Migrant Health Issues Research Articles

Protecting and promoting the rights of the 'reserve army of labour': a policy analysis of structural determinants of migrant worker health in Pakistan and Qatar.

Labour migrants who travel overseas for employment can face deep health inequities driven in large part by upstream social and structural determinants of health. We sought to study the 'labour migrant health ecosystem' between one sending country (Pakistan) and one host country (Qatar), with a focus on how the ecosystem realizes the rights of labour migrants when addressing the social and structural determinants (e.g. housing, employment law, etc.) of health. Study objectives were to (1) undertake an in-depth review of policies addressing the structural and social determinants of the health of labour migrants in both Pakistan and Qatar, analysing the extent to which these policies align with global guidance, are equity-focused and have clear accountability mechanisms in place, and (2) explore national stakeholder perspectives on priority setting for labour migrant health. We used a mixed methods approach, combining policy content analysis and interviews with stakeholders in both countries. We found a wide range of guidance from the multilateral system on addressing structural determinants of the health of labour migrants. However, policy responses in Pakistan and Qatar contained a limited number of these recommended interventions and had low implementation potential and minimal reference to gender, equity and rights. Key national stakeholders had few political incentives to act and lacked inter-country coordination mechanisms required for an effective and cohesive response to labour migrant health issues. Effectively addressing such determinants to achieve health equity for labour migrants will depend on a shift in governments' attitudes towards migrants-from a reserve army of transient, replaceable economic resources to rights-holding members of society deserving of equality, dignity and respect.

Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system.

The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019). Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.

Strategies to Enhance Retention in a Cohort Study Among Adults of Turkish Descent Living in Berlin

Retention is important for statistical power and external validity in long-term cohort studies. The aims of our study were to evaluate different retention strategies within a cohort study of adults of Turkish descent in Berlin, Germany, and to compare participants and non-participants. In 2011–2012, a population-based study was conducted among adults of Turkish descent to primarily examine recruitment strategies. 6 years later, the participants were re-contacted and invited to complete a self-report questionnaire regarding their health status, health care utilization, and satisfaction with medical services. The retention strategy comprised letters in both German and Turkish, phone calls, and home visits (by bilingual staff). We calculated the response rate and retention rate, using definitions of the American Association for Public Opinion Research, as well as the relative retention rate for each level of contact. Associations of baseline recruitment strategy, sociodemographic, migration-related and health-related factors with retention were investigated by logistic regression analysis. Of 557 persons contacted, 249 (44.7%) completed the questionnaire. This was 50.1% of those whose contact information was available. The relative retention rate was lowest for phone calls (8.9%) and highest for home visits (18.4%). Participants were more often non-smokers and German citizens than non-participants. For all remaining factors, no association with retention was found. In this study, among adults of Turkish descent, the retention rate increased considerably with every additional level of contact. Implementation of comprehensive retention strategies provided by culturally matched study personnel may lead to higher validity and statistical power in studies on migrant health issues.

Does migrant background predict to what extent colorectal cancer patients want to be informed about their life expectancy? \u2013 a cross-sectional analysis

BackgroundAlthough migrant health is a topic of interest across Europe and although health care services in Germany consider migrant health issues, people with a migrant background often experience difficulties regarding health care provision. The prevalence of various cancers among migrants is lower relative to non-migrants although this equalizes with increasing duration of residence. There are documented differences in health behavior and disease-coping strategies between migrants and non-migrants, but data are scarce on this subject. This analysis investigates the extent of information migrant and non-migrant colorectal cancer (CRC) patients in Germany want about their life expectancy and the level of trust they have in their treating physician.MethodData from 522 CRC patients were collected through a self-reported questionnaire. Migrant background was determined by the patients’ and/or their parents’ birthplace. Bivariate analyses were applied to determine the differences between migrants and non-migrants. A multivariate analysis was used to measure the effect of migration background, demographics, and cancer stage and treatment on the preferred extent of information about life expectancy and trust in their treating physician.ResultsThere were no significant differences regarding demographics or cancer stage and treatment between migrant and non-migrant CRC patients. Having a migrant background had no influence on the level of trust in the treating physician, but migrants preferred to be less informed about their life expectancy than non-migrants (21.4% vs. 13.4%, p = 0.04). The multivariate analysis showed that men (aOR = 2.102, CI: 1.123–3.932) and patients with a non-migrant background (aOR = 5.03, CI: 1.02–24.73) preferred receiving information about the approximate value of their life expectancy, rather than receiving no information.ConclusionThe study found more similarities than discrepancies between migrant and non-migrant CRC patients regarding demographic factors and stage of disease and treatment, which may be a consequence of an increasingly homogeneous cross-cultural society. However, cultural differences between the minority and host population remain and should always be taken into account in daily clinical practice and in the communication skills training of health care professionals. The study also indicates that recording migration background into health registers would facilitate migrant-sensitive research.

