Migration, Urbanism and Health: Moving Toward Systems-Informed Policy and Practice

Content sections

1. Key messages

2. Introduction

Migration and displacement have become increasingly salient issues in the global health landscape. The vulnerabilities and opportunities associated with mobility and urbanization need to be better addressed and accounted for, particularly given that migrants and displaced people represent a heterogeneous group with varied circumstances, experiences and contributions.

Migration and displacement are key determinants of health, potentially affecting epidemiological patterns of chronic and infectious diseases, mental health issues, among others. Additionally, migrants and displaced persons may face barriers in accessing healthcare and other basic services (e.g., water, sanitation, housing, safe and nutritious food, safe and fair employment) due to language, cultural, or economic factors. They may have elevated risks of injury, either during the migration journey or because of unsafe living or working conditions at their destination country.

Migration to urban areas, whether between or within countries, is a defining issue for cities. Increasingly, urban health planning is considering migration patterns, migrant health characteristics and migrant-inclusive services. While global dialogue often focuses on international migration, internal migration, especially in low- and middle-income countries (LMICs), is more prevalent. Specifically, rural to urban migration is a modern feature of LMICs, particularly given the impending effects of climate change and loss of rural livelihood options.

Urban health challenges are uniquely shaped by migration through several mechanisms. Migrants may concentrate in underserved neighborhoods where infrastructure is inadequate, increasing strain on services such as housing, sanitation and healthcare. Urban planning systems may not be responsive to undocumented populations or people on the move, creating mismatches in service provision. Further, migrants may experience exclusion from formal systems of social protection and labor, compounding vulnerability in environments already marked by inequity. These dynamics require integrated responses across sectors and levels of governance.

This paper considers both international and internal migration—including rural-to-urban migration—focusing on how these forms of mobility affect health equity in urban settings, particularly in LMICs. It explores the relationships between migration and urban health and outlines potential implications for policy and practice. It examines how urban health advocates, practitioners and migrants themselves might respond to migration challenges and considers holistic approaches to urban health in the context of migration.

3. Urban health and migration: what do we know?

3.4 Migrant-inclusive urban health: A systems framework

To promote urban health that genuinely includes migrants, changing the functioning of the health system alone, while crucial, is insufficient. For instance, reducing high risks of road traffic fatalities or respiratory disease due to air pollution among migrant workers depends not only on including them in data collection by health information systems, design of appropriate health promotion information, and access to health services, but also on policy decisions within the transport, energy, and planning sectors, among others. And, vice versa: even if health promotion activities and health services are geared to include migrant workers, services may go unused without accurate data about which groups of workers are affected and how to reach specific groups, such as day laborers, who may be reluctant to lose wages to seek care.

Figure 1 proposes a migrant-inclusive urban health framework to indicate various systems that might interact to affect the health of migrants. The outer spheres of Figure 1 represent multiple systems that can affect health beyond the health system alone. At the centre are “people”, “communities,” and “cities” to indicate that these systems behave in ways that affect individual migrants, migrant subgroups (as defined by nationality, legal status, work sector, etc.) and the health patterns of urban populations of migrants and non-migrants. These systems can also influence epidemiological risk and outcome patterns (e.g., infection and non-infectious diseases, nutrition, mental health) that include or exclude migrant groups and determine how well health information systems track disease patterns. Similarly, actions of multiple systems, such as immigration systems, health systems and employment practices, often combine to determine whether migrants are exposed to health hazards, whether they know their rights and entitlements and whether they work in safe and fairly paid jobs. Finally, civil society often fills in gaps where health systems or government services are not available for migrants.

Figure 1. Systems-informed urban health response to migration-related health needs.

The systems framework suggests that creating inclusive urban health will require going beyond health sector services, and addressing the important integration influences, such as social networks and community engagement, which can provide highly valued psycho-social support and help communicate health-related information.²⁵ Central to all these health-inducing factors are legal structures and budget allocation systems to support migrant health amidst increasing urbanization. Evidence suggest that these frameworks are crucial in ensuring migrant health: non-health-targeted public policies can significantly affect migrant health.²⁶ This underscores the need for a holistic approach to migrant health that considers the broader policy environment. Policies that promote social inclusion, provide easier access to healthcare, and support economic integration can significantly improve health outcomes for migrants.

A strategic and integrated approach to migration and urban health²⁷ must rely on the recognition that migration health is influenced by decisions made at various levels, from global to local, within and beyond the health sector. The ethical challenges in these decisions impact the provision and accessibility of healthcare services; it is crucial to consider specific ethical dimensions and vulnerabilities in each context.²⁸ Values such as solidarity, duty, equity, trust, and reciprocity, are central to addressing the health needs and rights of migrants.

