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Lebano A, Hamed S, Bradby H, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Azzedine F, Riza E, Karnaki P, Zota D, Linos A. Migrants' and refugees' health status and healthcare in Europe: a scoping literature review. BMC Public Health 2020; 20:1039. [PMID: 32605605 PMCID: PMC7329528 DOI: 10.1186/s12889-020-08749-8] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. METHODS This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants' access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards. RESULTS The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. CONCLUSIONS The European situation concerning migrants' and refugees' health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants' health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants' own views on their health and barriers to access to healthcare is key.
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Affiliation(s)
- Adele Lebano
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden.
- University of Edinburgh, School of Social and Political Science, Chrystal Macmillan Building15a, George Square, Edinburgh, EH8 9LD, UK.
| | - Sarah Hamed
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden
| | - Hannah Bradby
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden
| | - Alejandro Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | - Estrella Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | - Jorge Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | | | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, Goudi, 11527, Athens, Greece
| | - Pania Karnaki
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
| | - Dina Zota
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
| | - Athena Linos
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
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Del Puente F, Riccardi N, Taramasso L, Sarteschi G, Pincino R, Di Biagio A. Migrants and imported disease: Trends of admission in an Italian infectious disease ward during the migration crisis of 2015-2017. BMC Public Health 2020; 20:738. [PMID: 32434483 PMCID: PMC7238611 DOI: 10.1186/s12889-020-08886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Since 2014, the migrant population residing in Europe has dramatically increased. Migrants’ unmet health needs represent a barrier to integration and should be promptly addressed, without stigma, in order to favour resettlement. Methods All-cause of admissions in the migrant population at the Infectious Disease Clinic of Policlinico San Martino Hospital in Genoa between 2015 and 2017 were analysed. Patients were classified by duration of residence in Italy according to the Recommendation on Statistics of International Migration, cause of hospitalization, and region of origin. All data were evaluated with SPSS Statistics. Results Two hundred thirty-five people were admitted, 86 (36.5%) of them residing in Italy for less than 1 year. Except for a significant increase in migrants from Africa, there was no change considering the area of origin, hospitalization reason or by comparing residency in Italy for more or less than 1 year. A considerable number of hospitalizations were related to non-communicable pathologies and latent tuberculosis infection. Residents in Italy for less than 1 year or with active tuberculosis had prolonged hospitalizations, while HIV-infected had shorter hospital stays. Conclusions No difference in terms of diagnosis were found between migrants with longer or shorter period of residence in Italy. Adequate outpatient services for the management of communicable diseases could significantly reduce the length of hospitalizations in the migrant population.
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Affiliation(s)
- Filippo Del Puente
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Niccolò Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy.,StopTB Italia Onlus, Milan, Italy
| | - Lucia Taramasso
- Department of Internal Medicine, Infectious Diseases Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giovanni Sarteschi
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Rachele Pincino
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
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Karavokyros IG, Kirkilessis GI, Schizas D, Chelidonis G, Pikoulis E, Griniatsos J. Emergency inguinal hernioplasties in a tertiary public Hospital in Athens Greece, during the economic crisis. BMC Surg 2019; 19:18. [PMID: 30717719 PMCID: PMC6362572 DOI: 10.1186/s12893-019-0477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 01/23/2019] [Indexed: 12/01/2022] Open
Abstract
Background Although the effect of the recent Greek economic crisis and austerity on the population’s health and the health system effectiveness have been discussed a lot recently, data on common surgical conditions affecting large part of the population are missing. Using inguinal hernia as a model we investigated possible changes of citizens’ attitude regarding the time of referral, the perioperative details and the intraoperative findings of the emergency hernioplasties. Methods The present retrospective study was conducted by a Department of Surgery in a tertiary public hospital of the Greek capital. We reviewed the records of all hernioplasties performed during two 5-year periods: 2005–2009 and 2012–2016, i.e. before and during the crisis focusing on the emergency ones (either incarcerated or strangulated). Results An equal number of hernioplasties was performed in both periods. During the crisis however, an emergency hernioplasty was significantly more probable (HR 1.269, 95% CI 1.108–1.1454, p = 0.001), at a younger age (p = 0.04), mainly in patients younger than 75 years old (p = 0.0013). More patients presented with intestinal ischemia (7 vs 18, p = 0.002), requiring longer hospitalization (5.2 vs 9.6 days, p = 0.04), with higher cost (560 ± 262.4€ vs 2125 ± 1180.8€ p < 0.001). In contrast the percentage of patients with intestinal resection, their hospitalization length and treatment-cost remained unchanged. During the crisis there was a non-significant increase of emergency patients requiring ICU postoperatively (0 vs 4, p = 0.07) and a non-significant 60% increase of emergency operations in migrants/refugees population (3.5% vs 5.8%, p = 0.28). Epidural anesthesia was significantly more frequent during the crisis. Conclusion During the crisis: (i) the emergency hernioplasties increased significantly, (ii) more patients (exclusively Greek) presented with intestinal ischemia requiring longer hospitalization and higher treatment cost, (iii) the mean age of the urgently treated patients decreased significantly (iv) regional (epidural) anesthesia was more frequent. Although a direct causal relation could not be proven by the present study most observations can be explained by an increase of the patients who delayed the elective treatment of their hernia, and by a redistribution of the surgical workload towards big central hospitals. This can be prevented by adequately supporting the small district hospitals.
