Public health aspects of migrant health: a review of the evidence on health status for undocumented migrants in the European Region
... Research on health disparities between UMs and regular residents (including documented migrants) in Europe is limited. However, evidence shows that UMs face numerous health challenges [4]. Compared with the majority population, UMs report poorer self-perceived health and are at increased risk for mortality from non-communicable diseases, such as cardiovascular issues and cancers [1,[4][5][6][7][8][9]. ...
... However, evidence shows that UMs face numerous health challenges [4]. Compared with the majority population, UMs report poorer self-perceived health and are at increased risk for mortality from non-communicable diseases, such as cardiovascular issues and cancers [1,[4][5][6][7][8][9]. High rates of maternal mortality and adverse birth outcomes, including preterm birth and low birth weight, have also been noted among UMs [1,10]. ...
... Mental health is another critical area, as UMs are more likely to have risk factors for conditions such as depression, anxiety, and posttraumatic stress disorder (PTSD) than both the general population and documented migrants are [1,4,12,13]. ...
Objectives
This study aimed to explore the associations between mental health status and experienced pain among undocumented migrants (UMs) in France.
Methods
We used data from the multicentric cross-sectional “Premier Pas” study conducted in the Parisian and Bordeaux regions from February to April 2019. Participants over 18 years of age were recruited from sixty-three sites. Pain was assessed through two variables: overall pain and musculoskeletal pain. Mental health conditions, including anxiety, sleep disorders, depression, and posttraumatic stress disorder (PTSD) were evaluated. Logistic regression models were used to explore associations, controlling for social determinants of health (SDHs).
Results
Our findings revealed significant associations between mental health status and pain among the 1,188 included participants. Sleep disorder was associated to higher odds of musculoskeletal pain (aOR = 2.53, 95% CI [1.20–5.33], p = 0.014). Stratified results indicated that among women, depression was associated to higher odds of pain (aOR = 4.85, 95% CI [1.53–13.36], p = 0.007).
Conclusion
This large study confirms the connection between mental health status and pain among UMs, providing valuable evidence for clinicians to address mental health issues in this population.
... During public health crises, such as COVID-19, health literacy serves as an essential skillset to enable individuals to access relevant health information and services, to make appropriate decisions, and to practice healthy and preventive behaviors in their everyday lives. Despite the significant relevance of health literacy to health and health outcomes among migrant workers [18,19], it is unclear how health literacy has affected migrant workers' experiences during the pandemic. To address this gap, this study aimed to explore health literacy experiences among migrant workers in South Korea and how health literacy influenced their experiences of the COVID-19 pandemic. ...
... I was confined in a room alone. I was intimidated and worried to be alone after the positive COVID- 19 20]. " ...
... A recent national survey [27] revealed that one of the main reasons for unmet health care needs among immigrants in South Korea was communication difficulty (25.3%); the rate was much higher among non-professional employment visa holders, such as non-skilled migrant workers (54.2%). Migrant workers with low health literacy are at risk for significantly worse health outcomes than native workers [18,19]. These findings suggest the need for more tailored language programs targeting non-skilled migrant workers. ...
Background
Migrant workers are among the most vulnerable populations in society. This study explored the health-literacy experiences of migrant workers in South Korea and how the workers’daily lives have been affected by the coronavirus disease 2019 (COVID-19) pandemic.
Methods
We conducted a series of semi-structured individual and focus-group interviews with 23 migrant workers (eight Cambodians, six Nepalese, four Sri Lankans, three Bangladeshis, and two Pakistanis) residing in the Daegu and Busan metropolitan areas of South Korea. All interviews were digitally recorded and transcribed verbatim. The data were analyzed using content analysis.
Results
Migrant workers had difficulty accessing and using health care services due, in large part, to linguistic barriers and a lack of an adequate support system. Four main themes were identified: difficulty understanding and using medical services, obtaining necessary health and safety information, the impact of COVID-19, and protecting oneself from becoming infected with COVID-19. Most workers depended on information from social networking services (SNS) and co-workers.
Conclusions
Migrant workers’ difficulty with health care access was exacerbated during the COVID-19 pandemic. The findings suggest the necessity of enhancing migrant workers' health literacy, along with the use of SNS as a viable pathway for sharing health information and resources.
... Part of these migrants is undocumented [i.e., persons born abroad, of foreign nationality, and who have no right of residence in the country of residence (9,10)]. Limited data are available in Europe and France on the health of undocumented immigrants (9,11,12). It was estimated that 1.9-3.8 million undocumented migrants live in the European Union (EU) (11). ...
... Limited data are available in Europe and France on the health of undocumented immigrants (9,11,12). It was estimated that 1.9-3.8 million undocumented migrants live in the European Union (EU) (11). Despite the existence in France of social assistance for health cover for undocumented migrants (the State Medical Aid, AME), it is estimated that 49% of eligible undocumented migrants have not applied for their rights in Paris and the Bordeaux area (13). ...
... According to the data from the healthcare system and NGOs, undocumented migrants are unequally affected by infectious and tropical diseases in relation to the epidemiology in the countries of origin and poor living conditions in the host countries (11,17,18). A recent study observed an increase in ICU admissions in France for undocumented migrants, who were younger and more severely ill than other patients admitted (19). ...
Introduction
An increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France.
Methodology
The Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software.
Results
A total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived <3 years earlier. Among the participants, 24.8% declared a poor perceived health status and 33.5% a chronic health condition. Dental infections concerned 43.2% of the participants. Apart from dental issues, 12.9% reported suffering from at least one infectious disease: HIV infection (3.5%), chronic hepatitis B virus infection (3.1%), upper respiratory tract infection (1.7%), skin mycosis (1.2%), skin and soft tissue infection (0.8%), chronic hepatitis C infection (0.8%), urinary tract infection (0.7%), lower respiratory tract infection (0.7%), scabies (0.3%), tuberculosis disease (0.2%), vaginal mycosis (0.6%), and herpes (0.1%). Regarding HIV, HBV, and HCV infections, 56, 71, and 89%, respectively, were diagnosed after their arrival. Chronic viral infections were more often reported by undocumented migrants from sub-Saharan Africa and Latin America. In multivariate analysis, a higher risk of reporting chronic viral infection was observed among people food insecure.
Conclusion
This original study on a large random sample confirms the frequency of infectious diseases among undocumented migrants in France and the importance of integrating their screening during a health Rendezvous and their management into early access to care and inclusive medico-psycho-social management.
... However, research studies have documented the entire spectrum of health policies in countries, from those that are inclusive of all migrants regardless of their legal status, to much more restrictive policies, eroding the principles of UHC (Legido-Quigley et al., 2019;Cabieses et al., 2019;Yaya and Sanogo, 2019). In the European Union (EU), several studies have found considerable variation in healthcare access for migrants and refugees, between and within EU Member States (Cuadra, 2011;Woodward et al., 2013;De Vito et al., 2015;Keith and Van Ginneken, 2015;Cimas et al., 2016;Hannigan et al., 2016;Geeraert, 2018;Ledoux et al., 2018). A 2016 review of countries in the EU found that legal status was one of the most significant factors that influenced migrants' access to comprehensive health services (Hannigan et al., 2016). ...
... A 2016 review of countries in the EU found that legal status was one of the most significant factors that influenced migrants' access to comprehensive health services (Hannigan et al., 2016). Within the EU, undocumented migrants mostly had access to emergency care, but both formal and informal barriers hindered access in countries with UHC (De Vito et al., 2015). These barriers included differing interpretation and implementation of health policies, language and communication problems, lack of social networks, migrants' fears, and lack of knowledge about their rights, the healthcare system and healthcare professionals (De Vito et al., 2015;Woodward et al., 2013). ...
... Within the EU, undocumented migrants mostly had access to emergency care, but both formal and informal barriers hindered access in countries with UHC (De Vito et al., 2015). These barriers included differing interpretation and implementation of health policies, language and communication problems, lack of social networks, migrants' fears, and lack of knowledge about their rights, the healthcare system and healthcare professionals (De Vito et al., 2015;Woodward et al., 2013). ...
Notwithstanding the promise of the inclusivity of universal health coverage (UHC), the integration of migrants and refugees into host countries’ health systems remains elusive and contested. In South Africa, there is insufficient scholarly attention on UHC, migrants and refugees, given the country’s strategic importance in Africa and the envisaged implementation of the National Health Insurance (NHI) system. In this paper, a social exclusion conceptual framework is used to explore whether South African legislation, health policies and perspectives or actions of health policy actors facilitate UHC for migrants and refugees or exacerbate their exclusion. We combined a review of legislation and policies since 1994, with semi-structured interviews with 18 key informants from government, academia, civil society organizations and a United Nations organization. We used thematic analysis to identify themes and sub-themes from the qualitative data.
