Migration and Health from a Public Health Perspective

One of the main dimensions related to migration is that of health; this correlation is dynamic by nature and complex. Health is strongly related to the social determinants of health (job, income, education, and housing). When not properly supported by appropriate inter-sectoral policies, migration can expose the most vulnerable socioeconomic groups to significant problems. The protection of the health of migrants is an important investment of the public health because it promises benefits to both migrant population and natives. An essential aspect is to properly analyze the health needs of ethnic minorities. Both quantitative and qualitative research is necessary, and the involvement of the target communities is important. Another important aspect is the education and training of social and health workers involved in the care of migrants (with a multidisciplinary teamwork and “transcultural” approach), and the organization of services that can effectively be used. Finally, it is also essential to carry out an evaluation of health outcomes of the migrant population and the impact of adopted health policies. Protecting the health of ethnic minorities is both a challenge for governments and a test of the quality of their health systems

Immigrazione al femminile: approccio transculturale e soddisfazione delle cure infermieristiche

L’impatto del fenomeno migratorio in termini di cambiamenti demografici in Italia coinvolge anche il Sistema sanitario in tutte le sue articolazioni ed è crescente la consapevolezza della opportunità di sviluppare una “competenza culturale”, come strategia per affrontare le disuguaglianze di salute. Ciò comporta anche la necessità di sviluppare conoscenze nel campo del cosiddetto “nursing transculturale”. In Paesi con antica storia di migrazione, come gli Stati Uniti, lo studio di tali competenze è ormai consolidato, con una tendenza a diversificare gli orientamenti sulla base dei diversi gruppi etnici presenti sul territorio. La presente ricerca s’inserisce nell’ambito della ricerca infermieristica in Sanità pubblica e si basa sull’approccio di cura transculturale in un’ottica di genere con particolare riferimento alla soddisfazione per le cure ricevute, quale proxy di qualità erogata ai pazienti. La soddisfazione percepita è una caratteristica soggettiva che può avere significati diversi. Il ruolo dell'etica è importante in quest’ambito per potenziare il rispetto reciproco, l'uguaglianza, e costruire la fiducia nei pazienti per promuovere risultati positivi di cura. Il focus di questa ricerca nasce dal fatto che la maggior parte degli studi italiani e internazionali riscontrati analizza solo la competenza culturale degli operatori, mentre poco si sa circa le ricadute di quest’orientamento sulla soddisfazione degli utenti stranieri immigrati in un’ottica di genere. Obiettivi. Questo studio ha l’obiettivo di valutare le competenze culturali degli infermieri e la soddisfazione delle cure delle donne immigrate assistite negli stessi ambiti territoriali dell’ASL Roma 2 ex-B. Saranno obiettivi specifici quelli di: a) stabilire il grado di competenza culturale del personale infermieristico; b) comprendere il livello di soddisfazione/insoddisfazione delle donne immigrate per le cure ricevute; c) valutare eventuali correlazioni tra i dati raccolti; d) far emergere, all’interno del processo di presa in carico, le situazioni positive e gli aspetti di criticità; e) diffondere il concetto di assistenza infermieristica culturalmente adeguata. Risultati attesi. Poter caratterizzare la percezione della cura in un’ottica di genere e le competenze culturali dei professionisti che assistono le donne straniere, con possibilità di confronti incrociati; proporre una lettura dei bisogni di salute delle donne straniere; progettare una adeguata formazione sulle competenze culturali del personale operante. Tutto ciò per produrre dei benefici sia per le pazienti in termini di efficacia delle cure ricevute, che per gli infermieri in termini di qualità della dimensione professionale

Functional health literacy of asylum seekers and refugees. A pilot study in italy