Building bridges for migration in a planetary context

Abstract Europe is experiencing high volumes of migration, both within and to the region. Globally, several factors contributing to high-volume migration, ranging from economic ones (migrant workers) to forced displacement caused by conflict, persecution and climate changes (draught or other extreme weather conditions) severely affecting living conditions. The International Organisation for Migration (IOM) has estimated that in 2017, the number of international migrants living in Europe reached 78 million, over 10% of the European population, and that two-thirds of international migrants live in Europe or Asia. In EU countries, an estimated 22.3 million migrants are non-EU citizens (data as of 1 January 2018) and in 2017 alone, the EU has seen 2.4 million new arrivals from non-EU citizens to its Member States. Inevitably, this trend has significant implications for public health in Europe. Migration has significant implications for public health in Europe. Beyond potential pressures on healthcare systems, that can occur especially in instances of large scale rapid migration, some subgroups of migrants, particularly those forcibly displaced or those originating from countries with weak health systems (i.e. refugees, asylum seekers and irregular migrants) are particularly vulnerable and susceptible to infections. This may be due to the fact that they could come from countries with high prevalence of infectious diseases and/or low vaccine coverage. In addition, the migration journeys or substandard living conditions in overcrowded migrant centres may have increased the risk of contracting an infection. This plenary session will showcase several bridges contributing to strengthening public health functions and services in terms of migration, pinpointing the crucial importance of: public health resources and cross-sectoral cooperation: the case of the Mediterranean Programme for Intervention Epidemiology Training (MediPIET) building capacity in the EU enlargement and European Neighbourhood countries with particular focus on global health security; the impact of the programme on capacity building among infectious disease epidemiologists in a small country with a large influx of migrants;public health guidance: the case of guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA;public health policy and advocacy: the case of WHO Global Action Plan to promote the health of refugees and migrants;involvement of the affected population in the discussion and decision-making. The aim of this one-hour session is to stir the debate around migrant health issues and infectious diseases in the European context. The panel will start with a keynote speaker, followed by a lively expert discussion reflecting different perspectives. Key question/s addressed: How important is cross-sectoral and cross-regional cooperation in terms of migration and public health? How can we approach migration within and to Europe as a benefit for the region? Keynote speaker Sally Hargreaves Lecturer in Global Health, St George's University of London, United Kingdom Panellists Nada Ghosn Epidemiological Surveillance Unit, Ministry of Public Health, Lebanon Sally Hargreaves Imperial College London, UK Abal Moindazde France Isabel de la Mata DG SANTE, European Commission

Migrant inequalities in urban settings and changing public health practice

Abstract More than half of the world’s population now lives in urban areas, and urbanization has significant impacts on the whole of society. Cities are major destinations for internal and external migration alike. Access to services, affordable housing and quality employment in urban areas are challenges common to all vulnerable populations, including migrants. These difficult circumstances–and rising inequalities generally–have strained social inclusion efforts across Europe. In addition, migration has become highly politicized; fake news is used to undermine trust and divide communities. This leads to increased discrimination and is restricting access to education, work, justice and health. Power disparities lead to health inequalities. In this environment, policymakers, civil society actors and community advocates must work collaboratively and creatively across sectors to improve health and social outcomes not only for migrants, but for all vulnerable populations in urban environments. How can public health practice adapt to this context to better address the needs of migrants as well as other vulnerable populations? We should move away from describing the problems to work on the solutions. How can we change public perceptions? How can normative agencies and research institutions respond to and support the needs/challenges of public health practitioners ‘on the ground’ in cities? This session will attempt to address these and related critical questions, discussing the way forward for health equity and urban and migrant health while highlighting inspiring case studies. Topics include: What are some of the key ‘myths’ about migrant communities, living and working in cities, that must be corrected to facilitate social integration and improve service provision? Are migrants a burden on services (health, long term care, social care, childcare) or contributors? Are they receiving more benefits than contributing in taxes? How to respond to discrimination/racism and stigmatization?How do we ensure that urban health and social services are person-centred and founded on the principles of proportionate universality? Given the diversity of migration flows to cities, how do we develop appropriate public services for each group, considering cultural dimensions as well as nurture and build on their existing skills and resources?What is the role of living and working situations in shaping opportunities and health outcomes for migrants? Can housing, schools, workplaces or urban renewal projects in communities be used to build bridges to other forms of support?Where is public health failing and what needs to be changed for improved health and wellbeing and reduced inequalities, giving current contexts as described above? What can be done at the European level to address urban and migrant health issues? Brief introduction Caroline Costongs EuroHealthNet Setting the scene Bernadette Kumar Norwegian Centre for Minority Health Research, Research member of the UCL-Lancet Commission on Migration and Health WHO perspective Santino Severoni Division of Health Systems and Public Health, WHO EURO Perspective from practice Lucinda Hiam GP, Honorary Research Fellow at London School of Hygiene and Tropical Medicine, UK Perspective from practice Maryam Gardisi International Psychosocial Organisation IPSO, Germany Tying together the big picture Jean-Paul Moatti Board of Directors of the Institut de Recherche pour le Développement