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Affiliation(s)
- Ioannis G Karavokyros
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Agiou Thoma 17str, 115-27, Athens, GR, Greece.
| | - George I Kirkilessis
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Agiou Thoma 17str, 115-27, Athens, GR, Greece
| | - Demetrios Schizas
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Agiou Thoma 17str, 115-27, Athens, GR, Greece
| | | | - Emmanouil Pikoulis
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Agiou Thoma 17str, 115-27, Athens, GR, Greece
| | - John Griniatsos
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Agiou Thoma 17str, 115-27, Athens, GR, Greece
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Impact of the Refugee Crisis on the Greek Healthcare System: A Long Road to Ithaca. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081790. [PMID: 30127321 PMCID: PMC6121252 DOI: 10.3390/ijerph15081790] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022]
Abstract
Greece is the country of "Xenios Zeus", the Ancient Greek god of foreigners and hospitality; however, it is also the main point of entry to Europe. Since the beginning of 2014, 1,112,332 refugees crossed the borders of Greece. Overall, 33,677 children and adolescent refugees sought asylum in Greece from 2013 to 2017, while 57,042 refugees are currently being hosted. The rapid entry of refugees into Greece raised the critical issue of health policy. The Greek National Health Service (NHS) faces many challenges. Adequate economic and human support is essential if this situation is to be managed successfully. However, Greece still bears the burden of the economic downturn since 2009. In fact, the crisis led to shortages in crucial equipment, and unmet health needs for both locals and refugees. The NHS deals with traumatic experiences, as well as cultural and linguistic differences. Overcrowded reception centers and hotspots are highly demanding and are associated with severe disease burden. This highlights the importance of guidelines for medical screening, healthcare provision, and a well-managed transition to definitive medical facilities. Furthermore, non-governmental organizations make an essential contribution by ensuring appropriate support to refugee minors, especially when they experience poor access to the NHS.
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Sweileh WM, Wickramage K, Pottie K, Hui C, Roberts B, Sawalha AF, Zyoud SH. Bibliometric analysis of global migration health research in peer-reviewed literature (2000-2016). BMC Public Health 2018; 18:777. [PMID: 29925353 PMCID: PMC6011263 DOI: 10.1186/s12889-018-5689-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The health of migrants has become an important issue in global health and foreign policy. Assessing the current status of research activity and identifying gaps in global migration health (GMH) is an important step in mapping the evidence-base and on advocating health needs of migrants and mobile populations. The aim of this study was to analyze globally published peer-reviewed literature in GMH. METHODS A bibliometric analysis methodology was used. The Scopus database was used to retrieve documents in peer-reviewed journals in GMH for the study period from 2000 to 2016. A group of experts in GMH developed the needed keywords and validated the final search strategy. RESULTS The number of retrieved documents was 21,457. Approximately one third (6878; 32.1%) of the retrieved documents were published in the last three years of the study period. In total, 5451 (25.4%) documents were about refugees and asylum seekers, while 1328 (6.2%) were about migrant workers, 440 (2.1%) were about international students, 679 (3.2%) were about victims of human trafficking/smuggling, 26 (0.1%) were about patients' mobility across international borders, and the remaining documents were about unspecified categories of migrants. The majority of the retrieved documents (10,086; 47.0%) were in psychosocial and mental health domain, while 2945 (13.7%) documents were in infectious diseases, 6819 (31.8%) documents were in health policy and systems, 2759 (12.8%) documents were in maternal and reproductive health, and 1918 (8.9%) were in non-communicable diseases. The contribution of authors and institutions in Asian countries, Latin America, Africa, Middle East, and Eastern European countries was low. Literature in GMH represents the perspectives of high-income migrant destination countries. CONCLUSION Our heat map of research output shows that despite the ever-growing prominence of human mobility across the globe, and Sustainable Development Goals of leaving no one behind, research output on migrants' health is not consistent with the global migration pattern. A stronger evidence base is needed to enable authorities to make evidence-informed decisions on migration health policy and practice. Research collaboration and networks should be encouraged to prioritize research in GMH.
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Affiliation(s)
- Waleed M. Sweileh
- College of Medicine and Health Science, An-Najah National University, Nablus, Palestine
| | - Kolitha Wickramage
- International Organization for Migration, UN Migration Agency, Migration Health Division, Geneva, Switzerland
| | - Kevin Pottie
- Faculty of Medicine, University of Ottawa, Ottawa, CA Canada
| | - Charles Hui
- Faculty of Medicine, University of Ottawa, Ottawa, CA Canada
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ansam F. Sawalha
- College of Medicine and Health Science, An-Najah National University, Nablus, Palestine
| | - Saed H. Zyoud
- College of Medicine and Health Science, An-Najah National University, Nablus, Palestine
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Sequeira E. [Health care for refugees or the history of a pending issue]. Aten Primaria 2017; 49:448-449. [PMID: 28601229 PMCID: PMC6876036 DOI: 10.1016/j.aprim.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/08/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ethel Sequeira
- Medicina de familia, CAPSBE Casanova, Barcelona, España; Coordinación Grupo COCOOPSI de CAMFIC, Cataluña, España; Coordinación Grupo Medicina Tropical AISBE, Barcelona, España; Grupo Trasversal de Investigación de Atención Primaria IDIBAPS, Barcelona, España.
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