ground in coming years, but their increasing popularity could have serious implications for migration to EU member states. Pressing issues such as climate change will inevitably produce more refugees with each year as more frequent natural disasters destroy peoples’ homes and land. Countries like Denmark, with xenophobia so pervasive that it has been institutionalized, are already grappling with protests over immigration policy. What we do know, is that migration to Europe has no end in sight, and in order to ensure the healthcare needs of every European citizen and migrant are met, changes must be made to the current healthcare system.
 Thorneycroft, Peter. “The European Idea.” Foreign Affairs (pre-1986) 36.000003 (1958): 472. Web.
 Brubaker, Rogers. Citizenship and Nationhood in France and Germany. Cambridge, Mass: Harvard University Press, 1992. Print.