Can White allyship contribute to tackling ethnic inequalities in health? Reflections on the experiences of diverse young adults in England

Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action. This paper addresses these developments, and specifically engages with the contested notion of ‘allyship’. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation. White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity. The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings

Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review

Background: Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences. Methods: Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care. Results: Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms. Conclusion: Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance. Trial registration: PROSPERO Registration number: CRD42020218357

Immigration and health : heterogenous patterns in Spain

Objective: To compare health status (sub-study 1), sleep health (sub-study 2) and health care use (sub-study 3) between the Spanish population and immigrants from the seven leading countries in terms of number of immigrants; to examine whether differences are accounted for by socio-economic characteristics, and to determine whether the patterns of associations differ by gender. Methods: Cross-sectional study using data from the 2006 Spanish National Health Survey (n=29,476). A sample of individuals from Spain and the seven countries with most immigrants in Spain (Argentina, Bolivia, Colombia, Ecuador, Peru, Romania and Morocco) was selected. For the first sub-study those aged 20-64 years (n=20,731) were elected and for second and third sub-studies individuals aged 16-64 years (n=22,224). Main results: In both sexes, people from Bolivia had poorer health outcomes, above all Bolivian males (fully adjusted ORs = 4.84, 95% CI= 2.47-9.48 for self-perceived health status and 8.81 95% CI= 4.41-17.62). Conversely, people from Argentina and Colombia had the best health outcomes, in some cases better than Spanish people. Regarding insomnia symptoms and non-restorative sleep (NRS), in both sexes, people from Bolivia had a higher prevalence of insomnia symptoms and NRS. Conversely, people from Ecuador, Morocco and Romania had less insomnia symptoms and NRS than Spaniards. No differences were found between Spaniards and Colombians, Peruvians and most Argentineans. Regarding health care use, Romanian men were less likely to use health care at all levels. Women from Argentina, Bolivia and Ecuador reported a lower use of primary health care, whereas Peruvian women had a higher use than Spanish women. Among females, there were no differences in emergency visits or hospitalizations. Bolivian men reported higher hospitalization rates, Ecuadorians had lower hospitalization and Argentinean men reported more emergency visits. Conclusions: In Spain there is heterogeneity in the relationship between immigration and health, sleep quality and health care use in Spain, which depends on the specific country of birth and gender.Objetivo: Comparar el estado de salud (subestudio 1), la salud del sueño (subestudio 2) y el uso de servicios sanitarios (subestudio 3) entre la población nacida en España y población inmigrante procedente de los siete países que aportaban mayor número de inmigrantes; examinar si las diferencias se explican por las características socioeconómicas y determinar si los patrones de asociación difieren por género. Métodos: Estudio transversal con datos de la Encuesta Nacional de Salud de 2006 (n=29.476). Se seleccionaron las personas nacidas en España y las nacidas en los siete países con mayor número de inmigrantes en España (Argentina, Bolivia, Colombia, Ecuador, Perú, Rumania y Marruecos). Para el primer subestudio se selecionaron personas de 20 a 64 años (n=20731) y para el segundo y tercer sub-estudio los individuos de 16 a 64 años (n = 22.224). Resultados principales: En ambos sexos, las personas de Bolivia tuvieron peores resultados de salud, sobre todo los hombres de Bolivia (OR ajustado plenamente = 4,84, IC = 2,47-9,48 95% para el estado de salud percibido y 8,81 IC = 4,41-17,62 95%). Por el contrario, las personas de Argentina y Colombia tuvieron los mejores resultados en salud, en algunos casos mejor que los españoles. En cuanto a los síntomas de insomnio y sueño no reparador, en ambos sexos, la gente de Bolivia tenía una mayor prevalencia de síntomas de insomnio y sueño no reparador. Por el contrario, la gente de Ecuador, Marruecos y Rumanía tuvieron menos síntomas de insomnio y sueño no reparador que los españoles. No se encontraron diferencias entre españoles y colombianos, peruanos y la mayoría de los argentinos. En cuanto al uso de servicios sanitarios, los hombres rumanos utilizaron menos los servicios sanitarios en todos los niveles. Las mujeres de Argentina, Bolivia y Ecuador hicieron un menor uso de la atención primaria de la salud, mientras que las mujeres peruanas tuvieron un uso mayor que las mujeres españolas. Entre las mujeres, no hubo diferencias en las consultas de urgencia u hospitalizaciones. Los hombres bolivianos reportaron mayores tasas de hospitalización y uso de urgencias, los ecuatorianos tuvieron menos ingresos hospitalarios y más visitas a la atención primaria y los argentinos hicieron un mayor uso de las urgencias. Conclusiones: En España existe heterogeneidad en la relación entre la inmigración, la percepción de la salud, salud mental, los síntomas de insomnio, SNR y el uso de servicios sanitarios, que depende del país concreto de nacimiento y de diferencias de género

NOWHERELAND REVISITED IN TIMES OF PANDEMIC 2020

Undocumented Migrants (UDM) belong to the most vulnerable groups in times of global emergency situations. COVID-19 does hit hardest the most vulnerable groups and it is important to create an evidence base to guide policy making. The Center for Health and Migration, Vienna, has initiated a stock-taking of national regulations concerning access to health and social care for UDM. The initiative aims to create a landscape of policy frameworks to inform policy making and practice development. National experts on health and migration are contacted and asked to provide information on the respective legal frameworks in the following categories: work, housing, compulsory education, social welfare, and health. A validated template is used for data collection