URBANIZATION AND

IMMIGRATION
GROUP 12
 DEFINITION

URBANIZATION
 The process of global scale changing the social and environmental
landscape on every continent.
- WHO

IMMIGRATION
 the international movement of people into a destination country of which they
are not natives or where they do not possess citizenship in order to settle or
reside there, especially as permanent residents or naturalized citizens, or to
take-up employment as a migrant worker or temporarily as a foreign worker
- OXFORD UNIVERSITY PRESS
Source:
THE OFFICE OF
CHIEF
STATISTICIAN
MALAYSIA
DEPARTMENT OF
STATISTICS,
MALAYSIA 2015
CATEGORIES OF IMMIGRANTS
Family Class Immigrants

Independent/Economic Immigrants

Student Immigrants

Asylum Applicants
CATEGORIES OF IMMIGRANTS
 FACTORS OF IMMIGRATION

• Opportunities • Marriages • Family conflict

DEMOGRAPHIC

SOCIO-CULTURAL
ECONOMIC

for better • Fertility and the • The quest for

employment natural independence-
• Higher wages increase in younger
• Facilities population are generation
• Better working generally • Improved
conditions higher in rural technological
areas which facilities:
• Attractive
drift the
amenities
population
towards the city
 FACTORS OF IMMIGRATION

PUSH PULL
- unemployment - Employment
- Lack of services/amenities - Better service provision
- Poor safety & security - Safer environment (lower
crime rates)
- High crime rates
- Less risk of natural hazards
- National disasters (flood etc)
- Greater wealth/affluence
- Poverty
- Political security
- War
- Better quality of life
IN MALAYSIA

Source:
THE OFFICE OF CHIEF
STATISTICIAN MALAYSIA
DEPARTMENT OF STATISTICS,
MALAYSIA 2015
MEDICAL DISEASES AND IMMIGRANTS
 IMMIGRANTS AND NON -
COMMUNICABLE DISEASES
 Migrants with NCDs may be more vulnerable due to the conditions prevalent during their
travel
 Illegal migrants who do not have access to and are not informed about the availability of
healthcare may be a factor which influences the development or worsening of NCDs
among migrants
 NCDs have common characteristics that can make people more vulnerable when they are
refugees or migrants. NCDs:
 require the provision of continuous care over a long time, often for life;
 often require regular treatment with a drug, a medical technique or an appliance;
 can be associated with acute complications that require medical care, incur health costs and may
limit function, affect daily activities and reduce life expectancy;
 necessitate coordination of care provision and follow-up among various providers and settings;
and
 may require palliative care
 IMMIGRANTS AND COMMUNICABLE
DISEASES
 Communicable diseases are associated primarily with poverty.
 Migrants often come from communities affected by war, conflict or economic crisis and
undertake long, exhausting journeys that increase their risks for diseases
 Examples of diseases:
 HIV
 Viral hepatitis
 Tb, influenza (common respiratory tract infections)
 MERS-CoV
 Vector-borne diseases (Malaria)
 IMMIGRANTS AND COMMUNICABLE
DISEASES
 It is important to differentiate whether the disease was contracted locally or imported so that we
can assess the vulnerability towards the disease
 Importance of this?
 If locally contracted: indicates the success or failure of the vector control interventions within
the nation
 If imported: Related to migrant workers or visitors

 Vulnerability is likely to persist as Malaysia continues to attract significant populations of migrant

workers, tourists and students from endemic countries in SouthEast Asia, the Middle East and Africa
 .Additionally, undocumented migrants may continue to pose a challenge, as these populations
are hard to access and trace and the borders in certain areas are very porous
 In addition, the existing surveillance amongst high risk populations needs to be strengthened
despite the reduction in the number of cases.
 TB AND IMMIGRANTS
 By 2002, there were more than 45,000 people living with HIV who were vulnerable to TB
infection

 Migration related factors which contributed to the spread of the disease included:
 Increase in migrants (documented and undocumented)
 Increase in migrants from endemic countries
 Increase in urban migration

 These populations tend to stay in poorer living conditions where overcrowding and lack
of ventilation are common thus allowing easier transmission of the disease.
 TB AND IMMIGRANTS
In 2000, 10% of notified TB cases were in foreigners with majority (90%) from
Indonesia and Philippines. (Iyawoo K, 2004)

In 2003, a rate of 30% of foreign cases was reported among 425 patients at
the national referral centre. Rates were higher in men compared to
women. (Nissapatorn et al, 2007)