The South African Constitution and the National Health Act facilitate UHC, while the Immigration Act and the 2019 NHI Bill make the legal status of migrants the most significant determinant of healthcare access. This legislative disjuncture is exacerbated by variations in content, interpretation and/or implementation of policies at the provincial level. Resource constraints in the public health sector contribute to the perceived dysfunctionality of the public healthcare system, which affects the financial classification, quality of care and access for all public sector patients. However, migrants and refugees bear the brunt of the reported dysfunctionality, in addition to experiences of medical xenophobia. These issues need to be addressed to ensure that South Africa’s quest for UHC expressed through the NHI system is realized.
... They are frequently employed in informal, low-skill, precarious and hazardous jobs and are susceptible to work-related abuse and exploitation [4]. Access to medical services varies between countries and is frequently limited to emergency situations [5]. Overall, these factors tend to negatively impact on health and wellbeing of undocumented migrants [5][6][7]. ...
... Access to medical services varies between countries and is frequently limited to emergency situations [5]. Overall, these factors tend to negatively impact on health and wellbeing of undocumented migrants [5][6][7]. ...
... In Europe, there is only limited evidence about undocumented migrants' mental health and its determinants [5]. Most studies have reported data from small samples of participants, frequently retrospectively, and often collected in healthcare setting failing to reflect the situation in the community [6]. ...
Background
Undocumented migrants live and work in precarious conditions. Few studies have explored the mental health consequences of such environment. The objective of this study is to describe the mental health of migrants at different stages of a regularization program.
Methods
This cross-sectional study included migrants undocumented or in the process of regularization. We screened for symptoms of anxiety, depression and sleep disturbance using validated tools. We created a composite outcome of altered mental health including these components plus self-report of a recent diagnosis of mental health condition by a health professional.
Results
We enrolled 456 participants of whom 246 (53.9%) were undocumented. They were predominantly women (71.9%) with a median age of 43.3 (interquartile range: 15.5) years, from Latin America (63.6%) or Asia (20.2%) who had lived in Switzerland for 12 (IQR: 7) years. Overall, 57.2% presented symptoms of altered mental health. Prevalence of symptoms of anxiety, depression and sleep disturbance were 36% (95% confidence interval: 31.6–40.6%), 45.4% (95% CI: 40.8–50.1%) and 23% (95% CI: 19.2–27.2), respectively. Younger age (adjusted odd ratio: 0.7; 95% CI: 0.5–0.9 for each additional decade), social isolation (aOR: 2.4; 95% CI: 1.4–4.2), exposure to abuse (aOR: 1.9; 95% CI: 1.1–3.5), financial instability (aOR: 2.2; 95% CI: 1.4–3.7) and multi-morbidity (aOR: 3.2; 95% CI: 1.7–6.5) were associated with increased risk of having altered mental health while being in the early stages of the process of regularization had no effect (aOR: 1.3: 95% CI: 0.8–2.2).
Conclusions
This study highlights the need for multi-pronged social and health interventions addressing the various domains of undocumented migrants living difficulties as complement to legal status regularization policies. Protection against unfair working conditions and abuse, access to adequate housing, promoting social integration and preventive interventions to tackle the early occurrence of chronic diseases may all contribute to reduce the burden of altered mental health in this group. More research is needed to assess the long-term impact of legal status regularization on mental health.
... It includes persons who (a) lack the necessary documentation to legally enter a country but do so clandestinely; (b) enter or stay in a country using fraudulent documentation; or (c) after entering a country with valid legal documentation, stay beyond the period authorized or otherwise violate the terms of entry and remain without authorization [2]. This term is considered a synonym of "undocumented migrant", which refers to the individual's administrative situation and is one of the most widely used and accepted terms [2][3][4]. The term encompasses visa "overstayers", those who have lost resident status, rejected asylum seekers, and individuals who have entered a country illegally [3][4][5]. ...
... This term is considered a synonym of "undocumented migrant", which refers to the individual's administrative situation and is one of the most widely used and accepted terms [2][3][4]. The term encompasses visa "overstayers", those who have lost resident status, rejected asylum seekers, and individuals who have entered a country illegally [3][4][5]. ...
... In 2008 an estimated 1.9-3.8 million irregular migrants were living in the European Union [4]. ...
Background
There is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare utilization between irregular migrants, documented migrants, and Spanish nationals in a Spanish autonomous community.
Methods
This retrospective, observational study included the total adult population of Aragon, Spain: 930,131 Spanish nationals; 123,432 documented migrants; and 17,152 irregular migrants. Healthcare utilization data were compared between irregular migrants, documented migrants and Spanish nationals for the year 2011. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.
Results
The average annual use of healthcare services was lower for irregular migrants than for documented migrants and Spanish nationals at all levels of care analyzed: primary care (0.5 vs 4 vs 6.7 visits); specialized care (0.2 vs 1.8 vs 2.9 visits); planned hospital admissions (0.3 vs 2 vs 4.23 per 100 individuals), unplanned hospital admissions (0.5 vs 3.5 vs 5.2 per 100 individuals), and emergency room visits (0.4 vs 2.8 vs 2.8 per 10 individuals). The average annual prescription drug expenditure was also lower for irregular migrants (€9) than for documented migrants (€77) and Spanish nationals (€367). These differences were only partially attenuated after adjusting for age, sex, and morbidity burden.
Conclusions
Under conditions of equal access, healthcare utilization is much lower among irregular migrants than Spanish nationals (and lower than that of documented migrants), regardless of country of origin or length of stay in Spain.
... From the psycho-demographic perspective, life satisfaction is an individual assessment process in which persons liken their perceived status quo to their expectations and opportunities of the situation, either in ideal or in reference circumstances [9,10]. As far as the migrant population is concerned, existing studies have identified three dimensions that are openly linked to migrants' prejudiced valuation process, explicitly as cultural, social, and economic integration [11,12]. In terms of economic integration, good living conditions depend not only on the affluence and resources of an individual but also on other factors that collectively influence life satisfaction. ...
... Finally, community factors, such as type of dwelling (formal and informal) were associated with both male and female migrants who are residing in an informal type of dwelling being less likely to experience thriving life satisfaction [100,101], while both male and female migrants of international status were associated with the predicted outcome that they are more likely to experience thriving life satisfaction. Although reasons for these decreased odds of aspiring to have thriving life satisfaction among both migrants may not be fully known to the authors, a combination of factors, including religiosity and high levels of connectedness, may be contributing to the lower odds of life satisfaction [12,14]. The increased odds of international migrants experiencing thriving life satisfaction is predominantly expected, as they have the purpose of moving from their own country to another country. ...
Background
Migrant populations in any country are a vulnerable group, and psycho-demographic research measuring life satisfaction has been used to assess migrants’ well-being in developed and developing countries. However, South Africa, with its high influx of migrant populations, has investigated these topical concerns from the perspective of xenophobia, with mixed findings. However, no, or very few studies have examined life satisfaction among migrants in South Africa. This study, therefore, extends previous literature by examining the determinants of life satisfaction among South Africa’s internal and international migrant populations.
Methods
We conducted a cross-sectional study from the 2009 to 2021 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) surveys among migrant populations in two ways: a full sample and a gender-stratified sample. A sample of male and female migrants ranging from 15 to 49 years of age were recruited into this study. Cantril’s Self-Anchoring Ladder Life Satisfaction scale captured their life satisfaction alongside relevant social demographic factors. Descriptive statistics were applied for the data analysis of the demographic factors. Bivariate and multivariate logistics regression analyses were conducted to assess the associations and the predictive factors of life satisfaction among migrants, both internal and international.
Results
The key findings were the gender distribution of life satisfaction, showing that more international (male – 66.0% and female – 67.1%) migrants reported having a thriving life satisfaction than internal migrants (male – 61.7% and female – 61.5%). Findings from the Pearson correlation coefficient revealed a significant association between the individual, household, and community factors by migrant status (ρ < 0.05). However, the probit coefficients revealed that individual factors (age 48⁺: AOR = 2.18, 95% CI: 1.13, 3.23, and secondary/higher education: AOR = 1.1., 95% CI: 0.01, 1.19) and household factors (two persons living in households (H/H): AOR = 1.05, 95% CI: 0.50, 1.10), and community factors (international migrant status: AOR = 2.12, 95% CI: 0.08, 2.16) significantly increase the prediction of higher odds of life satisfaction by gender among migrants. The ordered logit coefficients also showed that individual factors (middle and high income and having health insurance) and household factors (receiving SASSA social grant) predicted the highest life satisfaction among migrants (internal and international).
Conclusion
We found substantial evidence that individual-, household-, and community-level factors were associated with life satisfaction among migrants. In particular, the pattern of life satisfaction varied slightly between male and female migrants, as well as with migrant status in South Africa. These findings collectively may provide helpful information for policymakers and practitioners to optimise interventions for migrant populations to improve their life satisfaction. Evidence from this study also calls on the government of South Africa to begin tracking the life satisfaction of its nationals, whether migrants or not.
... Migrant workers who are economically disadvantaged are one of the most vulnerable populations in healthcare [28,42]. They face higher health risks due to greater barriers to seeking healthcare and communicating with health professionals during healthcare encounters [28,56,58]. ...
