Barbarians at the gate: storming the Gothenburg consensus.

The concept, techniques, and applications of health impact assessment (HIA) hold promise to raise the profi le of health within the overall project, policy and programme planning, and assessment cycle. HIA in the public sector has progressed over the past two decades with a strong Eurocentric focus on transportation and social programmes and policies. In 1999, the publication of the Gothenburg consensus from WHO’s European Centre for Health Policy further enhanced the visibility of HIA, but achieved little to put its high ideals into operation. By contrast, the private sector HIA has had a more focused history, with an emphasis on large industrial projects in the developing world with rigorous adherence to assessment protocols. Has the post-Gothenburg HIA movement expanded beyond being Eurocentric and moved towards a global perspective? These considerations are relevant clear focus on the health needs of vulnerable migrant populations is needed to prevent inequalities in health outcomes for tuberculosis due to limited access to health care, which prevents migrant populations from accessing information that would enable them to avoid tuberculosis or to obtain early diagnosis and treatment. Ensuring access to and proper diagnosis and treatment is not only important from a public health standpoint but also to prevent and combat racism and xenophobia. Second, surveillance must be strengthened but with due consideration of the special confi dentiality issues related to legal status. In low-incidence high-income countries, entry screening of immigrants for tuberculosis while costly, has had little overall eff ect and has not proven to be cost eff ective. Thus, third, a much more cost-eff ective and sanguine approach is increased investment in global tuberculosis control. One analysis concluded that US-funded investments to expand tuberculosis control in Mexico, Haiti, and the Dominican Republic could reduce tuberculosis-related morbidity and mortality in migrants to the USA, and would result in substantial cost savings to the USA. Our best strategy to deal with tuberculosis in migrants is to invest in global tuberculosis control, strengthening national tuberculosis programmes, in line with the Global Plan to Stop TB (which is based on the WHO Stop TB Strategy). Additionally, we must invest in development of better tools (new drugs, diagnostics, and a vaccine) to enhance tuberculosis control as well as a new vision for migrant health. In view of globalisation and migration, the mantra, “tuberculosis anywhere is tuberculosis everywhere” rings true.