Access to healthcare for undocumented migrants: Analysis of avoidable hospital admissions in Sicily from 2003 to 2013

Access to healthcare services for undocumented migrants is one of the main public health issues currently being debated among European countries. Exclusion from primary healthcare services may lead to serious consequences for migrants' health. We analyzed the risk among undocumented migrants, in comparison with regular migrants, of being hospitalized for preventable conditions in the Region of Sicily (Italy). We performed a hospital-based cross-sectional study of the foreign population hospitalized in the Sicily region between 1 January 2003 and 31 December 2013. The first outcome was the proportion of avoidable hospitalization (AHs) among regular and irregular migrants. Second outcomes were the subcategories of AHs for chronic, acute and vaccine preventable diseases. 85 309 hospital admissions were analyzed. In the hospitalized population, in comparison to regular migrants, undocumented migrants show a higher proportion of hospitalization for diseases preventable through primary and preventive care (AOR1·48, 95%CI 1·37-1·59). The proportion of avoidable hospitalizations associated with the lack of legal status is higher for vaccine preventable conditions (AOR 2·06, 95%CI 1·66-2·56) than for chronic conditions (AOR 1·47, 95%CI 1·42-1·63) and acute conditions (AOR 1·37; 95%CI 1·23-1·53). Between 2003 and 2013, the proportion of avoidable hospitalizations decreased both in regular and undocumented migrants but decreased faster for regular than for undocumented migrants. Undocumented migrants experience higher proportion of hospitalization for preventable conditions in comparison with regular migrants probably due to a lack of access to the national healthcare service. Policies and strategies to involve them in primary healthcare and preventive services should be developed to tackle this inequality

Universal health coverage in the context of migration and displacement: a cosmopolitan perspective

Migration and displacement are reshaping societies and economies with profound implications for health equity and universal health coverage (UHC). In this Viewpoint, we review the unique health challenges faced by migrants and displaced people, as well as the limitations of current UHC policies and financing arrangements. We propose a cosmopolitan approach to UHC, grounded in global solidarity and structured around four pillars: supranational financing, integrated cross-border care, harmonised legal frameworks, and long-term investment in inclusive health systems. We also explore what this approach could mean practically for regional or global financing mechanisms and sources of funding, including progressive contributions and the integration of health into climate finance. Achieving equitable and effective UHC in a world shaped by mobility and crisis requires global thinking and collective action. We call for a reimagining of UHC via a cosmopolitan approach, which offers a pathway to reframe health and wellbeing as a shared right and responsibility, transcending national borders

Health diplomacy: spotlight on refugees and migrants

Nowadays, refugees and migrants are the focus of intense political debate worldwide. From the public health perspective, population movement, including forced migration, is a complex phenomenon and is a high priority on the political and policy agenda of most WHO Member States. Health diplomacy and the health of refugees and migrants are intrinsically linked. Human mobility is relevant to all countries and creates important challenges in terms of both sustainable development and human rights, to ensure equality and achieve results through the Sustainable Development Goals. This book is part of the WHO Regional Office for Europe’s commitment to work for the health of refugees and migrants. It showcases good practices by which governments, non-state actors and international and nongovernmental organizations attempt to address the complexity of migration, by strengthening health system responsiveness to refugee and migrant health matters, and by coordinating and developing foreign policy solutions to improve health at the global, regional, country and local levels

Refugees and migrants in times of COVID-19: mapping trends of public health and migration policies and practices

Refugees and migrants have been disproportionately affected by both the direct effects of the COVID-19 pandemic and the restrictive migration measures put in place, which, in turn, have hampered coordinated and consistent public health responses. This report maps how the needs of refugee and migrant have been addressed in COVID-19 responses across countries and how these have varied considerably from inclusive policies to discriminatory practices. Many countries ensured access to health care for refugees and migrants regardless of migration status, and several countries also suspended forced returns and prioritized alternatives to immigration detention. An integrated approach to migration and public health policies covering protection-sensitive access to territories, a flexible approach to migration status and non-discriminatory access to health care is suggested as a policy consideration to uphold international conventions protecting the right to health without discrimination for refugees and migrants

A desk review on institutional and non-institutional organizations active in the field of migrant’s health in the WHO European Region

Background Migrants have problematic access to health-care; non-institutional organizations (NGOs), as well as institutional bodies may play a role facilitating their access to mainstream health care. Aim Our research reviews actions that address migrant’s need to understand how, where, and who participates to this effort. Method Data were from desk or web research, declaration from organisations and their websites, information from WHO Country offices.  Results 154 NGO were identified in the WHO EURO region. 58% were direct health care providers while the remaining provided either mediation services or belong to umbrella organization. 173 National Institutes (GOVs) were found; less than the 20% were directly or indirectly involved in health care, whereas the majority was involved in research, policy development, international relations and human rights. Conclusion and recommendation Some gaps and duplications were identified. WHO can play an overarching role in the exchange of expertise and harmonisation of the efforts in this field