... Migrant workers who are economically disadvantaged are one of the most vulnerable populations in healthcare [28,42]. They face higher health risks due to greater barriers to seeking healthcare and communicating with health professionals during healthcare encounters [28,56,58]. Studies have shown that those who have trouble accessing healthcare services due to financial constraints, trouble getting timely appointments with doctors, or a conflict in their personal schedules during clinic hours are more likely to look for general health information online [10,105]. ...
Economically disadvantaged migrant workers are one of the most vulnerable groups in healthcare. Studies have shown that chatbots can help patients and health professionals in healthcare settings. However, the design of health chatbots for migrant workers has not been thoroughly investigated. Scenario-based interviews with nineteen participants, including ten economically disadvantaged Thai migrant workers and nine relevant stakeholders, were conducted to examine how they seek healthcare, obtain health information, and communicate with health professionals to gain a deeper understanding of the barriers that migrant workers encounter in healthcare. The findings of the interview show that migrant workers face a variety of barriers, such as a lack of familiarity with the healthcare system in the host country, language barriers, cultural barriers to seeking healthcare, and communication barriers with health professionals. Then, the technological design strategies and the benefits of health chatbots from the perspective of migrant workers were discussed, including their potential to help migrant workers navigate the healthcare system step-by-step, obtain reliable health information, improve their health literacy, and facilitate communication with health professionals. Finally, five design implications for chatbots were proposed to guide future development of health chatbots to help migrant workers. Policymakers and health professionals can benefit from the design implications of migrant worker-centered health chatbots when they develop health chatbots that promote the health and well-being of migrant workers.
... Global evidence of migrants' access to healthcare is scant (Lebano et al., 2020) and generally country-specific, making it difficult to draw comparisons and commonalities across countries (De Vito et al., 2015). Most of the literature has focused on the health status of migrants compared to the local population documenting the differences in the use of health services (Affronti et al. 2011) and showing that inequalities still exist in accessing healthcare (Ho et al., 1997;Tognetti, 2015); some highlighted barriers to access to healthcare such as organisational and administrative issues, also knowledge and language difficulties (Chappuis et al., 2015;Norredam et al., 2010;Sarría-Santamera et al., 2016;Graetz et al. 2017), while others studies (Giannoni et al., 2016;Singh et al., 2013) reported that individuals in an equal state of health but unequal in other characteristics, such as the income level or immigrant status, may have unequal probabilities for accessing healthcare. ...
... Often, legal entitlement does not guarantee access and administrative procedures such as requirements for documentation or policies discretionary decisions create barriers to accessibility, this effect has been well documented in the literature (Bradby et al., 2015;De Vito et al., 2015;Matlin et al., 2018). Moreover, the structure and the organisation of health systems, as determined by government policy, have a profound influence on the ability of particular groups to access healthcare (Marmot et al., 2008;O'Donnell et al., 2016). ...
Migrants and refugees try to reach Europe to seek protection and a better life. The responsiveness and stewardship of the European countries health system have an impact on the ability to access healthcare. This study aims to investigate the differential probability of healthcare unmet needs among migrants living in four European countries. We used a 2019 cross-sectional data from the European Union Income and Living Conditions survey. We performed a two-stage probit model with sample selection, first to identify the respondents with need for care, then those who need it but have not received it. We analysed reasons for unmet needs through accessibility, availability and acceptability. We then performed country studies assessing the national health systems, financing mechanisms and migration policies. Bringing together data on financial hardship and unmet needs reveals that migrants living in Europe have a higher risk of facing unmet healthcare needs compared to native citizens, and affordability of care remains a substantial barrier. Our results showed the country heterogeneity in the differential migrants’ unmet needs according to the place where they live, and this disparity seems attributed to the health system and policies applied. Given the diversity of socioeconomic conditions throughout the European countries, the health of migrants depends to a large degree on the integration and health policies in place. We believe that EU policies should apply further efforts to respect core health and protection ethics and to acknowledge, among others, principles of ‘do-no-harm’, equity and the right to health.
... The individual migrant's health is the result of, inter alia, previous experiences, the migratory process, social determinants of health as well as the migrant's current social situation (De Vito et al., 2015). Several international studies show that health problems among undocumented migrants/rejected asylum seekers correspond with the health problems seen in ordinary general practices. ...
... Most of the health problems are mainly related to digestive problems, mental health issues, musculoskeletal disorders and obstetric care, and can be treated in primary health care (Ehmsen et al., 2014;The City Church Mission, 2021). Some infectious diseases, e.g., tuberculosis and hepatitis, are more prevalent among undocumented migrants than among the general population (De Vito et al., 2015). Relatively few studies differentiate between undocumented migrants in general and finally rejected asylum seekers. ...
Asylum seekers are in an extraordinary situation as their future life depend on decisions made by authorities in a bewildering, bureaucratic system, with excessive waiting and unpredictable timeframes. Those that are not granted asylum, and not able to return to their country of origin, can neither spatially nor temporally visualize if, when or how a potential change is going to occur. This paper is part of a larger study based on narrative interviews with asylum seekers and refugees in asylum centers in Norway, exploring their experiences before, during, and after flight. As we found that the life circumstances for those being refused asylum, were highly different from other participants in the project, we chose to address this particular group in a separate paper. The participants in this part of the study consisted of 21 individuals (of a total of 78 participants) in the age range 18–44, of whom eight were female and 13 males. Trough qualitative interviews and participant observation the aim of this study was to explore and describe the life condition and mental health situation of rejected asylum seekers in Norway. We found that the gradual loss of rights, opportunities and finances are experienced as a form of violence that leads to extreme mental and social suffering. This policy clearly conflicts with Human Rights incorporated in the Norwegian constitution, and we argue that it legitimizes treating asylum seekers as a group of undesirable and underserving political bodies, with serious consequences for their mental health and wellbeing.
... As a result, migration to another country may be appealing, and being granted asylum can make the difference between life and death for some LGBTQ people. That said, the irregular status of migrants, especially asylumseeking migrants, and associated economic and social marginalisation, offers one explanation why migrants are at greater risk of health problems (De Vito et al. 2015). ...
... Moreover, LGBTQ migrants described significant difficulties or potential future problems in Sweden, a finding which is in line with previous research (Misund Dahl et al. 2020). Some migrants felt like second-class citizens and experienced relatively poorer health in the new country (Fang et al. 2015), a possible consequence of the uncertain, irregular status, and economic and social marginalisation (De Vito et al. 2015). ...
This paper explores the lived experiences of LGBTQ migrants participating in a civil society group in Sweden during the migration process and their reflections on the future. Eleven migrants who self-identified as LGBTQ (seven male/gay, one female/lesbian, one female/bi-sexual, and two transgender/gay persons) from three local support groups for LGBTQ migrants agreed to be interviewed. Participants came from Guinea, Iraq, Kurdistan, North Macedonia, Nigeria, Nicaragua, Pakistan, the Russian Federation, Syria, Uganda and Ukraine. Interpretative-phenomenological analysis resulted in three themes: Past: from daily stress to the fear of being killed; Present: safety, belonging and resources to support the transition to a new life; and Future: making a positive difference or being afraid of what’s ahead. Participants’ health-related journeys and reflections about the future were complex in terms of favourable and unfavourable lived experiences, which become resources and risks for personal development. Study findings offers an enhanced awareness of the complex landscape of, and interaction between, vulnerability and potentiality. Based on the findings, we suggest the adoption of a health promoting approach focusing on the LGBTQ migrants’ strengths and personal resources.
... The latest estimates suggest that 20 to 30 million migrants live in a foreign country without legal residence permit (undocumented), among whom 1.9 to 3.8 million are in Europe [1,2]. Previous studies showed that undocumented migrants tend to present frequent health problems in the context of adverse living and working conditions [3][4][5][6]. Specifically, undocumented migrants were shown to be at high risk of occupational hazards and chronic physical illnesses [7][8][9]. Due to precarious legal and economic conditions, many are forced to perform degrading, physically demanding and low-paid jobs in under-regulated sectors of the labour economy [7,[10][11][12]. ...
... As by definition undocumented migrants are not registered and random sampling was not feasible, chances are that our convenience sample may not be representative of the undocumented migrants' population both in Geneva and elsewhere in Europe. Notably, we excluded former asylum seekers which may account for a substantial share of this group in other countries [1,5]. In addition, we cannot exclude residual confounding. ...
Background
In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration.
Methods
This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included.
Results
Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p -value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables.
Conclusion
At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health.
... 1 Already before the pandemic, in the World Health Organization (WHO) European Region, refugees and migrants faced socioeconomic, sociocultural and educational barriers when accessing immunization services in host countries. 2 Seroprevalence studies have shown suboptimal immunity to various vaccinepreventable diseases, indicating lower vaccination coverage in refugees and migrants compared to the host population average. 3 During the pandemic, the vulnerability of these groups might have increased. ...
