Imagine every child healthy: Transforming paediatric migrant health through participation and collaboration in Europe

Abstract

Without exception, the EU countries have signed the Convention on the Rights of the Child that affords all children and adolescents the right to healthcare without discrimination. To realise this right, it is essential to focus on those whose health needs have often been neglected: There can be no public health without refugee and migrant health.^{1, 2} In Europe, one in four children are either foreign-born themselves or have foreign-born parents.³ Children and adolescents represented 25% of the total number of first-time asylum applicants recorded in 2022; with one in six of them travelling unaccompanied.⁴ As the years of childhood and adolescence are critical for sustaining lifelong health and well-being, minors deserve our special attention among people on the move. If their specific health needs and vulnerabilities are met, they have enormous potential to drive and enable sustainable development of their new communities.⁵

Migrant health is a highly dynamic and rapidly developing field. Early research centred on ‘unusual’, often infectious, diseases in minority ethnic groups. Later research trends placed emphasis on the study of biological differences, with a focus on genetically inheritable diseases, before turning to explore behavioural and biological differences at the population level.⁶ All of these approaches carry the risk of inadvertently entrenching the perception of migrants as ‘others’ in contrast to the native population rather than focusing on the unique circumstances of each case. Therefore, as early as in 1984, researchers emphasised the need to rethink migrant health systemically.⁷ Today, the migration experience itself has been shown to significantly influence the well-being of the migrating children and adults as well as the children born to migrant parents.^{2, 6} It is now a crucial task for public health research to explore how the experiences related to migration interact with other recognised social determinants of health, such as age, gender, legal status, education and discrimination. Such comprehensive research approaches are needed to enable researchers and clinicians to address structural health inequalities affecting a significant part of Europe's population, and effectively enhance public health.

More recently, paediatric migrant health emerged as a distinct field within migrant health. This development acknowledges that the effects of migration on children and adolescents are different to those on adults. A basic concept of migrant health is the migration cycle describing how stressors and risk factors encountered before, during, and after their journey give rise to specific health needs and vulnerabilities.⁸ For minors in particular, the health impact of the changing environment and context experienced during and after their migration journey highly depends on the persons they travel and live with and the person's material, social and cultural resources. Risks of experiencing violence increase significantly if minors, and in particular female ones, travel unaccompanied.⁹ The health effects of risk factors also vary considerably depending on the child's age and psychosocial developmental stage. Children born to migrant parents after completion of the travel and transit phase face again distinct experiences and challenges. Based on the migration cycle for adults, we therefore suggest a modified paediatric migration cycle, highlighting these important differences (Figure 1).

Unfortunately, many European health systems are still ill-fitted to serve paediatric migrant populations.^10-12 A lack of contextualised, high-quality evidence on migrant child and adolescent health in Europe hinders progress. This is underlined by the most recent WHO report on refugee and migrant health that underscores the absence of comparable data across countries and over time and regrets the scarcity of intervention research.¹³ The main influencing factors of migrant healthcare delivery are summarised in the 3 C model: communication, confidence of migrants in their healthcare providers and their own ability to influence their health outcomes and continuity of care.¹⁴ The much-needed improvements in these areas are slowed down by legal, financial, discrimination, and language barriers which present significant opportunities for further research.^{10, 14-16}

The Confederation of European Specialists in Paediatrics (CESP), renamed the European Academy of Paediatrics (EAP) in 2001, was established in 1961 and guided by a collaborative spirit: Paediatricians across Europe recognised the need to collaborate across borders to realise the shared vision of all children and adolescents in the EU growing up healthy.¹⁷

Previous international EAP initiatives to improve the health of migrant children and adolescents have resulted in recommendations and practical guides,¹⁸ explored primary care providers' perspectives on migrant health¹¹ or worked on the integration of migrant health knowledge in European training programs.

The Refugees and Migrants in Europe—Adolescent and Child Health (REACH) network, established in 2023 as a Strategic Advisory Group of the European Academy of Paediatrics (EAP), seeks to further leverage the potential of international collaboration and participatory research approaches to improve paediatric migrant health. The network comprises paediatricians and other healthcare workers from multiple European nations. It provides a platform to further the research, advocacy, and educational agenda for paediatric migrant health in Europe. Working closely with non-medical stakeholders, the REACH network strives to implement sustainable, participatory research approaches that emphasise regular participation and shared decision-making power.

The first project of the REACH strategic advisory group is the MIgrant Child & Adolescent health—Research in Europe Priority Setting Partnership (Mi-CARE PSP), following the standardised approach of the James Lind Alliance.¹⁹ The participatory health research approach involves researchers, paediatric migrant healthcare workers, migrant children and adolescents and their caregivers. It has been proposed as an effective remedy for the current mismatch of available data and needs. It also holds the potential to foster trust between patients, researchers, and healthcare providers and enhance the relevance of the resulting evidence.²⁰

More than 30 years after the adoption of the Child Rights Convention, there are still considerable gaps in research and healthcare provision within the realm of paediatric migrant health in Europe. The REACH network's mission and approach are based on the conviction that it is high time to fill these gaps. By joining forces to prioritise the well-being of migrant children and adolescents, we will foster healthier and more resilient communities for everyone.

The REACH network is open to welcoming new members – researchers, paediatric migrant healthcare workers, or caregivers of migrant children and adolescents – who share our vision of all children in Europe receiving the best possible healthcare. Please visit the website www.eapaediatrics.eu/advisory-groups/reach and write to [email protected] if you would like to become a member.

Veronika Wiemker: Conceptualization; writing – original draft; writing – review and editing; visualization; investigation. Ruud G. Nijman: Conceptualization; writing – review and editing; investigation. Julia Brandenberger: Conceptualization; writing – review and editing; supervision; investigation.

The authors declare that no funding was received for the preparation of this manuscript. An Academy of Medical Sciences (AMS) networking grant (NGR1\1167) enables the referenced research prioritisation exercise.