OBJECTIVES: Health equity (HE) ensures equitable healthcare access for all, regardless of socio-economic status, identity, or background, and is a key WHO global health priority. Asylum seekers, refugees, and recent migrants in the European Union (EU) are often excluded from HE evaluations due to their temporary residence status, though many settle locally. This study examines inclusion of asylum seekers, refugees, and recent migrants hosted by the EU in data collection used for HE evaluation.

METHODS: Measuring health disparities among population subgroups is a standard approach for assessing HE. Characteristics such as socio-economic status and ethnicity are used to classify populations into subgroups, while unmet health needs is a metric measuring access to healthcare across defined subgroups. Data is often collected through household surveys that track expenditures on goods and services (including healthcare).

Methodologies and questionnaires for four surveys (household budget survey, EU statistics on income and living conditions survey, EU labor force survey, and European health interview survey) were reviewed to identify inclusion of asylum seekers, refugees, and recent migrants. Asylum seekers and refugees’ headcount was defined from Agency for Asylum and European Commission while unmet health needs data was collected from published literature.

RESULTS: Despite hosting 1.1 million asylum seekers and 7.1 million refugees in the EU in 2023, all surveys excluded these populations in national statistics on expenditures and healthcare services consumption. Primary reason for exclusion was an anticipated non-response rate due to linguistic barriers and misunderstanding of survey objectives. Only migrants with longer-term residence were included whose unmet health needs in Germany, Greece, Spain, and France in 2019 was 11.6%, while all residents in these countries experienced unmet needs ranging from 0.2% (Spain) to 8.1% (Greece).

CONCLUSIONS: Exclusion of vulnerable populations when measuring access to health may result in underestimation of health equity metrics which may be misleading for policy makers.