... Most Member States of the European Region do not have specific immunization directives focusing on refugees and migrants. 2 Ascertaining whether these groups have completed their vaccinations is impossible without consistent, comprehensive and standardized disaggregated data, shared across borders and along migratory routes for effective health needs and burden-of-disease monitoring. 3,6 Because of the lack of clarity in existing national policies and inconsistent guidelines between countries, 7 healthcare professionals might misunderstand vaccination recommendations for refugees and migrants, particularly when vaccination documentation is not available. ...
... A similar study [12] suggested that those who access health care are more likely to have been in the country for a longer amount of time and have different socio-demographic characteristics, and hence different risk profiles for infection, from the wider migrant population. Italian law states that undocumented migrants have the right to healthcare without being reported to immigration authorities, however in other countries civil servants (including healthcare workers) are legally obliged to report undocumented migrants [63]. This must be considered if this framework were to be applied elsewhere since it might lead those most at risk to be excluded from the screening. ...
An increase in global migration towards developed countries along with climate change has led to the occurrence of Neglected Tropical Diseases (NTDs) in otherwise non-endemic countries. In this paper we focus on Soil Transmitted Helminth (STH) infections which disproportionately affect people living in poverty in tropical regions. To reduce the threat of STHs in migrant populations living in non-endemic countries, diagnosis and treatment are paramount but also present logistical challenges. This study investigates how statistical modelling can be used to assist the identification of individuals infected with STHs. Specifically, we show how to combine individual variables (e.g., age, sex and time in Italy) with publicly available country indicators (Human Development Index, Multidimensional Poverty Index and Inequality-adjusted Human Development Index) which describe development in the migrant’s country of origin. We combine these indices and their factors in binomial mixed-effects models which can be used to predict the status of STH infections in migrant populations. By presenting a case study on migrants in southern Italy, we assess the relative importance of the individual-level variables and country-level indicators in enhancing the predictive power of the models. The results show that the country-level indices play a more important role but also highlight that individual data can help improve the model performance when combined with the former. To the best of our knowledge this is the first study investigating using country-level indicators to predict parasite infection status of migrants. Our study indicates that statistical models can play an important role in reducing the resources required to identify migrants requiring anthelmintic treatment against STHs and help to make statistically informed decisions.
... 3 Even where states do not formally restrict access to medical care, administrative, organisational and cultural barriers, as well as mistrust of public service providers, represent serious obstacles (Fox-Ruhs & Ruhs, 2022;Mladovsky, 2023;Mladovsky et al., 2012;Rechel et al., 2013;Spahl, 2022). These barriers discourage irregular migrants from seeking care in public structures despite formal entitlements, with detrimental implications for both the health Page 4 of 18 Piccoli and Perna Comparative Migration Studies (2024) 12:20 of irregular migrants themselves (Biswas et al., 2011;Lebano et al., 2020;Piccoli, 2022;De Vito et al., 2015;Woodward et al., 2014) and public health systems more generally (Boso & Vancea, 2016;European Union Fundamental Rights Agency, 2015;Kerani & Kwakwa, 2018). In many countries, CSOs fill some of these gaps. ...
Individuals who reside in a country without regular authorisation generally find it difficult to access public medical services beyond emergency treatment. Even in countries with universal healthcare, there is often a gap between rights on paper and their implementation. Civil society organisations (CSOs) fill this gap by providing medical services to vulnerable populations, including irregular migrants. What, if any, are the ethical dilemmas that arise for CSO staff when delivering such services in countries with universal healthcare? Under what conditions do these dilemmas arise? And what strategies do CSO staff use to mitigate them? We answer these questions using 40 semi-structured interviews with CSO staff working in two European countries with high levels of irregularity, universal healthcare provisions on paper, and significant differences in approaches and availability of public services for irregular migrants: Italy and Spain. We show that CSO staff providing medical services to irregular migrants in places with universal healthcare coverage face a fundamental dilemma between humanitarianism and equity. CSO staff respond to the humanitarian belief in the value of taking all possible steps to prevent or alleviate human suffering, thus promoting a decent quality of life that includes access to both emergency and non-emergency care. In doing so, however, they run the risk of substituting rather than complementing public provisions, thereby preventing governments from assuming responsibility for these services in the long term. Individuals who acknowledge the existence of this dilemma generally oppose the creation of parallel structures; that is, services specifically developed for irregular migrants outside the public system; while those who ignore it essentially subscribe to a tiered system, giving up on considerations of equity. We argue that CSOs involved in the provision of healthcare to irregular migrants do not simply provide services; they also play an inherently political role.
... The present study contributes to filling this gap by presenting a detailed description of the health needs of a large cohort of undocumented Chinese migrants in Prato, Italy. Chinese communities have a strong social structure that may offer protection and social support to undocumented migrants [10,11] and there are now a large number of Chinese present in Europe [12,13]. We therefore performed an analysis of data collected in a large cohort of first-generation Chinese migrants investigated in the CHinese In Prato study (CHIP) [14][15][16] to examine main risk factors of undocumented Chinese migrants (with or without the STP code) when compared to Chinese registered with the NHS. ...
... Dans la population générale, un faible niveau de protection sociale est associé à une augmentation du renoncement aux soins, à la rupture de suivi ou de traitements de maladies chroniques, à la survenue de complications, à une augmentation du recours aux soins d'urgence et in fine à la nécessité de soins hospitaliers complexes et plus coûteux [15][16][17][18][19][20][21][22]. En Espagne, la suppression du dispositif de protection sociale des étrangers en situation irrégulière a été associée à une augmentation de leur taux de mortalité, à l'augmentation de l'incidence de certaines maladies infectieuses et à un recours accru aux services d'urgence [23][24][25]. ...
... Their persistent exclusion from basic rights is often justified as a means to deter more irregular migration (Baldwin-Edwards and Kraler 2009, 131). Because of this, irregular immigrants are among the most vulnerable members of a society (Ellermann 2010;Fox-ruhs and Ruhs 2022;Joseph 2017), e.g., they face a higher risk of mortality than the general population (Piccoli and Wanner 2022;Vito et al. 2015). ...
Collective regularisation programmes providing legal status to unauthorised immigrants were frequently used by European countries until the late 2000s, when they fell out of fashion. In 2020, at the start of the Covid-19 pandemic, some European governments made use of collective regularisations again, breaking this “taboo”, while others did not. Why this variation in response? We compare policy-making in three Southern European countries that have frequently resorted to collective regularisations in the past, but which took divergent paths during the Covid-19 pandemic despite facing similar health and economic-related pressures: a collective regularisation in Portugal, a targeted regularisation in Italy, and no regularisation in Greece. Informed by a theoretical model that builds on existing explanatory frameworks on migration policy, we use expert interviews, legal and policy documents, parliamentary debates, and press coverage to explain variation in policy outputs. Our findings point to the importance of three conditions: (1) the balance of liberalising versus restrictionist pressures, (2) government ideology, and (3) the scope and implementation of pre-existing regularisation mechanisms. We show that the Covid-19 pandemic worked as a catalyst for the return of policies that were previously considered “taboo” only when policy changes were considered to be cost-free. We argue that, despite functional pressures and discursive opportunities created by the pandemic, the regulation of the status of unauthorised migrants is characterised by continuity and incremental change rather than by sudden ruptures.
... There are shared and differential needs and experiences within refugee and migrant populations. Some research takes a primary focus on health issues that matter only for specific populations (e.g., trafficking) while other research takes a primary focus on cross-cutting issues (e.g., language and cultural barriers) [21,22]. Of course, there can be intersections between these types of studies too, so categorising them as one or the other becomes difficult. ...
Migration is a longstanding, growing global phenomenon. As a social determinant of health, migration can lead to health inequities between people on the move and host populations. Thus, it is imperative that there is a coordinated effort to advance migration‐ and health‐related goals. WHO has a specific remit to support evidence‐based decision‐making in its Member States. As part of that remit, WHO Europe presents this Framework for Refugee and Migrant Health Research in the WHO European Region. It is designed as a starting point for debating and analysing a broad range of options and approaches to help inform a WHO global research agenda on health and migration. This is important because refugee and migrant health research is a complex interdisciplinary field that is expanding in a fast‐changing socio‐political environment. The Framework is intended for all stakeholders involved: academic, civil society organisations, refugees, migrants, policy‐makers, healthcare providers, educators and funders. It is developed by academics in consultation with these stakeholder groups. It reflects on three specific interrelated dynamics in research practice. These are (i) research prioritisation; (ii) study samples and (iii) research design. The Framework offers recommendations to consider for each one of these. It elucidates the value of involving refugees and migrants in research and research agendas and the need to develop an ecosystem that will support and sustain participatory, interdisciplinary, transdisciplinary and inter‐sectoral projects.
... The Italian National Healthcare Service is known worldwide for being a universalistic system that guarantees healthcare services for all its resident population, regardless of personal, ethnic, social or economic characteristics [1]. The universalistic approach is also valid for undocumented migrants, who have the right to urgent care, essential care, diagnosis of preventive care, and treatment of potentially dangerous infectious diseases [2]. The Legislative Decree 286/98 that clarifies this entitlement [3] made Italy the first in Europe to address migrants' health and access to health services through specific policies [4]. ...
Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.
