As part of a health promotion initiative, this issue of *La Santé en action* focuses on the overall health of vulnerable migrants, including health determinants, the environment, socioeconomic status, access to employment, healthcare, and preventive care, as well as life trajectories, past traumas, and mental health.

This issue provides an overview of the scientific knowledge, practices, systems, and programs implemented to address the health challenges faced by migrants.

The health of exiles (immigrants, refugees, asylum seekers, or undocumented foreigners) is generally better upon arrival than that of nationals of so-called host countries, but it deteriorates rapidly thereafter, due to difficulties in accessing care and, above all, the treatment they receive from the society where they hoped to build a new life.

This is the observation made by Didier Fassin, a physician, sociologist, and anthropologist who holds the Chair of Public Health at the Collège de France. Tracing back over a century of history, he questions this segmentation of a specific area of health—as if there were some unique aspect to migrants that justifies studying them separately—and demonstrates that their health depends largely on the conditions in which they are forced to live and work. We should speak less of “migrant health” and more of inequalities in the fields of public health and occupational health, while acknowledging certain specificities linked to experiences in the country of origin and during the migration journey, which can have serious consequences for their mental well-being.

Migrants’ Life and Healthcare Journeys: Multiple Inequalities

Migrant populations often carry invisible wounds—related not to physical but to mental health—such as a high prevalence of post-traumatic stress disorder and depression, which are still too often detected too late or not at all. Living and reception conditions often contribute to reinforcing feelings of isolation, loss of identity, and uncertainty that leave them vulnerable, when they are not subjected to racism or stigmatization. These vulnerable migrant populations find themselves at the intersection of inequalities related to origin, gender, and socioeconomic precariousness. They are also highly exposed to violence, as noted by the Defender of Rights and the Abbé-Pierre Foundation.

Improving migrants’ living conditions and, consequently, their health

In response to these situations, actions and programs can be implemented to improve the health of migrants in vulnerable situations. These actions are based on principles common to interventions with vulnerable populations of any kind, notably the pursuit of equity, contextualization, and the individualization of care.

This involves addressing both:

• systemic factors contributing to the creation of situations of vulnerability (stereotypes, prejudices, discriminatory practices, difficulties accessing institutions/government agencies);

• the development of individual and collective resources and skills (training and techniques tailored for professionals, communication with the public, support for participation and empowerment);

• the methods of health interventions with the public.

Beyond these support and care initiatives, the challenge lies in implementing a truly inclusive health promotion policy that would enable structural action on the social determinants of health (health insurance, housing, income, education, etc.) that impact the health of vulnerable populations.

A targeted communication initiative for migrants from sub-Saharan Africa

For several years now, Santé publique France has been implementing communication initiatives aimed at populations from French-speaking sub-Saharan Africa living in France.

• Africa Radio

A partner of Santé publique France for over 30 years, Africa Radio is the most established African media outlet in France. Every Thursday, the “Health Topic of the Week” segment addresses a different preventive health topic, such as vaccination, tuberculosis, HIV, nutrition, skin lightening, contraception, and many others.

• The Health Guest

The Health Guest is a social media initiative, particularly on Facebook, that complements the radio program. Short videos are published every Tuesday around 5 p.m. as a regular feature. They feature a guest from the nonprofit sector, the medical field, or an expert from Santé publique France discussing a prevention strategy. Since March 2020, a special production approach has been implemented for our COVID-19 videos.

• HIV Campaigns

A specific initiative was launched for the December 1, 2020, HIV campaign, involving the creation and broadcast of radio spots, as well as the production of testimonials from HIV-positive individuals for publication on social media.