2.3. Migration

The impact of migration on overall growth varies very much by country, but generally in many countries its contribution has increased over time. However, it’s unrealistic to believe that migration can offset the enormous inertia of population ageing in the EU. Nevertheless, migration can smooth the ageing pattern providing extra time for the policies to adapt.

Migration to EU countries has been constantly increasing over the past 25 years. For the European population at large, the relevant net gain in international migrants accounts for 70% of the overall population growth. In the European Union, there are about 25 million migrants (non-nationals). Most of them originate from Mediterranean countries and former colonies. During the past 20 years, Europe experienced very important annual increases of inward migration and over the last 5 years, EU net migrant inflows reached an annual level of 2 million. Increased immigration flows are mainly due to strong and persisting push and pull factors related to globalisation and the North-South divide in terms of demographic trends and welfare standards.

The EU is set to remain a popular destination for migrants over the coming decades. Eurostat’s conservative projection is that around 40 million people will immigrate in the European Union between now and 2050. As many of them are working-age migrants they will bring down the average age of the population. However, the longer-term repercussions remain uncertain, as they depend on the more or less restrictive nature of family reunification policies and birth patterns of migrants. Despite the current flows, immigration can only partially compensate for the effects of low fertility and extended life expectancy on the age distribution of the European population.

In relation to skill level, Europe attracts less high skilled immigrants and more low skilled immigrants compared to the USA, Australia and Canada, while vacancies in highly skilled jobs are increasing. In relation to labour market participation, participation/ employment rates of immigrants and their descendents remain low in many Member States. Illegal migration contributing to irregular work remains high. Almost in all Member States the integration of immigrants represents an important issue. Immigrants are among the most vulnerable groups. The fight against discrimination represents an important dimension of this issue.

The influx of migrants in the EU may impact on health services demand. Poverty and social uneasiness among non-EU immigrants together with the wide diffusion among immigrants coming from specific areas of diseases almost absent or assumed to be eradicated in the EU (e.g. tuberculosis, malaria, Hansen disease, leishmaniosis and filariasis) may lead to further problems. Migrants may have difficulties in accessing health care services, they may be unable to use them adequately and the quality of the health care services provided to them may be lower than in general. Migrants' cultural beliefs and language barriers may impact on attitudes to and use of health care services. On the other hand, health workers may be less able to observe problems among immigrants affecting the efficiency of care. This makes additional training necessary for healthcare personnel in order to make them able to respond sensitively to the needs of immigrant populations. The health status and the use of health services among immigrants may be improved by providing appropriate and qualified interpreting and translation services. A special concern is the descendents of migrants, which may face special health and social problems. Moreover, voluntary pregnancy termination shows that abortion rates are much higher for foreign than for European women.

Female Genital Mutilation (FGM) is not only an important issue in Africa, the Middle-East and Asia where it has been traditionally practised, but due to the arrival of immigrants, refugees and asylum seekers from these countries FGM has now also become a European concern. It is estimated that in the European Union alone, 500 000 girls and women are affected or threatened by the practice of FGM. The magnitude and serious medical and social consequences of this practice in Europe and, moreover, the human rights that might be violated by it, should not be underestimated.

The number of children born to immigrants usually reflects the cultural background these immigrant groups have lived with in the past. Over the last decades, first generation immigrants from Western Asia and Northern Africa had higher fertility rates than non-immigrants. However, their children, the second generation, have much lower rates, mostly only slightly more than the non-immigrants. Childlessness is rather rare among minority groups, although a bit rising. Fertility of immigrants from Western countries (EU Member States, Northern America, and Japan) does usually not deviate very much from non-immigrants.

Within the EU, a significant population movement is occurring from EUNMS to EU15 states, where in general they are economically active and fulfil and important skilled and unskilled workforce role. However, they (and their family dependants) may present specific challenges to health systems, not least if they are not fluent in the language of their new country of residence. Their outward movement may also reduce the healthcare workforce in their countries of birth and training