... The health of undocumented immigrants represents an important concern in most societies [1][2][3][4][5][6]. Yet, this group of the population is often excluded from public benefits. ...
Background
The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died.
Methods
We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities’ policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons.
Results
We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants.
Conclusions
We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts.
... According to IOM (2014) and World Health Organization (WHO) (2018), ensuring equitable access to health care is a global challenge. This is particularly an issue for migrants, who are regarded as one of the groups at higher risk for health problems because of their status as foreigners and the effects of economic and social marginalization (S anchez, 2014;De Vito et al., 2015). Dang et al. (2018) and Shwetha and Prasad (2018) argued that conditions at migrants' origin and destination such as low earnings and nature of occupation can lead to deprivation, thereby resulting in greater exposure to health susceptibilities. ...
Purpose
This study aims to investigate the health-care-seeking behaviour and practices of West African migrants who reside and operate in Wa, Ghana, as itinerant retailers.
Design/methodology/approach
The study was cross-sectional and used the quantitative research approach. The analysis was done on a target population comprising 122 itinerant immigrant retail traders in Wa, Ghana. Fisher’s exact test and logistic regression were used to analyse the data.
Findings
Malaria was the commonest disease among them. Five in ten of the migrants preferred to report malaria episodes to a private health facility than to a government facility. Significant associations were identified between four dimensions (health facility, self-medication, home remedy and consult others) of health-seeking behaviour, and some background characteristics. The main reason why migrants prefer government health facilities was because of their better health personnel. They self-medicated because of easy accessibility of over-the-counter medicine shops. Also, when ill, the migrants usually consulted family members who would be in a position to take them home when their ailment worsens.
Research limitations/implications
Snowball sampling was used to select the respondents which could potentially lead to a sample that is not fully representative of the population in general.
Originality/value
Studies concerning migration and health in Ghana have been focused on internal migrants. Yet, minority immigrant traders equally encounter adverse health conditions but limited studies have been conducted to espouse their health-seeking behaviour. This study imperatively contributes to the subject matter that has limited literature in the country.
... Within a document, it is crucial to identify the elements that are going to be relevant for the analysis: while the images and the text have been recorded without the author's intervention, 7 Ball, 2007 8 Ignatief, 2001 there is a number of mute or evident factors, such as cultural artifacts, which are to be left, referred as "social facts'', produced, shared and used in social organized ways 9 , therefore subject to cultural aspects In order for the data to gain meaning, provide understanding and therefore unfold empirical knowledge, documents must go through a process of examination and interpretation. 10 This systematic procedure treats several forms of document, varying from advertisements, to minutes of meetings, to diaries. After collecting and reading material inherent in our field of research we have gone through an initial process of categorization of the sources, operating through primary data of publication and narrowing down to field, topics and key concepts. ...
Global migrations represent a matter involving dynamics related to geography, ethnical background, situations of war and climate issues. However, the challenge has taken, over the last decades, a strong geo-political connotation on which western governments bet a relevant part of consensus and political action, often sacrificing humanitarian ideals in favor of the accord of electorates. As often happens, interests of the western world do not coincide with global ones, and research of consensus can correspond to a lack of attention to basic rights. Within this scenario, and according to the background hereby proposed, the research is an attempt to explore the issue of access to healthcare for refugees and migrants.
... Due to their (il)legal status, in most jurisdictions, irregular migrants do not have the same rights and guarantees as regular migrants (let alone nationals). This paper will deal with the right to health (Hayden 2012), in the particular aspect of access to health care (De Vito et al, 2015), specifically during a health crisis such as the COVID-19 pandemic, through the analysis of various scholarly works on internal human rights law. 1 As a case study, the paper will use the case of Portugal, a particularly generous jurisdiction towards access to healthcare by irregular migrants. In March 2020, the Portuguese Government decided to temporarily regularize, for public health and humanitarian reasons, those who had already submitted applications for regularization. ...
In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including healthcare. The Portuguese constitutional and legal framework is particularly generous regarding the right to healthcare to irregular migrants. Nevertheless, until now, several practical barriers prevented full access to healthcare services provided by the national health service, even in situations in which it was legally granted. This decision is not only remarkable in light of the fulfilling of migrants’ rights to health, as imposed by international commitments assumed by, but also in view of the fight against COVID-19. The decision is grounded both on human rights and in public health reasons. The paper is divided in two main parts. In the first one, it analyzes national State obligations with regard to healthcare provision to migrants in irregular situation. In the second part, it analyzes the Portuguese solution, using this case study to discuss the possible mechanisms to comply with such obligations.
... In contrast to the free movement of EU citizens, undocumented migrants per definition lack the right to reside on a state's territory (De Vito et al. 2015). This makes the category subject to what de Genova calls 'deportability', defined as 'the possibility of being removed from the space of the nation-state' (de Genova 2002, 439). ...
Undocumented migrants and poor EU citizens have been frequent topics for Swedish political debate and media reports in recent years. However, there is a lack of representative, large-scale studies on media representation of these groups. This study aims to compare and analyse (1) the broad patterns of representation of EU citizens and undocumented migrants in Swedish national press and (2) how these patterns relate to relevant regulative events over the period 2006–2016. Theoretically, it draws on critical discourse analysis and social problems theory. The sample includes 10 022 referrals in 5411 news articles and the methodological strategy is inspired by corpus-driven discourse studies. Words that tend to occur in the near vicinity of the migrant categories (collocates) are a primary focus for the analysis. The study finds that media referred to EU citizens by employing poverty related discourses during the period 2013–2016 and that the governmental term ‘vulnerable’ EU citizens was adopted in media when a national coordinator was appointed. In contrast, undocumented migrants were associated with discourses on social rights over a time period (2008–2013) when rights to health care and education were debated and subsequently introduced.
... The code was established by law in 1995 and was subsequently upheld by law in 1998. Prior to these legal securities, undocumented migrants could only access health care services through emergency rooms, until voluntary associations organized free medical centres in the 1980s [12][13][14][15]. ...
Background
Service-learning experiences, informed by the realities of poverty and marginalization, are important for the education of future health professionals in order to commit them to tackling health inequalities and working with underserved populations. At the Caritas Medical Centre for undocumented migrants and homeless in Rome, students obtain an educational experience of service. The aim of this study is to try to measure the long-term impact of this experience on the professional and life choices of the student participants.
Methods
A questionnaire was designed and distributed by email to all 19–29 years old participants in the experience. Responses were collected and analysed in a quantitative descriptive way and in a qualitative way using the knowledge, skills and attitudes model.
Results
One hundred and seven students responded from the total 763 questionnaires distributed. Ninety-five percent of participants expressed a very high overall satisfaction, 93% declared that the experience influenced his/her future personal choices, and 84% found that the experience influenced their professional choices. Results were arranged into 6 categories of comments: knowledge about the realities of migration, poverty, and marginalization; relational skills; collaborative skills; attitudes towards migrants, poor people and others; Attitudes towards future professions; Attitudes towards life. A final category was listed with self-reflective questions related to the experience.
Conclusion
This research shows the importance of service-learning experiences made during academic studies from young students of medicine and other faculties. Developing a relationship with marginalized and homeless people, within a voluntary service setting, can influence the future professional and personal choices of students. Universities should recognize the value of such experiences and establish partnerships with non-profit organizations to allow future health professionals to confront health inequities and commit themselves to their reduction.
Background
South Korea achieved universal health coverage (UHC) through the National Health Insurance (NHI). However, humanitarian sojourners under temporary stay permits were initially excluded. Alongside recommendations from the National Human Rights Commission of Korea (NHRCK), the 2019 Amendment of the NHI Act expanded eligibility of the NHI. While this marked significant progress toward greater universality in health care, it also led to unintended consequences for humanitarian sojourners.
Methods
This study employed a two-fold approach aligned with the trajectory of the Amendment. First, we conducted semi-structured in-depth interviews to analyze diverse perspectives on the universality of health coverage, the benefits of NHI, and the limitations of policies prior to the 2019 Amendment. Participants included government officials from the Ministry of Health and Welfare, Ministry of Justice, and NHRCK, as well as humanitarian sojourners sharing real-life experiences. Second, we examined the expected and unexpected outcomes of the Amendment by reviewing legal documents, reports, and media coverage after the Amendment. Specifically, we analyzed precedents set by the Korean Constitutional Court regarding the constitutional litigation, white papers, and interviews published in the news.
Results
Despite achieving UHC, Korea had limited universality of health coverage prior to the 2019 Amendment, as humanitarian sojourners were excluded from local subscription. The 2019 Amendment of NHI Act expanded eligibility, making local subscription mandatory for humanitarian sojourners. However, unintended consequences emerged from differential treatment in calculating insurance premiums, determining dependents within the same households, and enforcing penalties for missed payments. Such disparities not only continue to restrict access to care but jeopardizes visa extensions for humanitarian sojourners.