Moreover, migration requires effective multilevel governance of migration-related issues at local, national, and international levels. At the local level, this means building alliances and partnerships, raising awareness in the population, and supporting the development of migrants’ potential in their new home. In many contexts, the spontaneous formation of numbers of local, voluntary associations and groups is quite common, driven by a moral duty of care. These can be extremely valuable because they develop detailed knowledge and respond quickly during emergencies. Local authorities need to support and involve such groups, especially where emergencies become prolonged. Because such groups often support undocumented migrants, on the edge of legality, they may be excluded from government action, yet this may set up serious tensions and conflicts within the local population.

To address this multiplicity of influences requires a holistic approach that encompasses all aspects of migrant health, including decent housing, access to basic services, social participation, decent work, emergency preparedness, and mutual support and social cohesion with native populations. A holistic approach transcends the strictly medical aspects of health care, recognizing the importance of a broader perspective for achieving migrant health in all aspects of their lives, and therefore public health for all. Promoting healthy lifestyles and prevention among migrants is also critical to long-term health trajectories, as exemplified by the long-term experiences of the WHO Healthy Cities project.²⁹

4. Data and research: what evidence is needed to promote urban health equity?

Strategic, integrated action to improve urban health and health equity in the context of migration requires accurate, efficient, and timely data that builds on the existing evidence base. Below we highlight priority areas for new research. In addition to those highlighted, the first WHO Global research agenda on health, migration and displacement outlines key global research priorities and acts as a framework and guide for prioritizing research in this area.³⁰ This framework can be used as a catalyst for further research in emerging areas such as urban health and migration, and to strengthen research activities and translation into policy and practice on the topic at regional and national level.

Priority research areas

A local and global lens. Detailed information on local urban settings is important for understanding and developing context-specific interventions to improve urban health and health equity in the context of migration. However, understanding global factors influencing the movement of people—particularly between and within low- and middle-income countries in the Global South, which host the largest numbers of migrants—is critical not only to global and regional action but for local interventions. Cross-country research on migration and urban health would supplement focused local studies by learning across two or more countries, e.g., using comparable administrative data, to examine key questions (see below).

Population mobility. Population mobility tracking, both between and within countries, will help understand how urban settings affect health and vice versa. Some countries have adopted dispersal policies for new arrivals, particularly for refugees and asylum seekers, seeking to deconcentrate migrant groups and to match them to available resources such as housing and health services.³¹ However, the tracking of mobility—particularly when involving personal or location data—may lead to unintended consequences, such as privacy violations, inappropriate use of data beyond public health purposes (e.g., for immigration control), or feelings of being monitored among migrant populations. These risks can reduce trust in health systems and discourage participation in research or public services.

To mitigate these risks, it is essential to apply strong ethical safeguards: ensuring informed consent, protecting data anonymity, establishing clear limits on data use, and involving independent oversight. Participatory approaches that engage migrant communities in the design and governance of data systems can further enhance transparency, trust, and relevance. On the other hand, understanding the factors driving mobility within countries, including both push and pull factors, to and away from and within urban contexts, and circular and seasonal migration is important for urban health decision-making.

Pandemics and other health stressors. COVID-19 had a significant effect on the flow of migration between and within countries and threw a spotlight on urban health inequities, including the role of the built and social environment and health resourcing. Data collected over the pandemic about health impacts and inequities and examining this through a migration lens are important both in terms of learning about some of the drivers of health inequities and in terms of preparedness for future health events – e.g., decision making about distribution of health infrastructure and resources and consideration of specific requirements of migrants in any public health measures.

Structural drivers. Complex upstream and downstream determinants of health influence outcomes in urban settings and understanding the structural drivers of urban health inequities associated with migration will contribute to informed health decision-making. For example, policies of nation states vary regarding settlement of migrants, including refugees and asylum seekers. These policies include immigration laws (e.g., mandatory detention of asylum seekers arriving by boat in Australia or regional resettlement policies that direct new arrivals away from urban areas). Influential policies also include housing and industrial relations policies that intersect with immigration policies (e.g., lack of social housing, poor social security safety nets). The Health in All Policies approach, championed by the WHO, emphasizes that non-health sectors should consider health impacts. Examining, for example, how migration and other policies affect health would provide evidence to transform policy- related structural drivers.³²

An intersectional approach. In addition to structural drivers, migration related-health inequities in urban settings are also influenced by oppression and discrimination, such as racism, sexism, agism, ableism, and heteronormativity.³³ It is essential to understand how these systems impact health, both in the policies around migration and the day-to-day experiences of migrants in urban areas. For example, policies can affect housing or employment discrimination and inequitable resource distribution for health and other services that are targeted away from areas of high migration settlement.