Literature shows how some groups of populations, among which are people seeking international protection and refugees, find it difficult to access services in national health systems. Usually, asylum seekers have limited Health Literacy (HL), which makes understanding the appropriate health information difficult. The objective of this research is to consider the relationship between how people requesting international protection and refugees approach the Italian Health System to request health services and their level of Functional Health Literacy (FHL). These relationships are examined through mixed methods. Data were obtained using several tools: a self-administered questionnaire in which the subjects revealed social and demographic data and a face-to-face interview together with the S-FHL Scale fulfilment in order to identify the functional level of HL. Twenty-one subjects were interviewed in two Centers of Protection System for Asylum Seekers and Refugees (SPRAR). Results show a picture of the actual situation. Data report a problematic or insufficient FHL level. Some factors, such as gender, age and health perceptions, play a role in the FHL levels. Some racial prejudices were reported. Language barriers had the most impact on the communication gap. Nevertheless, none of the subjects were denied health services. In conclusion, although this study is a pilot, we have experienced difficulty in obtaining asylum seekers’ trust to be open about their experience. This explains the number of the sample that should be more indicated for a qualitative study. Our results are in accordance with literature for inadequate level of FHL and lack of knowledge of the Italian Health System. This study highlighted several other issues to be taken into consideration for future research on the subject

Long-term impact of Global Health educational experiences in Rome. An attempt of measurement

Background Global health education (GHE) is spreading in Europe and in other parts of the world. Since 2008, Sapienza University of Rome has offered activities to medical and other health profession students related to global health (GH), which is grounded in the theory of social determinants of health and inspired by social justice. The educational activities included elective courses as well as community and service-learning experiences, referred to as GH gyms. This study attempts to measure the long-term impact of these educational experiences, especially to demonstrate their influence on the perceived social responsibility of future health professionals. Methods A questionnaire was elaborated and tested on a small sample of participants. It was sent to participants by e-mail. Quantitative results were analysed through descriptive statistics and qualitative answers were carefully read and classified. Results A total of 758 students from different faculties took part to the educational experiences. Only 488 e-mail addresses were available. One hundred and five (21.5%) questionnaires were returned. Participation in GH gyms was perceived to have had a higher influence on future professional and personal choices, when compared to participation in elective GH courses. Conclusions The study shows that consideration of health and social issues related with inequities in health and the use of interactive teaching methodologies had important effects on social responsibility of a large number of students. As there could be a selection bias among respondents, more research is needed to understand the impact of GH educational experiences. The inclusion of global health education in health and social curricula and the use of interactive methodologies with a correct evaluation of results are the indications that emerge from this research, together with the necessity of a strong involvement of students, professors and the whole academic reality

Medical education: an Italian contribution to the discussion on global health education

Abstract Background In Italy an important contribution to the spread of global health education (GHE) grew from the establishment and work of the Italian Network for Global Health Education (INGHE). INGHE gave a national shared definition of global health (GH), grounded in the theory of determinants of health, inspired by a vision of social justice, and committed to reduce health inequities. The aim of this article is to share with the international community INGHE’s point of view on Medical Education. Methods To express its view of medical education at the national level, INGHE established a dedicated commission, which elaborated a first draft of the document and then shared and discussed it with all other members. Results INGHE elaborated a paper where it explained the need to change medical education in order to prepare future health professionals for the challenges of the globalized and unequal world. In this article the authors summarize the experience of INGHE and share with the international community its document. Conclusions The authors believe it is necessary now, more than ever, to insert this new approach to health at social and academic levels. Students should play a fundamental role in the spread of GHE, and activities related with GHE could be considered an important part of the third mission of universities to promote social justice

Disability, rehabilitation, and assistive technologies for refugees and asylum seekers in Italy. Policies and challenges

Good health and well-being for all, including those with disabilities, is one of the main sustainable development goals. Data on refugees and asylum seekers with disabilities are limited. Refugees have poor access to rehabilitation and assistive technologies, although laws and policies in Italy guarantee this type of healthcare. However, there are several limitations to the successful implementation of these services. First, the national health system is regionally based, and therefore healthcare facilities and services vary in terms of quality in different regions. A link between reception centers and the healthcare system is therefore highly recommended, because only 10 out of 20 regions have specific services for refugees and asylum seekers with disabilities. Second, only 2% of the total available posts for hosting refugees are reserved for people with disabilities. The lack of a standardized vulnerability assessment represents the main barrier to the organization of specific services for migrants within the community. National stakeholders urgently need to collaborate in order to remove barriers to rehabilitation and assistive technology for refugees with disabilities. Initiatives should focus on health literacy and the empowerment of migrants, data collection on health, disability, and assistive technology, and the organization of community-based rehabilitation programs