Conclusions
Our findings highlight a critical gap between policy intent and policy impact, revealing the consequences that disproportionately affect the most vulnerable populations, even under the UHC. Effective implementation of UHC requires a deeper understanding of how government officials and judicial authorities perceive universality and view refugee populations. The discrepancies identified in this study underscore the urgent need for coherent policies that not only expand health coverage but also establish a robust safety net to protect marginalized groups.
Objective
The aim of the article is to describe the validation process of a research tool used to measure the intensity and direction of medical personnel’s attitudes towards immigrant patients.
Design
An instrument validation design with a cross-sectional survey was conducted. The validation process was carried out in two phases. In phase 1, the content validity of the tool was analyzed. The competent judges method was used. The reliability of the judges was verified in terms of the consistency of evaluations (the I-CVI index was calculated). In phase 2, the questionnaire was tested among 340 healthcare professionals who have professional contact with immigrants, in terms of its factorial validity (exploratory and confirmatory factor analysis), internal consistency (reliability measured by Cronbach’s alpha coefficient) and absolute stability (measured by the test-retest method).
Results
The research results indicate satisfactory content validity of the tool (I-CVI>0.8). The reliability of the tool measured by Cronbach’s alpha coefficient was high (0.86). The reliability study based on the test - retest method (after 3 weeks) showed high consistency of measurements (0.75). Exploratory factor analysis allowed extracting 1 factor, which explains 55.7% of the variance. The validity of the one-factor solution was confirmed by confirmatory factor analysis. Satisfactory goodness of fit indices were obtained (RMSEA = 0.038; PCLOSE = 0.624; AGFI = 0.966; GFI = 0.990; CFI = 0.996).
Conclusion
The presented tool has satisfactory psychometric properties. The AHPI is a tool that can be used for quick assessment of the intensity and direction of attitudes of medical students and healthcare professionals towards immigrant patients, which can help shape educational and training processes.
Medical State Assistance is a French public health insurance programme that allows undocumented migrants (UM) to access primary, secondary, and tertiary care services free of user charge, either premium or out-of-pocket. The objective of this study is to assess the effect of Medical State Assistance on access to healthcare services and on usual source of care (USC). We rely on representative data of 1,223 UM attending places of assistance to vulnerable populations in Paris and in the greater area of Bordeaux (France). In this sample, 51% of UM are covered by Medical State Assistance. We use probit and ordinary least square regressions to model healthcare uses of undocumented migrants. The results show that UM covered by Medical State Assistance are more likely to access outpatient healthcare services (by +22.4 percentage points) and less likely to do so on non-governmental organizations (by −6.7 percentage points) than their eligible but uncovered counterpart. Additionally, covered undocumented migrants made 36.9% more medical visits in outpatient healthcare services and 65.4% fewer visits in non-governmental organizations than eligible but uncovered ones. Moreover, covered UM are also more likely to report that primary care services are their USC, in preference to emergency departments and other outpatient care services. UM covered by Medical State Assistance are more likely to consult in outpatient healthcare services.
Résumé
Les discriminations en soins liées aux origines font l'objet de plus en plus d'attention en médecine. La pandémie de Covid-19, par son ampleur, a contribué à leur mise en lumière. Des données, bien que peu nombreuses, existent en France sur leur existence. Ces discriminations ont un impact sur le parcours de soins et participent au renoncement aux soins des populations les plus concernées. La problématique des discriminations se pose de façon particulière pour les maladies infectieuses. En effet, l’épidémiologie des maladies infectieuses étant inégalement répartie dans le monde, des représentations sociales erronées sont fréquentes et exposent à un raccourci préjudiciable entre migrants et maladies infectieuses. Le caractère transmissible de certaines maladies infectieuses renforce leur potentiel de stigmatisation. Dans ce contexte, il est nécessaire de s'interroger sur la place qu'il convient de donner aux déterminants sociaux, à l'origine géographique, au phénotype et à l'ethnicité dans l'enseignement et le raisonnement médical. Le monde anglophone utilise le concept de « race » de manière structurelle sans que cette « norme internationale » n'ait, jusqu'alors, été appliquée en France dans une posture d'universalisme républicain. Afin d'améliorer la prise en soins des personnes faisant partie de groupes minoritaires, il apparaît important de mieux documenter et d'enseigner un raisonnement clinique basé sur l'origine qui soit plus nuancé, sans pour autant négliger l'importance du recueil et de la prise en compte des déterminants sociaux de la santé et des facteurs environnementaux.
Background
In Bangladesh, remittances constitute a substantial portion of the country’s foreign exchange earnings and serve as a primary source of income. However, a considerable number of Bangladeshi citizens reside overseas without proper documentation, exposing them to significant challenges such as limited access to healthcare and socioeconomic opportunities. Moreover, their irregular migration status often results in engaging in risky health behaviors that further exacerbate their vulnerability. Hence, this study aimed to investigate the risky health behavior and HIV/STI susceptibility of Bangladeshi irregular international migrants residing across the globe with undocumented status.
Methods
Using a qualitative Interpretative Phenomenological Approach (IPA), 25 illegal migrants were interviewed who are currently living illegally or returned to their home country. The author used a thematic approach to code and analyze the data, combining an integrated data-driven inductive approach with a deductive approach. Concurrent processing and coding were facilitated by employing the Granheim model in data analysis.
Results
The study identified four risky health behaviors among irregular Bangladeshi migrants: hazardous living conditions, risky jobs, suicidal ideation, and tobacco consumption. Additionally, the authors found some HIV/STI risk behavior among them including engaging in unprotected sex, consuming alcohol and drugs during sexual activity, and having limited access to medical facilities.
Conclusions
The findings of this study can be used by health professional, governments, policymakers, NGOs, and concerned agencies to develop welfare strategies and initiatives for vulnerable undocumented migrant workers.
Purpose. Undocumented immigrants often face mental health issues and multisite pain. Links between pain and mental health have been described however not among undocumented immigrants in France. Describing these associations supports further research on the mental health of this population, especially when no cause can explain the pain. The main objective of this study was to analyze associations between pain and mental health among undocumented immigrants in France.
Methods. We drew from the data collected in the multicentric cross-sectional “Premier Pas” study carried out in the Parisian and Bordeaux region between February and April 2019. Undocumented immigrants over the age of 18 were included from sixty-three sites. Participants were asked about their mental health and whether they were experiencing pain. Associations were explored using univariate and multivariate analysis with logistic regression models.
Results. Among 1188 research participants, our results showed associations between pain and mental health: musculoskeletal pain with sleep disorder and abdominal pain with anxiety and sleep disorder. Also, social determinants of health such as the duration of residence in France, housing conditions or food insecurity were associated with different types of pain.
Conclusion. This study is the first to document the existence of associations between pain experienced by undocumented immigrants in France and their mental health. It provides a new contribution to the French literature and evidence for clinicians to investigate the mental health ofundocumented immigrants experiencing pain.
Background: The phenomenon of migration from regions with more limited resources is a reality of the globalized world. It is estimated that at the end of 2019, almost 80 million migrants were displaced around the world, with 46% of them being children. Almost 20% of the irregular immigrants who arrived in Spain were child irregular migrants, who travelled alone or accompanied by family members after leaving their countries of origin seeking, to find a better future. Child irregular migrants have specific healthcare needs. The objectives of our present study were to describe and understand the experiences of healthcare providers in relation to the healthcare needs and the process of emergency care for child irregular migrants who come to Spain in small vessels. Methods: In this descriptive qualitative study, two focus groups were convened, and in-depth interviews with 21 participants were conducted, followed by inductive data analysis using ATLAS.ti 9.3 software. Results: Three main themes emerged from the analysis: (1) more vulnerable groups for whom the priority is emergency care; (2) the health and social care of child migrants; and (3) challenges and advances in the care of child migrants. Conclusions: For healthcare providers, protecting children, placing value on the family unit, and ensuring that children feel safe at all times are very important. Learning about the experiences of healthcare providers can contribute towards improving the health and social care of children in emergency care.
Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives.
Swiss health and social care system is complex and is based on universal coverage. However, discontinuity in health and social path and repeated access to emergency units are symptoms of inequity. The aim of this paper is to highlight the interactions between vulnerable patients with socio-sanitary actors to propose some innovative solutions to promote social justice. A six-month ethnography of 15 vulnerable patients’ health and social transitions in the region of Ticino Canton in Switzerland gives new insight into conflict situations in assistance relationships, where reciprocal stereotyping between professionals and patients undermines continuity of care. The cultural dimension of health and social institutions is identified in the problem-solving approach which is legitimized as the only one for dealing with complex situations. The analysis shows how clinical vulnerability relates strongly to an unmanaged so-called liminality phase. Culture is an invisible dimension in care, but its effects on equity are major. Two possible interventions are discussed, which are culturally informed reorganization of the care network and collaboration with a sociosanitary cultural mediator.
Purpose
Resettled refugees in the U.S. face a disproportionately high risk of COVID-19 exposure, infection, and death. This study examines COVID-19 vaccination status among adult participants and their minor children, reasons for vaccine hesitancy, and predictors of vaccine uptake, as well as sources of COVID-19 news and information and trust in those sources.