International organizations and migrant health in Europe.

International organizations have defined and managed different aspects of migrant health issues for decades, yet we lack a systematic understanding of how they reach decisions and what they do on the ground. The present article seeks to clarify the state of knowledge on the relationship between international organizations and migrant health in Europe. To do so, we review the operations of six organizations widely recognized as key actors in the field of migrant health: the European Commission, the Regional Office for Europe of the World Health Organization, the International Organization on Migration, Médecins du Monde, Médecins Sans Frontières, and the Open Society Foundation. We find that international organizations operate in a complementary fashion, with each taking on a unique role in migrant health provision. States often rely on international organizations as policy advisors or sub-contractors for interventions, especially in the case of emergencies. These linkages yield a complex web of relationships, which can vary depending on the country under consideration or the health policy issue in question.

C.3. Poster walk: Migrant health issues

C.3. Poster walk: Migrant health issues

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions.

A Qualitative View of Drug Use Behaviors of Mexican Male Injection Drug Users Deported from the United States

Deportees are a hidden yet highly vulnerable and numerous population. Significantly, little data exists about the substance use and deportation experiences of Mexicans deported from the United States. This pilot qualitative study describes illicit drug use behaviors among 24 Mexico-born male injection drug users (IDUs), ≥18 years old, residing in Tijuana, Mexico who self-identified as deportees from the United States. In-person interviews were conducted in Tijuana, Mexico in 2008. Content analysis of interview transcripts identified major themes in participants’ experiences. Few participants had personal or family exposures to illicit drugs prior to their first U.S. migration. Participants reported numerous deportations. Social (i.e., friends/family, post-migration stressors) and environmental factors (e.g., drug availability) were perceived to contribute to substance use initiation in the U.S. Drugs consumed in the United States included marijuana, heroin, cocaine, methamphetamine, and crack. More than half of men were IDUs prior to deportation. Addiction and justice system experiences reportedly contributed to deportation. After deportation, several men injected new drugs, primarily heroin or methamphetamine, or a combination of both drugs. Many men perceived an increase in their substance use after deportation and reported shame and loss of familial social and economic support. Early intervention is needed to stem illicit drug use in Mexican migrant youths. Binational cooperation around migrant health issues is warranted. Migrant-oriented programs may expand components that address mental health and drug use behaviors in an effort to reduce transmission of blood-borne infections. Special considerations are merited for substance users in correctional systems in the United States and Mexico, as well as substance users in United States immigration detention centers. The health status and health behaviors of deportees are likely to impact receiving Mexican communities. Programs that address health, social, and economic issues may aid deportees in resettling in Mexico.

Micronesian Migrant Health Issues in Hawaii

Up to 15,000 or more Micronesian migrants currently live in Hawaii. Factors driving this recent emigration include inadequate employment opportunities, a limited economic base, and insufficient health and educational infrastructures in the U.S. affiliated Micronesian island entities in the Western Pacific. The aim of this study was to examine reasons why Micronesians were relocating to Hawaii, since there was evidence of healthcare related migration. This study provides the results of an assessment of health and key social determinants among Micronesian migrants conducted in 2007. Results show that diabetes is the most prevalent reported medical condition (35%) among adults &gt;40 years of age. Micronesian migrants in Hawaii report coming to Hawaii for health care, but also for educational and employment opportunities.