Lost to follow-up and transfer out was greater in foreigners compared to

locals. No difference in risk factors, new cases, smear negative cases.
 TB AND IMMIGRANTS

 3 out of 100 foreign workers who underwent health screening suffered from dangerous
diseases such as Tuberculosis (TB), Hepatitis B and AIDS
 Out of 1.27 million foreign workers screened, 3.0 to 3.5 percent failed the second
screening test for TB and other diseases
 Latest statistics in 2013, showed that a total of 16,751 foreign workers suffer from TB, and
these exclude illegal immigrants
 There are still foreign workers who failed their medical examination here even after
undergoing health screening in their country of origin.
 Health authorities also claimed that most medical certificates issued in their country of
origin were false and unreliable.
- FOMEMA
MALARIA IN MALAYSIA

 Malaysia is a nation that is vulnerable to malaria transmission from nearby

endemic areas, both within and outside the country.

 In 2005, imported cases accounted for 10.5 per cent of all national cases
with most cases coming from Indonesia, Papua New Guinea and sub-
Saharan Africa.

 As of 2009, the majority of cases were still indigenous (locally acquired), but
since 2011, the number of indigenous imported cases of human malaria has
reduced over time.
PREVENTION AND CONTROL OF
DISEASES IN RELATION TO IMMIGRANTS
 Health care access for immigrants

 Screening of immigrants

 Vaccination for new immigrants

 PREVENTION AND CONTROL OF
DISEASES IN RELATION TO IMMIGRANTS
 Amendments to the Medical Fees Act 1951 for Foreigners
 medical cost of foreign workers will be increased by 30% in 2015
 In 2016, it will be increased by another 30%
 subsequently be raised by 40% in 2017

 Enforcement of the Hospitalization and Surgical Scheme for Foreign Workers in 2011 by MoH
 mandatory medical coverage for all foreign workers with a premium of RM120 and a total
coverage of RM10, 000
 Until now, up to RM20 billion has been subsidized by the government for the health care of foreign
workers
 Unfortunately, for illegal immigrants, this treatment has not been given due to the irresponsible
conduct of some agents and middlemen ( surpass the health screenings and enter the country
without vaccination)
 National TB Control Program
 established in 1961

 Within the same year, the BCG vaccination program was introduced as one of the
strategies in the program

 In 1973, the TB team was established in each state in Malaysia

 In 1984, Directly Observed Treatment Short Course (DOTS) was implemented as the
treatment for patients and until today, it still continues as one of the strategies in the
National TB Program

 In 1994, it is place under the general medical and health system by following the
suggestion from the WHO and in line with the implementation of primary care concept in
Malaysia

 The current National TB Control Program managerial team is a sector under the Disease
Control Division, Ministry of Health, Putrajaya and the Advisor of the program is the Head of
Respiratory Medicine
 5 ELEMENTS OF DOTS

 Political commitment with increased and sustained financing

 Case detection through quality-assured bacteriology

 Standardized treatment, with supervision and patient support

 An effective drug supply and management system

 Monitoring and evaluation system, and impact measurement

 References
1. http://www.who.int/globalchange/ecosystems/urbanization/en/. WHO. Climate Change and Human
Health 2010
2. OxfordDictionaries.com. Oxford University Press. Retrieved 11 May 2016.
3. The Office of Chief Statistician Malaysia Department Of Statistics, Malaysia 2015
4. http ://www.nationalgeographic.com/xpeditions/lessons/09/g68/migrationguidestudent.pdf National
Geographic Society. (2005). Human Migration Guide, 6-8.
5. JKN Selangor, Ministry of Health, Malaysia
6. Foreign Worker’s Medical Examination Monitoring Agency (FOMEMA) report 2015
7. Millennium Development Goals 2015 Report
8. http://policy.mofcom.gov.cn/GlobalLaw/english/flaw!fetch.action?libcode=flaw&id=6c78b97f-6c22-
4f74-a8e0-25930007f3c7&classcode=330 Global Law. Laws of Malaysia. Prevention and Control of
Infectious Disease Act 1988
9. http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/migrant-health-
in-the-european-region/migration-and-health-key-issues WHO, Migration and health: Key Issues
10. Nur Hairani Abd Rahman, Khairiah Salwa Mokhtar. Challenges of National TB Control Program
Implementation: The Malaysian experience. 2014
11. http://www.who.int/tb/dots/whatisdots/en/index3.html The five elements of DOTS