Method
The data in this study were drawn from the Telehealth and COVID-19 Knowledge, Attitudes, and Practices in New York Refugee Communities Survey (N = 353), conducted March-May, 2022.
Results
The multivariate results indicate that in this sample of resettled refugees, those who reported higher levels of educational attainment, were from Afghanistan, and those who had fewer concerns about the vaccine were more likely to accept vaccination. The participants in this study identified local health workers, clinics, and community organizations – places where social workers are present – as both the largest source of nonsocial media COVID-19 news and information and the most trusted source of COVID-19 news and information.
Discussion
The implications from this study provide social workers with an understanding of the social and behavioral factors impacting vaccine uptake in refugee communities.
Conclusion
According to the NASW Code of Ethics, social workers must challenge inequalities that persist against marginalized groups, such as racial and ethnic health disparities. Social work practitioners can play an essential role in decreasing unjust health disparities by providing accurate, culturally appropriate information on public health concerns such as COVID-19 to their refugee clients and within interprofessional collaboration.
Since February 2022, the Ukrainian refugee crisis has been highlighting mental health problems associated with trauma and distress. This study aimed to evaluate the mental health status of twenty-seven refugee minors (10 to 18 years old) who fled Ukraine and temporarily settled in the Republic of Korea (ROK). This cross-sectional survey study aimed to evaluate the mental health status of ethnic Korean Ukrainian refugee minors. The Child and Adolescent Trauma Screen—Youth Report (CATS), generalized anxiety disorder seven-item scale (GAD-7), and subjective unit of distress scale (SUDs) were used for assessment. A preliminary analysis indicated that 77% Ukrainian refugee minors were exposed to and experienced war-related trauma. They are at a relatively low risk of trauma symptoms, anxiety, and distress due to stable family and visa status and a comparably better environment in the ROK. Meanwhile, refugee teenagers showed higher rates of psychological distress compared with refugee children. This finding suggests that an early psychological interventions in a host country may be beneficial to prevent mental health issues in refugee minors.
The increasing presence of documented and undocumented migrants increases the commitment of the Italian National Health Service to their health needs, following its founding principle of equity. In particular, chronic diseases, such as diabetes, represent a crucial area where patients’ health is affected by their adherence to care pathways, for which the recent literature has reported alarming low levels. In the case of migrants, obstacles to adherence, such as language or organizational barriers, could be overcome thanks also to charitable organizations providing healthcare services. In this study, we aimed to compare the adherence among documented and undocumented migrants who received healthcare services in Milan, Italy, either from the National Health Service (NHS) or from a charitable organization. We identified a cohort of newly taken into care diabetic patients composed of two groups: (i) documented migrants that attend the NHS; and (ii) undocumented migrants that attend a charity. Information was tracked by merging two datasets: the regional healthcare information system of Lombardy, and a unique dataset that collects data on specialistic visits and pharmaceutical prescriptions for all people visiting one of the most prominent charitable organizations in Italy. The annual diabetologist visit was used as the measure of adherence. The probability of being adherent was compared among the two groups by using a multivariate log-binomial regression model, considering a set of personal characteristics that may impact health behaviors. The cohort comprised 6429 subjects. The percentage of adherence was 52% among the documented migrants, and 74% among the undocumented. Regression results confirmed this pattern: undocumented patients have an increased probability of being adherent by 1.19 times (95% CI: 1.12 to 1.26) compared to documented ones. Our study revealed the potentiality of charitable organizations in guaranteeing continuity of care to undocumented migrants. We argue that this mechanism would benefit from central coordination by the government.
Aims:
To examine the associations between undocumented pregnant migrant women and the risk of experiencing stillbirth or preterm birth.
Methods:
A retrospective case-control study based on nationwide registers from Statistics Denmark and hospital journals from the seven largest hospital wards in Denmark from 1 January 2011 to 31 December 2018. A total of 882 undocumented pregnant migrant women and 3528 matched controls (both documented migrant and non-migrant women) were included. Logistic regression models were used to estimate the risk of undocumented pregnant migrant women experiencing (a) stillbirth and (b) preterm birth compared with the control group.
Results:
Of the undocumented pregnant migrant women, 33.3% were EU citizens, 16.2% were applicants for residence and 50.5% had an unknown basis for residence. The mean age of the undocumented pregnant migrant women was 28.4 years, whereas the mean age of women in the control group was 30.9 years. Higher adjusted odds of experiencing stillbirth (aOR 3.50; 95% CI 1.31-9.38) and preterm birth (aOR 1.41; 95% CI 1.04-1.93) were observed among the undocumented pregnant migrant women compared with the control group. The basis of residence was not associated with higher odds of experiencing stillbirth or preterm birth.
Conclusions:
We found a higher risk of stillbirth and preterm birth among the undocumented pregnant migrant women than in the control group. Our findings suggest a need to increase the focus on providing access to antenatal care among those women currently excluded from this care.
Bu çalışmada göçmenler ve sağlık ilişkisi incelenmektedir. İnsanların tarih sahnesine çıktığından beri göç olgusundan söz edilebilmektedir. Modern zamanlardaki göç olgusu çok farklı problem alanlarının tartışılmasını sağlamaktadır. Bu alanların en önemlisi hiç kuşkusuz sağlıktır. Göçmenler ve sağlık ilişkisi yerel ölçekte kaynak ve hedef ülkeyi etkilemekle birlikte sonuçları açısından tüm küreyi etkilemektedir. Küreselleşmenin geldiği aşama itibarıyla sorunlar karmaşık hale gelmektedir. Sağlığın sosyal belirleyicileri ve sağlıkta eşitsizlik olguları göç olgusu ve onun sonuçları düzeyinde berraklaşmaktadır. Bu çalışmada göçmenler ve sağlık ilişkisi göçmenlerin sağlık statüsü, hedef ülkenin hastalık panoraması, göçmenlerin sağlık hizmeti kullanımında dezavantajları irdelenmiştir. Bu kavramlar, sonuçları ve olası etkileri bakımından değerlendirilmiş olup sağlık sosyolojisi çerçevesinde bir perspektif sunulmaya çalışılmıştır. Zira göçmenler ve yerleşiklerin sağlık durumunun farklılaşmasında en önemli değişken göç sürecidir. Bunun dışında, coğrafi faktörler sabitken sağlık örüntüleri açısından farklı bir değerlendirme söz konusu olmayacaktır. Ayrıca, Türkiye'de göçmenlerin sağlık örüntüleri ele alınmıştır. Sonuç olarak, sağlıkta eşitsizliklerin giderilmesi modelleri çerçevesinde göçmenlerin sağlık durumunun iyileştirilmesi için öneriler geliştirilmiştir.
Growing evidence is emerging on the higher risk of infection and adverse outcomes for the most disadvantaged groups of the population, and COVID-19 vaccination campaigns worldwide are struggling to ensure equitable access to immunization for all. From 21 June 2021 to 15 October 2021, the Local Health Unit ASL Roma 1 adopted a tailored immunization strategy to reach socially vulnerable groups of the population with the primary vaccination course. This strategy was developed with a step-by-step, participatory approach. Through engagement with internal and external stakeholders, target groups were identified, potential barriers analyzed, solutions discussed, and tailored interventions designed. Over nine thousand individuals from among irregular migrants, homeless people and hard-to-reach communities were contacted and vaccinated.
A rise in forced migration worldwide puts the needs of mental health issues of refugees into focus. Refugees are being affected by stressors before, during, and after migration. A higher prevalence of PTSD is found in refugees as well as a higher prevalence of mood disorders and anxiety disorders in long-term resettled refugees. Apart from the pre-migration traumas experienced by refugees, post-migration conditions have a crucial impact on the well-being of refugees. In general, barriers and challenges in their treatment are manifold, with complex implications for their mental health care.
Migrant populations experience poor health, and their outcomes tend to be poorer in comparison with the general population. Vulnerability and inequality are further exacerbated in undocumented migrants, as the most invisible to healthcare systems. This a public health challenge requiring tailored action towards universal health coverage and health system equity.
Objectives: To estimate health needs among undocumented migrants in the areas of maternal & perinatal health and COVID-19; and to test a combination of methodologies for systematic monitoring and evaluation.
Methods: This research is based on three retrospective cohort and cross-sectional studies using a combination of diverse and complementary data sources to reflect the complex nature of health outcomes and healthcare access in undocumented migrants, including: national/regional health management information systems, third sector healthcare provider health information systems, and surveys at selected healthcare facilities.
Cohort: Undocumented migrants having accessed: (i) maternity healthcare through National/Regional Health Services in Lombardy Region (Italy) from 2016 to 2020; (ii) healthcare through a third sector healthcare provider in Milan (Italy) from February 24th to May 24th, 2020; (iii) healthcare through participating healthcare providers in Switzerland (Geneva Region), USA (Baltimore City), Italy (Lombardy Region), and France (Paris Region) from February to May 2021.