Hospitalisation among immigrants in Italy

BACKGROUND: Immigration is increasing in Italy. In 2003, 2.6 million foreign citizens lived in the country; 52% were men and the majority were young adults who migrated for work. The purpose of this study was to investigate differences in hospitalisation between immigrants and the resident population during the year 2000 in the Lazio region. METHODS: Hospital admissions of immigrants from Less Developed Countries were compared to those of residents. We measured differences in hospitalisation rates and proportions admitted. RESULTS: Adult immigrants have lower hospitalisation rates than residents (134.6 vs. 160.5 per thousand population for acute care; 26.4 vs. 38.3 for day care). However, hospitalisation rates for some specific causes (injuries, particularly for men, infectious diseases, deliveries and induced abortions, ill-defined conditions) were higher for immigrants than for residents. Immigrants under 18 years seem to be generally healthy; causes of admission in this group are similar to those of residents of the same age (respiratory diseases, injuries and poisoning). The only important differences are for infectious and parasitic diseases, with a higher proportion among immigrant youths. CONCLUSION: The low hospitalisation rates for foreigners may suggest that they are a population with good health status. However, critical areas, related to poor living and working conditions and to social vulnerability, have been identified. Under-utilisation of services and low day care rates may be partially due to administrative, linguistic, and cultural barriers. As the presence of foreigners becomes an established phenomenon, it is important to evaluate their epidemiological profile, develop instruments to monitor and fulfil their specific health needs and plan health services for a multi-ethnic population

Social determinants of mental health in Italy: the role of education in the comparison of migrant and Italian residents

Mental health is impacted by social, economic, and environmental factors, the Social Determinants of Health (SDH). Migrants experiencing precarious living and working conditions may be more at risk of poor mental health than the majority population. This paper aims to evaluate the relationship of educational attainment and other SDH with depressive symptoms among the resident population, including Italians and migrants. This study examined the respondents to the Italian “Progressi delle Aziende Sanitarie per la Salute in Italia” (PASSI) surveillance system, 2014–18. The sample of 144.055 respondents is composed of the resident working adults aged 25–69 with Italian citizenship (n = 136.514) and foreign citizenship (n = 7.491). Findings show that among Italians high level of education appears to be a protective factor for mental health, in accordance with the international evidence (adjPR: tertiary education 0,74 p-value = 0.000). However, among immigrants high level of education is associated with the presence of depressive symptoms (adjPR: tertiary education: 1.61 p-value = 0.006), particularly for men (adjPR: tertiary education: 2.40 p-value = 0.006). The longer the length of stay in Italy for immigrants the higher the risk of depressive symptoms: adjPR for 10+ years: 2.23 p-value = 0.005. The data show that high education could represent a risk factor for mental health of immigrants. Moreover, among migrants there are some significant mental health inequities between male and female related to the duration of stay in Italy, economic activity and educational level. Considering that health is related to the nature of society as well as to access to technical solutions, multicultural societies require culturally oriented interventions for tackling health inequities. This means developing evidence-based policies in order to tackle health inequalities in the population as a whole, including culturally oriented measures in the larger framework of developing diversity sensitive services

Life-course vaccinations for migrants and refugees. Drawing lessons from the COVID-19 vaccination campaigns

Covid-19 showed once more, and very evidently, that some disadvantaged subgroups, including mi- grants and refugees (M&Rs), are at higher risk of contracting a disease or suffering from its severe con- sequences in areas with high transmission [1,2]. This may be due to their living conditions, which make physical distancing difficult, and/or to their legal status, which may exclude them from health care services. Additionally, COVID-19 reminded us that M&Rs tend to also have suboptimal vaccination coverage compared to the general population due to several concurrent factors [3,4]: – exclusion from health and vaccination plans and systems, often due to a lack of legal entitlements to health care or due to administrative/residence barriers; – health system barriers due to language, lack of cultural sensitivity, lack of outreach and community engagement capacity, lack of collaboration with civil society organisations, barriers to primary care, and vaccination services access, including vaccination costs; – high mobility of M&Rs; – lack of confidence in the health system and misconceptions about the vaccine. We propose some elements useful for orienting the research agenda and generating debate based on the experience of the COVID-19 pandemic. While M&Rs experienced exclusion due to the pandemic in many contexts, in others, it has been an opportunity not just to maximise coverage, but also to set up, test, and implement new, effective, and replicable approaches in vaccination services

Risk of Covid-19 severe outcomes and mortality in migrants and ethnic minorities compared to the general population in the european WHO region. A systematic review

The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans