The Drivers of Demand for Language Services in Health Care

Allison Squires

Societies with a rich diversity of skills and experiences are better placed to stimulate growth through their human resources, and migration is one of the ways in which the exchange of talent, services, and skills can be fostered. Yet migration remains highly politicized and often negatively perceived, despite the obvious need for diversification in today's rapidly evolving societies and economies.

(Appave & Laczko, 2011: 15)

Figure 1.1 illustrates the current complexity of global migration. Geographically, individuals tend to migrate first within their country, usually from rural to urban areas. Reasons for domestic migration may include changes in local conditions that force migration owing to economic (job seeking or employment changes), political (conflict or war), educational (degree or training seeking) or ecological reasons. If international migration occurs, this may happen first within the local region (e.g. South Asia) and then internationally. The most common pattern is from a low or middle income country to a high income country. Additionally, an individual's education level will often dictate how migration occurs, whether it is voluntary and driven by a confirmed opportunity, voluntary and driven by potential opportunity, or involuntary driven by a variety of reasons.

More than ever before, individuals migrate to other countries primarily for work opportunities when career advancement opportunities arise, their local economies do not produce enough opportunities for paid employment or when underemployment prevails. War and conflict zones may also drive workers from their country temporarily or permanently and transferring the skills of these migrants can prove challenging (The International Bank for Reconstruction and Development 2011; Appave & Laczko, 2011; Docquier et al., 2009). Nonetheless, migration for work often benefits many workers as they develop new technical, social and linguistic skills that may make them more competitive in their originating country labor markets and act as buffers against economic shocks (Durand & Massey, 2010; Siqueira et al., 2013; Walani, 2013; Shihadeh & Barranco, 2010; Bartram, 2010; Hagan et al., 2011; Tilly, 2011; Docquier et al., 2009). Migrating workers are also major contributors to the global economy through remittances: earnings sent back to the home country to the migrant's family often to pay for housing and healthcare costs (Carling, 2009). In 2014, the World Bank estimated that remittances sent home by migrating workers contributed US$400 billion to the global economy and would increase by 7–9% annually through 2020 (The World Bank, 2016). With international travel easier than at any other point in history, the 21st-century worker has a high probability of migrating permanently or temporarily for work at some point in their lifetime.

Yet as a global phenomenon, 21st century global migration patterns are changing health services delivery in countries around the world. For some healthcare systems, this presents new demands on service delivery while others see increased challenges on already stretched ones. Changing countries is stressful in good and bad ways and often impacts individual and family health. Legacies of origin country health system strengths and deficiencies will travel with the migrant in terms of their health profile. Whether they are an investment banker who has moved from New York to London or an internationally educated nurse from the Philippines who moves to the Middle East to staff healthcare systems or a Central American migrant fleeing stagnant economies and drug violence, newly arrived migrant workers undergo a transition period, often known as culture shock. The stress of the transition often affects their mental health as some individuals adapt more readily than others to new cultures, contexts and stressors while others may develop depression, anxiety and other mental health sequelae that affect their physical health, all as a direct result of their migration experiences and sudden absence of traditional support systems (Rudmin, 2010; Bauer et al., 2010; Riggs et al., 2012; Viruell-Fuentes et al., 2012; Teruya & Bazargan-Hejazi, 2013; Lassetter & Callister, 2008). Even though the cumulative causation of migration may increase social networks and support systems abroad (Fussell, 2010; Sanderson & Kentor, 2008) that may lessen the effects of migration experiences on health, the phenomenon's effects on health are complex.

Consequently, migrants may or may not access the healthcare system in their destination country when needed. Several factors influence these behaviors. First, insurance schemes play a large role in whether or not the migrant accesses the local healthcare system simply owing to whether or not they can get coverage in their new country. Even countries with universal health coverage do not necessarily provide coverage to new immigrants (Biswas et al., 2011; Docquier et al., 2009; Reyes & Hardy, 2015; Siddiqi et al., 2013). The second major factor is a language barrier. Even if a migrant comes from a country, for example, where English is an or the official language and has migrated to another English-speaking country, the language of healthcare systems and illness descriptors can be different enough to affect how and when the migrant accesses the healthcare system...