Results: (i) The study on maternal and perinatal health included 1595 undocumented migrant women and their neonates. 57.37% women had ≥4 antenatal visits, 68.21% had the first one within 12 weeks of gestation, 63.45% had at least two ultrasound tests including one within 12 weeks of gestation, and 6.21% had complete laboratory tests. Total cesarean sections were 26.89%. Emergency resuscitation for birth asphyxia was conducted in 2.63% births, and 49.03% neonates initiated breastfeeding within 2 hours from birth. 80.56% pregnancies were physiological though severe hemorrhage (>1000ml) occurred in 2.26% women. Intra-uterine growth restriction affected 4.76% fetuses, 9.28% neonates were pre-term, 17.24% small for gestational age, 7.2% had a low weight at birth (<2.5Kg), 1.44% poor Apgar score, and 3.07% presented malformations. (ii) The study on COVID-19 illness included 272 undocumented migrants. Risk factors were frequent and included hypertension, immune depression, and prior close contact with COVID-19 cases. Presenting symptoms were worse, compared with patients with other respiratory conditions. (iii) The study on COVID-19 vaccination demand included 812 undocumented migrants. Overall, 14.1% of participants reported prior COVID-19 infection, 29.5% risk factors, and 26.2% fear of developing severe COVID-19 infection. Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, co-morbidity, and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%). Participants mainly searched for information about vaccination in the traditional and social media.
Conclusions: Health outcomes and healthcare access were poor in undocumented migrants. Socio-economic and health outcomes showed vulnerability and inequality in comparison to the general population. Known risk factors including fragile socio-economic conditions along with legal and linguistic barriers to healthcare need to be addressed through tailored interventions including outreach health promotion, healthcare provider training, cultural mediation, translation, and functional language learning. Furthermore, a systematic monitoring and evaluation system is needed to routinely collect, integrate, and analyze data on key indicators from both National/Regional Health Services and third sector healthcare providers in combination with ad hoc surveys for specific data outside routine information systems.
Refugees and asylum-seekers often encounter situations in which their health and well-being are compromised. Despite their health needs, access to healthcare is often restricted in host countries, and this is aggravated by various reasons such as a lack of inclusive policies, language and cultural barriers, financial ability to afford, and legal status. Improving refugees´ and migrants’ health, is also to ensure that they are protected from the financial consequences of receiving medical care.
To measure financial protection in the country of asylum, I have looked primarily into the consequences falling on the refugees and asylum seekers living in Egypt when accessing healthcare, that by measuring the incidence and intensity of catastrophic health expenditures and their impact on impoverishment. Then, I looked at the equity in the use of health services and the efficiency of allocation of subsidies by the United agency for refugees (UNHCR). Finally, I explored the accessibility to healthcare and the reasons for the unmet health needs of migrants and refugees living in 4 countries in Europe and drew comparisons between those countries.
All through this research, findings highlight important challenges in the access to healthcare by migrants and refugees. In the first country of asylum, refugees largely live under the poverty line and usually incur out-of-pocket payments that lead to catastrophic health expenditure. Moreover, the analysis demonstrates that without equitable subsidy and efficient allocation by UNHCR, poor refugees cannot afford healthcare services. Whereas all the EU countries have ensured migrant integration policies to address protection and human rights principles, major disparities between member states were noted in the application of those policies, which increase the unmet needs of migrants and refugees in Europe and aggravate the risk conditions.
Resumen
Los refugiados y los solicitantes de asilo a menudo se encuentran con situaciones en las que su salud y su bienestar se ven comprometidos. A pesar de sus necesidades de salud, el acceso a la atención sanitaria está a menudo restringido a los países de acogida, y esto se ve agravado por diversos motivos como la falta de políticas inclusivas, las barreras lingüísticas y culturales, la capacidad económica por pagar y el estatus legal. Mejorar la salud de los refugiados y emigrantes implica garantizar que estén protegidos de las consecuencias económicas de recibir atención médica.
Para medir la protección financiera en el país de asilo, he analizado principalmente las consecuencias que recaen sobre los refugiados y los solicitantes de asilo que viven en Egipto cuando acceden a la asistencia sanitaria, midiendo la incidencia y la intensidad de los gastos sanitarias catastróficas y su impacto en el empobrecimiento. Después, analicé la equidad en el uso de los servicios de salud y la eficiencia de la asignación de subvenciones por parte de la Agencia de Naciones Unidas para los Refugiados (ACNUR). Finalmente, exploré la accesibilidad a la asistencia sanitaria y los motivos que conducen a que las necesidades sanitarias no se cubran para los emigrantes y refugiados que viven en 4 países de Europa, e hice comparaciones entre estos países.
Durante toda la investigación, los resultados destacaron importantes retos en el acceso a la atención sanitaria por parte de emigrantes y refugiados. En el primer país de asilo, los refugiados viven en gran parte bajo el umbral de la pobreza y suelen incurrir en pagos en metálico que provocan un gasto sanitario catastrófico. Además, el análisis demuestra que sin una subvención equitativa y una asignación eficiente por parte de ACNUR los refugiados pobres no pueden pagar los servicios sanitarios. Mientras todos los países de la UE han asegurado políticas de integración de los emigrantes para abordar los principios de protección y derechos humanos, se han observado grandes disparidades entre los estados miembros en la aplicación de estas políticas, lo que provoca que no se cubran las necesidades de salud de los emigrantes y refugiados en Europa, agravando las condiciones de riesgo.
Background
France is one of the world's most vaccine hesitant countries and vaccine hesitancy (VH) is considered one of the world's leading threats to global health. However, little is known about VH in immigrant populations in France. Using data from the 2016 Health Barometer, we examined VH among newcomers, more established immigrants, and the native-born population in France.
Methods
Data was collected from French speaking individuals aged from 15 to 75 years old, residing in France. Individuals were selected through randomly generated landline and mobile phone numbers. Vaccine hesitancy was assessed through four questions and a “time spent in France” variable was created, using the year of arrival in France. Associations were studied using logistic regression.
Results
A sample of 15,216 participants residing in France included 1,524 foreign-born immigrants and 13,692 native-born individuals, with a mean age of 46-years. Most participants (75.7%) reported being favorable to vaccination regardless of country of origin but immigrants were less hesitant toward vaccinations than the host population. Foreign-born immigrants from North Africa had the most favorable views whereas those from sub-Saharan Africa held most unfavorable views on vaccination. With time spent in France, the opinions towards vaccination became more negative (aOR = 0.57, 95 %CI [0.40–0.79], p = 0.001) and the risk of vaccine refusal (aOR = 2.34, 95 %CI [1.45 – 3.78] p = 0.001) and reluctant acceptance of vaccines increased (aOR = 1.89 95 %CI [1.20 – 2.99], p = 0.006).Foreign-born individuals with the longest residency in France had more negative opinions than native-born individuals, regardless of region of origin.
Conclusion
Immigrants were less hesitant toward vaccinations than the host population, but vaccine hesitancy increased with time spent in France. The provision of appropriate information and awareness to facilitate critical thinking towards antivaccine theories is necessary for immigrants in France.
(1) Background: Informal patient payments continue to persist in the Serbian health care system, exposing vulnerable groups to private spending on health care. Migrants may in particular be subject to such payments, as they often experience barriers in access to health care. Little is known about migrants paying informally to access health care in Serbia. The study aims to explore pathways of accessing health care, including the role of informal patient payments, from the perspectives of civil servants and non-western migrants in Serbia. (2) Methods: Respondents (n = 8 civil servants and n = 6 migrants) were recruited in Belgrade in 2018, where semi-structured interviews were conducted. The interviews were analysed applying the grounded theory methodological steps. (3) Results: Data reveal different pathways to navigate the Serbian health care system, and ultimately whether paying informally occurs. Migrants appear less prone to paying informally and receive the same or better-quality health care. Locals experience the need to pay informal patient payments, quasi-formal payments and to bring medicine, materials or equipment when in health facilities. (4) Conclusions: Paying informally or using private care in Serbia appear to have become common. Despite a comprehensive health insurance coverage, high levels of out-of-pocket payments show barriers in accessing health care. It is highly important to not confuse the cultural beliefs with forced spending on health care and such private spending should be reduced to not push people into poverty.
The transportation of human beings from one location to the other could play a crucial role in the transmission of infectious diseases which could result in a major epidemic such as Tuberculosis, Ebola, Covid-19, and others that are currently invading the nations of the world. Concerning the high poverty level, much concentration on livestock farming, open grazing, rising urbanization, and globalization, the human being is exposed to more infectious diseases that can be transited and transmitted. The transmission of infectious diseases can be in the form of a chain; some are imported from high-risk countries and contacted by friends and families which will later spread into the larger society. It can also be contacted through imported livestock which will later spread among other animals and be contacted by a human. Importation of infectious diseases is not only applicable to humans but animals. Findings from the empirical studies reviewed show that a close nexus between urban mobility and the transmission of infectious diseases. To ensure adequate health safety, it is recommended that regional as well as international complementarity of trade should be checked such that high-risk countries should be banned from participating in trade with other low-risk countries; preventive measures should be enforced without any form of sentiment, human beings should minimize or reduce travelling.
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