Developed economies, including Australia, have increasingly been using international migration to compensate for demographic trend and skill shortages. Australia has one of the highest proportion of overseas-born people in the world: an estimated 26 percent of the total resident population was born overseas. This is expected to increase over the next decade.
So the health of immigrants and their use of health services are having increasing impacts on demands on the health system, its responsiveness, and the national health profile.
One of the most significant demographic trends in Australia today is the ageing of the population. This is an increase in the share of older people -- defined as people aged 65 and older -- relative to the youth (0 to 14 years) and working-age population (15 to 64 years). One in six Australians is now over 65, compared to one in seven in 2011 and only one in 25 in 1911.
The reasons for this trend are complex. These include the impact of the "baby boomer" generation and declines in fertility and mortality, combined with an increase in life expectancy.
Older people are living longer, which is an achievement of our health system. But an increase in life expectancy and decline in the death rate have created a paradoxical situation in which these older people have increased the country's rates of illness and disability. This has led to a rise in health-care costs and an increase in use of health services, as well as hospitalisation.
While an ageing population adds to the burden on the health system, an intake of migrants who are generally young and healthier than the average Australian, due to their selectivity, might help balance this out. So, in fact, increasing migration would be of benefit to Australia's health.
Australian immigrants are healthy
Australia uses something called the "points system" to determine the eligibility of most of those who apply to immigrate here. Points are given for productivity-related factors such as language, education, age (more points are given to younger applicants) and skills.
But it is reasonable to assume the points system would not apply to English migrants who arrived before the abandonment of the White Australian policy in 1973 and to New Zealand migrants. Together, these two groups make up a large proportion of the migrants from English-speaking countries. The points system also does not apply to those who migrate under the family, special eligibility, and humanitarian and refugee programs.
Having said that, skilled migrants selected under a points-based system make up most (around 68 percent) of all migrants in Australia. The rest (32 percent) taken in under the migration program come in through having a family member here.
Skilled migrants (and in many cases, their dependants) go through medical screening to meet minimum health requirements. The Department of Immigration and Border Protection specifies that, to meet the health requirement, an applicant must be free of a health condition that is:
- considered to be a threat to public health or a danger to the Australian community
- likely to result in significant health care and community service costs to the Australian community
- likely to require health care and community services that would limit the access of Australian citizens and permanent residents to those services as these are already in short supply.
Humanitarian migrants have a health waiver provision, but they make up a very small proportion of the total migration program.
Research has shown that immigrants tend to have better health status that the Australia-born populations. This health advantage narrows significantly over time, leading to their health becoming similar to that of Australians.
Migrants' contribution to the workforce
Immigrants make up a substantial part of the health workforce in Australia. The international movement of health professionals is a major component of migration. Australia has been dependent on international medical graduates for a long time.
For example, according to an estimate by the Department of Health and Ageing, international medical graduates comprise about 39 percent of the medical workforce in Australia and 46 percent of general practitioners in rural and remote locations. Another estimate suggests 53 percent of medical practitioners in Australia are foreign-trained.
The dependence on international doctors will likely be maintained in future for a variety of reasons, such as to redress medical workforce maldistribution. Given Australia's ageing patient and practitioner base and some key areas of the health workforce already in very short supply, this contribution of migrants is significant for Australia's health profile.
Monitoring the health and well-being of immigrants is important for the overall health and public health systems in Australia. The issue of migrant health has become additionally important because the goal of Australia's migration program has moved towards meeting the labour market needs of the economy. Good health is essential to fully realise the social and economic potential of immigrants.
We must also continue to collect and examine data on the health care needs and health service utilisation of Australian-born and foreign-born patients. Finally, we must educate ourselves about important contributions migrants make to ensure informed decisions are made to protect the public health system.
Population growth has profound impacts on Australian life, and sorting myths from facts can be difficult. This article is part of our series, Is Australia Full?, which aims to help inform a wide-ranging and often emotive debate. You can read other articles in the Is Australia Full? series here.