Health risks at work mean risks at home: Spatial aspects of COVID-19 among migrant workers in precarious jobs in England.

During COVID-19 lockdowns in England, 'key workers' including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers' experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers' families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers' lives beyond the workplace

Community-led responses to COVID-19 within Gypsy and Traveller communities in England: A participatory qualitative research study.

Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions. In future emergencies, communities must be given better material, political and technical support to help them to design and implement effective community-led solutions, particularly where government institutions are untrusted or untrustworthy

Reordering the machinery of participation with young people

In this article, we reflect on our ongoing work that attempts to redistribute the agenda‐setting powers of researchers, research funders and the complex of private and public partnerships in the biomedical sciences. Despite calls for diversification, the current landscape is dominated by a traditional medical habitus that prioritises discovery science. This has moral and political consequences. Simultaneously, we have seen a slow rise in top–down infrastructures of public participation in medical science. While we are critical of the resulting machinery of participation, we believe in its premise that knowledge and expertise are everywhere. In our research project—called Utopia Now!—we have been seeking to involve young people in deciding the future of biomedical research. However, this project is itself premised on a number of our own complicities with the power held by universities and research infrastructures. Here, we explore three preliminary tactics through which we attempt to make these complicities politically productive, taking into account the limitations of working as early career researchers. We find that our mediation between young people and researchers across disciplines is not only integral for re‐politicising medical research, but also changes our understanding of knowledge production as a process of reordering, sorting and sharing

An examination of unmet health needs as perceived by Roma in Central and Eastern Europe.

BACKGROUND: Roma comprise the largest ethnic minority in Europe, with an estimated population of 10-12 million. Roughly 50-60% of European Roma live in the countries of Central and Eastern Europe. In this study, we set out to quantify and explain disparities in unmet health needs for Roma populations relative to non-Roma populations, using self-reported access to health care. METHODS: The United Nations Development Programme/World Bank/European Commission 2011 regional Roma survey was used for this study (12 countries, 8735 Roma and 4572 non-Roma living in same communities), with self-reported unmet health need (did not consult a doctor or health professional when they felt it was necessary in past year) as the primary outcome. Multivariable logistic regressions were performed to study the determinants of unmet health need for Roma populations relative to non-Roma populations. Covariates controlled for included sociodemographic characteristics, economic ability, health status and healthcare access. RESULTS: We found in unadjusted models that Roma throughout Central and Eastern Europe, with the exception of Montenegro, are two to three times more likely to report having an unmet health need in the past 12 months than non-Roma living nearby. These disparities largely remain significant, even after adjusting for gender, age, marital status, employment status, education, number of chronic conditions, health insurance status and geographical proximity to medical providers. CONCLUSIONS: Controlling for conventional measures of access to medical care (i.e. geographic access to providers and health insurance) does not eliminate observed disparities in unmet need. Although improving funding and routine access to healthcare services for Roma is important in its own right as a means of increasing inclusion, there is a need for detailed assessments of the barriers that exist in each country, within and outside the health system, coupled with measures to implement existing commitments on Roma rights

Looking at the Russian health care system: through the eyes of patients with diabetes and their physicians

Aims People with diabetes are well placed to evaluate and to assess the performance of health systems. We take the perspective of people living with diabetes and those caring for them to gain insights into how the contemporary Russian health system works for them. Methods We conducted 15 semi-structured interviews with patients with diabetes and physicians in rural and urban settings, in public and private sectors. Interviewees were identified using snowball sampling. Results Patients worried about high and rising costs of care, while physicians noted concerns about lack of time to treat patients adequately. Although all specifically diabetes-related services are free of charge, patients requiring urgent surgery often face high user fees, either to bypass waiting lists in state facilities or to be treated immediately in a private institution. These ‘hidden’, out-of-pocket payments impact adversely on equity and act as a barrier to timely care. Conclusions Although reform of health services in Russia has led to improvements in quality of care for diabetes, many gaps remain, particularly for management of complications. This paper provides further evidence of how people with diabetes can shed light on the reality, as opposed to the rhetoric of health system reform, especially in middle-income countries. </jats:sec

An examination of Roma health insurance status in Central and Eastern Europe.

BACKGROUND: Roma in Central and Eastern Europe (CEE) face problems in accessing health care, and a lack of access to statutory health insurance schemes is a key factor. This study seeks to quantify differences in health insurance coverage between Roma and non-Roma and assess whether variations can be explained by socio-economic factors. METHODS: Secondary household survey data collected in 12 CEE countries in 2011 were analysed. A univariate analysis assessed the effect of Roma status on insurance coverage by country. Multivariate analyses were used to progressively adjust for socio-demographic factors, employment status and income. Country-specific literature was drawn on to examine the context of the findings. RESULTS: Lack of insurance coverage for Roma populations varied considerably between countries, from 2.8% without insurance in Slovakia to 67.7% in Albania. Roma were significantly less likely to have health insurance than non-Roma in all countries except Slovakia and Serbia. The greatest differences in Roma and non-Roma insurance coverage were in Montenegro, Bosnia and Herzegovina, Croatia, Bulgaria and Romania. When adjusting for employment status and income, the gap between Roma and non-Roma remained significant in Montenegro, Croatia, Bosnia and Herzegovina, Bulgaria, Romania and Moldova. CONCLUSION: Roma are significantly less likely to have insurance coverage in most CEE countries, and this gap remains when adjusting for socio-economic differences between Roma and non-Roma in many countries. Much needs to be done to address the known barriers that Roma face in accessing insurance coverage, such as tackling problems related to documentation and the receipt of social benefits