a paradigm shift

Funding Information: In addition to academic and health service colleagues involved in case studies 1, 2 and 3, we wish to acknowledge the following organisations and (with permission) the following individuals: Community organisation that collaborated in case study 1- Doras, Limerick, Ireland; Funder case study 1= Irish Research Council, New Foundations Award; Quote case study 1- Ewa Zak-Dyndal; Community organisations that collaborated in case study 2\u2013Intercultural Diversity Education Centre, Ireland and Shannon Family Resource Centre; Funder case study 2\u2013Health Research Board, Dublin, Ireland (HRA-PHR-2015-1344); Quote case study 2\u2013Colette Bradley; Community organizations that collaborated in case study 3\u2013AD SUMUS\u2013Associa\u00E7\u00E3o de Imigrantes de Almada; AJPAS\u2013Associa\u00E7\u00E3o de Interven\u00E7\u00E3o Comunit\u00E1ria; Alto Comissariado para as Migra\u00E7\u00F5es; ALCC\u2013Associa\u00E7\u00E3o Lusofonia Cultura e Cidadania; Associa\u00E7\u00E3o Casa-da-\u00CDndia; Associa\u00E7\u00E3o de Imigrantes Mundo Feliz; Associa\u00E7\u00E3o Isl\u00E2mica da Tapada das Merc\u00EAs e Mem Martins; Associa\u00E7\u00E3o Lusofonia Cultura e Cidadania; Associa\u00E7\u00E3o Unidos de Cabo Verde; Casa do Brasil; Centro Porta Amiga de Almada\u2013AMI; Cruz Vermelha Portuguesa\u2013Delega\u00E7\u00E3o de Braga; InPulsar- Associa\u00E7\u00E3o para o Desenvolvimento Comunit\u00E1rio; NIALP\u2013Intercultural Association Lisboa; Prosaudesc\u2013Associa\u00E7\u00E3o de Promotores de Sa\u00FAde Ambiente e Desenvolvimento S\u00F3cio Cultural; Solidariedade Imigrante\u2013Associa\u00E7\u00E3o para a Defesa dos Direitos dos Imigrantes; UAI\u2013Associa\u00E7\u00E3o Cultural Luso-brasileira de Apoio \u00E0 Integra\u00E7\u00E3o em Portugal; Funder case study 3 Fundo para o Asilo, Migra\u00E7\u00E3o e Integra\u00E7\u00E3o (Ref.PT/2021/FAMI/693). AG is supported by FCT - Funda\u00E7\u00E3o para a Ci\u00EAncia e Tecnologia, I.P. (Reference CEECINST/00042/2021/CP1773/CT0001 and DOI identifier 10.54499/CEECINST/00042/2021/CP1773/CT0001). Publisher Copyright: © 2024While people's involvement in health research is increasingly the encouraged norm in many countries, the involvement of refugees and migrants in research about their health is rare. Here, we call for a paradigm shift in the field of refugee and migrant health to make participatory health research routine, i.e. normalised. To disrupt ‘business as usual’, we synthesise evidence about meaningful research partnerships and features of inclusive participatory spaces. We present examples of decolonial, culturally attuned methods that can be used to reimagine and reinvigorate research practice because they encourage critical reflexivity and power-sharing: arts-based research using music and singing, participatory learning and action research, Photovoice and co-design (ideas generation) workshops. We consider the consequences of not making this paradigm shift. We conclude with recommendations for specific structural and policy changes and empirical research questions that are needed to inform the normalisation of participatory health research in this field.publishersversionpublishe

Migrant health in Italy: a better health status difficult to maintain-country of origin and assimilation effects studied from the Italian risk factor surveillance data

Many studies on migrant health have focused on aspects of morbidity and mortality, but very few approach the relevant issues of migrants' health considering behavioral risk factors. Previous studies have often been limited methodologically because of sample size or lack of information on migrant country of origin. Information about risk factors is fundamental to direct any intervention, particularly with regard to non-communicable diseases that are leading causes of death and disease. Thus, the main focus of our analysis is the influence of country of origin and the assimilation process

The policy and politics of migrants and health: European view

O que sabemos hoje, quais as lacunas na compreensão do problema e quais as perspetivas futuras? Nas últimas décadas, os países Europeus têm-se confrontado com um aumento dos fluxos migratórios, tornando a migração um fenómeno comum e em sociedades cada vez mais diversificadas. No contexto do processo migratório, as populações migrantes e refugiadas confrontam-se, no país de acolhimento, com um novo contexto social, cultural e linguístico. Por outro lado, a atual complexidade deste processo decorre, também, de uma população migrante heterogénea, com diferentes características e necessidades em saúde. A migração coloca importantes desafios para a saúde, relativamente aos determinantes sociais de saúde, planeamento e implementação de políticas de saúde efetivas e adaptação dos sistemas de saúde, incluindo a resposta a disparidades nas necessidades de saúde, bem como a capacidade dos profissionais de saúde para lidar com a diversidade cultural. Todos estes aspetos devem ser considerados em sociedades que procuram a integração efetiva de migrantes e a qualidade e equidade nos cuidados de saúde para alcançar o bem-estar de toda a população. Este livro constitui uma oportunidade para debater este tema atual e prioritário, essencialmente ao nível de politicas de saúde, da intervenção e da investigação futura. Tem como objetivo proporcionar uma visão abrangente do conhecimento atual desta temática, discutir lacunas na compreensão do problema e analisar como coletivamente prosseguir de forma a atingir o objetivo último de melhorar a saúde e o bem-estar das populações migrantes/refugiadas e da sociedade em geral. Irá interessar uma audiência nacional e internacional de atores e investigadores