Micronesian Migrant Health Issues in Hawaii

Increasing numbers of people from the Federated States of Micronesia and the Republic of the Marshall Islands are presenting for clinical and public health services across the U.S., especially in Hawaii. We review the impact of historical and contemporary relationships between the U.S. and these Freely Associated States on the health status and health care access of these migrants. We draw upon both epidemiological evidence and clinical experience to suggest measures to assure health care access and appropriate clinical care for these populations. We also point to potential public health measures, and indicate directions for future research.

Overcoming migrants’ barriers to health

Climate change, global conflict and economic necessity are driving the highest levels of migration in history. According to the International Organization for Migration (IOM) some 192 million people are living outside their place of birth, representing about 3% of the world's population. The sheer scale of human displacement has turned migrant health into a priority global public-health issue, an issue rendered more complex by the diversity of the populations involved--from people in search of work or education to more vulnerable groups like asylum seekers and refugees. Apart from the increased potential for the spread of infectious disease that a more mobile global population brings, there is also rising concern that migrants' health needs are not always adequately met. Many countries restrict access to health care for certain migrant groups--including irregular migrants and asylum seekers. For example, until a recent court ruling, the United Kingdom restricted access to free health care to some migrants--including irregular migrants--to counter any possibility that they were entering the country primarily for free medical treatment. Dr Daniel Lopez-Acuna, director of WHO's Health Action in Crises Recovery and Transition Programmes, says migrant health issues are coming to a head in some countries, which is why they have been raised at the highest levels within the public-health agenda at national and international health levels. [ILLUSTRATION OMITTED] For Lopez-Acuna, the threat of communicable diseases spreading is only one aspect of the issue: With ever-increasing migrant populations in many countries, more strain is being put on government systems that provide health services to the public, he says. This strain is even greater when the flow of humanity is between lower-income countries, says Dr Eric Laroche, assistant director-general of the Health Action in Crises cluster of departments at the World Health Organization (WHO). Providing health care for new flows of migrants can place extra burdens on the receiving country, he says, and cites poverty, marginality and the stress of displacement among the factors affecting the health of populations on the move. At the World Health Assembly in May, WHO agreed on four strategies to address the vulnerabilities and healthcare needs of migrants. Advocacy and policy development is crucial to ensure migrants have equitable access to health services, says Lopez-Acuna. There is also a need to assess trends in migrants' health by improving country health information systems, which can help identify and fill gaps in service delivery. Lopez-Acuna also believes it is essential to train policy-makers and health stakeholders on migrant health issues, and to improve service delivery to reinforce migrant-friendly public-health services and establish minimum health-care standards for all vulnerable migrant groups. Between 1960 and 2005 the number of international migrants in the world more than doubled, from an estimated 75 million in 1960 to almost 191 million in 2005, according to a United Nations report, Trends in total migrant stock, 2005 revision. Migration is now running at about 3% annually, according to the IOM. Undocumented migration is harder to track but the International Labour Organization estimates that there are 15-30 million irregular immigrants internationally. Refugees represent 9.7% of global migrants, according to the Worm refugee survey in 2005, which estimated that there were 17 million global refugees, most of whom were hosted by African countries. Family reunification and the allure of a better life, including enhanced prospects for work or education are driving migration to countries belonging to the Organisation for Economic Co-operation and Development (OECD). From 2004 to 2005 immigration to OECD countries increased by four million people. This labour-driven trend is expected to continue as high-income countries with low fertility see their populations decline and age. …

Cross‐cultural health issues in contemporary Australia

In recent decades, Australia has rapidly become one of the more ethnically diverse societies with over 120 different languages groups and 41.9% of the population having at least one parent born overseas. This presents a great challenge for decision‐makers and service providers to plan and provide effective and responsive health services for communities with such diverse languages, cultural backgrounds, migration circumstances and socioeconomic status. In order to offer equitable, culturally sensitive and appropriate health services, there is a pressing need to identify and manage cross‐cultural health issues. This paper will first clarify concepts fundamental to the understanding of cross‐cultural phenomena. It will then discuss several priority migrant health issues including communication breakdown, reproductive health, mental health, workplace health and safety, and doubly disadvantaged groups. Finally, it will recommend measures to address the above issues and to promote equity, access and quality in health care for migrants.