Two-way integration. Integration is a two-way process of mutual accommodation between incoming and receiving communities and affects the health of migrants. However, research has tended to focus on the extent to which migrants are able to adapt to their new communities (e.g., securing work, housing, etc.), rather than how receiving communities may themselves adapt and change.³⁴ Further data are required in urban settings on attitudes towards accommodation of receiving communities as well as the effectiveness of interventions to improve receiving community social environments (e.g., the Welcoming Cities initiative in Australia that accredits local areas for their efforts to promote inclusion and diversity³⁵) and examination of the ways that employment or other systems evolve and adapt to respond to the needs of migrants.

Political will. More evidence is needed on the social and economic impacts of migration at the levels of cities and whole societies and on how different migration policies affect a range of societal goals. A better understanding of how to secure benefits and counter potential risks from migration will inform political debates and counter xenophobia, while opening the door to more effective approaches to urban health.

Nature of approaches and types of data. Advocacy for improved health equity in urban settings requires the centering of lived experience, both of incoming and receiving communities, making the voices of refugees and migrants heard through participatory research approaches. It is also crucial to have intersectional and interdisciplinary approaches, including mixed-methods designs, for data collection and analysis in migration and urban health research.³⁶ Research efforts should also be supported by data linkage approaches that enable existing datasets to be integrated and re-used to answer more comprehensive questions spanning focus areas. Longitudinal research designs are particularly important, as they can answer questions about causality, long-term health trajectories, and time-lag effects of urban migration on health outcomes. Furthermore, applying complex systems thinking³⁷ and implementation science can provide unique perspective on the upstream structural and social determinants of health in urban settings. These methodologies not only capture the interconnectedness of influencing factors, but can also enhance the translation of evidence into policy and practice by identifying leverage points for action.

Despite the expanding literature on migration and urban health, several critical gaps persist. Much existing research is fragmented, limited to descriptive studies, or focuses narrowly on access to health services, often overlooking structural, political, and systemic factors that shape health outcomes. There is a lack of longitudinal and comparative studies that examine causation, temporal dynamics, or policy effectiveness. In particular, insufficient attention has been given to how intersecting factors compound health inequities in urban settings. Additionally, limited data availability, inconsistent definitions, and ethical concerns around data use (especially in mobility tracking) hinder deeper insights. Addressing these limitations is essential to informing more effective, context-sensitive, and equity-oriented urban health policies and practices.

5. Conclusion

For urban health strategies to be effective, governments and other decision-makers must take account of the contemporary reality of population mobility and the fundamental contribution of migrants to the functioning of cities and urban health. This directly responds to the recognition that migration and displacement are key determinants of urban health and that migrant workers consistently support urban infrastructures. To promote inclusive urban health responses, decision-makers must remain alert to practical health-promoting strategies that do not expect migrants to reach the services, but instead reach out to migrants where they live and work, including interventions such as outreach initiatives and mobile clinics, as well as ensuring that policy settings are reflective of people’s needs.

Recognizing the social determinants of health of migrants who may be exposed to multiple health risks, also means adopting systems science perspectives.³⁸ Systems science perspectives recognise the complexity of health influences and the interactions between health intervention opportunities. To promote urban health that includes mobile populations, strategies need to go beyond narrow ‘health systems’ approaches by harnessing the interactions between the many health-influencing systems (e.g., immigration, financial, social, political). This reiterates the call for a systems-informed, holistic approach to urban health—one that addresses not just healthcare access but also the structural and policy-level drivers. Evidence repeatedly indicates that establishing good coordination between these multiple systems will help advance migrant-inclusive urban health responses.³⁹ Hence, legal frameworks must evolve and that intersecting systems must be aligned to address health risks effectively.

Among the greatest risks to inclusive urban health in most settings are the political winds that fuel the fires of discrimination against diversity. Xenophobic and exclusionary rhetoric readily hinders the gears of those systems that could be including migrants in one-health strategies. Future urban health depends on building political will for change and on migrants and non-migrants joining together to design systems strategies that treat health as a mutual priority, because “there is no they but only us”.

Therefore, to promote urban health, it is fundamental to prioritize migrants’ health by ensuring policies that are built on evidence-informed decision-making. Doing so will not only address immediate service gaps but prepare urban health systems to respond to emerging challenges such as climate change, future pandemics, and geopolitical shifts—macro factors that will continue to shape migration patterns and outcomes.

Ethics and consent

Ethics and consent not required for the performed study.