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Seidlein AH, Kuhn E. [Live-ins: A mapping of relevant actors and moral norms at the public health level]. Pflege 2024; 37:215-222. [PMID: 38130154 DOI: 10.1024/1012-5302/a000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Live-ins: A mapping of relevant actors and moral norms at the public health level Abstract: Background: Live-ins are embedded in a network of multiple actors that shape their current working and living situation. The causes and effects of live-in arrangements go far beyond the actual care relationship and include structures and stakeholders that are interconnected at the Public Health level. Besides a legal responsibility, these actors also have a moral responsibility, which the article focuses on. Aim: The article provides an overview of relevant actors and moral norms in the context of live-ins at the public health level. Methods: The method followed the "Context and Actor Analysis". Actors at the public health level that are relevant for the live-ins' situation were identified, and the responsibilities and tasks presented in their websites as well as their respective target groups were collected. The ethical dimension was extracted from these self-descriptions. Results: The 23 actors address the live-ins directly or indirectly in their various social roles. The self-given tasks and the moral norms deduced from them, for which the actors are particularly responsible, illustrate the importance of justice and respect. Conclusions: The work provides the basis for an urgently needed empirical-ethical analysis on the current state of responsibility-taking. Not only the variety of the live-ins' roles, but also the multitude of actors involved and shared norms illustrate the necessity of close cooperation to be able to fulfil their responsibility.
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Affiliation(s)
- Anna-Henrikje Seidlein
- Institut für Ethik und Geschichte der Medizin, Universitätsmedizin Greifswald, Deutschland
| | - Eva Kuhn
- Sektion Global Health, Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Deutschland
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Ng SH, Kaur S, Cheah PY, Ong ZL, Lim J, Voo TC. Migration health ethics in Southeast Asia: a scoping review. Wellcome Open Res 2024; 8:391. [PMID: 38595706 PMCID: PMC11002524 DOI: 10.12688/wellcomeopenres.19572.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 04/11/2024] Open
Abstract
Background Asia hosts the second-largest international migrant population in the world. In Southeast Asia (SEA), key types of migration are labour migration, forced migration, and environmental migration. This scoping review seeks to identify key themes and gaps in current research on the ethics of healthcare for mobile and marginalised populations in SEA, and the ethics of research involving these populations. Methods We performed a scoping review using three broad concepts: population (stateless population, migrants, refugees, asylum seekers, internally displaced people), issues (healthcare and ethics), and context (11 countries in SEA). Three databases (PubMed, CINAHL, and Web of Science) were searched from 2000 until May 2023 over a period of four months (February 2023 to May 2023). Other relevant publications were identified through citation searches, and six bioethics journals were hand searched. All searches were conducted in English, and relevant publications were screened against the inclusion and exclusion criteria. Data were subsequently imported into NVivo 14, and thematic analysis was conducted. Results We identified 18 papers with substantial bioethical analysis. Ethical concepts that guide the analysis were 'capability, agency, dignity', 'vulnerability', 'precarity, complicity, and structural violence' (n=7). Ethical issues were discussed from the perspective of research ethics (n=9), clinical ethics (n=1) and public health ethics (n=1). All publications are from researchers based in Singapore, Thailand, and Malaysia. Research gaps identified include the need for more research involving migrant children, research from migrant-sending countries, studies on quality of migrant healthcare, participatory health research, and research with internal migrants. Conclusions More empirical research is necessary to better understand the ethical issues that exist in the domains of research, clinical care, and public health. Critical examination of the interplay between migration, health and ethics with consideration of the diverse factors and contexts involved is crucial for the advancement of migration health ethics in SEA.
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Affiliation(s)
- Shu Hui Ng
- School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia
| | - Sharon Kaur
- Faculty of Law, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Oxford, OX3 7LG, UK
| | - Zhen Ling Ong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jane Lim
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
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Fiorini G, Franchi M, Pellegrini G, Rigamonti AE, Sartorio A, Marazzi N, Corrao G, Cella SG. Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy. Sci Rep 2023; 13:7424. [PMID: 37156791 PMCID: PMC10167203 DOI: 10.1038/s41598-023-34572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Undocumented migrants represent a large part of the population in Countries of the European Union (EU) such as Italy. Their health burden is not fully understood and likely to be related mainly to chronic conditions. Information on their health needs and conditions may help to target public health interventions but is not found in national public health databases. We conducted a retrospective observational study of non-communicable disease (NCD) burden and management in undocumented migrants receiving medical care from Opera San Francesco, a non-governmental organization (NGO) in Milan, Italy. We analyzed the health records of 53,683 clients over a period of 10 years and collected data on demographics, diagnosis and pharmacological treatments prescribed. 17,292 (32.2%) of clients had one or more NCD diagnosis. The proportion of clients suffering from at least one NCD increased from 2011 to 2020. The risk of having an NCD was lower in men than women (RR = 0.88, 95% CI 0.86-0.89), increased with age (p for trend < 0.001) and changed with ethnicity. African and Asian migrants had a lower risk than Europeans of cardiovascular diseases (RR 0.62 CI 0.58-0.67, RR 0.85 CI 0.78-0.92 respectively) and mental health disorders (RR 0.66 CI 0.61-0.71, RR 0.60 CI 0.54-0.67 respectively), while the risk was higher in Latin American people (RR 1.07 CI 1.01-1.13, RR 1.18 CI 1.11-1.25). There was a higher risk of diabetes in those from Asia and Latin America (RR 1.68 CI 1.44-1.97, RR 1.39 CI 1.21-1.60). Overall, migrants from Latin America had the greatest risk of chronic disease and this was true for diabetes, cardiovascular diseases and mental health disorders. Undocumented migrants demonstrate a significantly different health burden of NCDs, which varies with ethnicity and background. Data from NGOs providing them with medical assistance should be included in structuring public health interventions aimed at the prevention and treatment of NCDs. This could help to better allocate resources and address their health needs.
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Affiliation(s)
- Gianfrancesco Fiorini
- Istituti Clinici Zucchi, GSD, Monza, Italy
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Giacomo Pellegrini
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Antonello Emilio Rigamonti
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Nicoletta Marazzi
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Silvano Gabriele Cella
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
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van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt N. The impact of persistent precarity on patients' capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa. Front Med (Lausanne) 2023; 10:1061190. [PMID: 37064034 PMCID: PMC10098191 DOI: 10.3389/fmed.2023.1061190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background People living with multimorbidity in low-and middle-income countries (LMICs) experience a high workload trying to meet the demands of self-management. In an unequal society like South Africa, many people face continuous economic uncertainty, which can impact on their capacity to manage their illnesses and lead to poor health outcomes. Using precariousness - the real and perceived impact of uncertainty - as a lens, this paper aims to identify, characterise, and understand the workload and capacity associated with self-management amongst people with multimorbidity living in precarious circumstances in urban and rural South Africa. Methods We conducted qualitative semi-structured interviews with 30 patients with HIV and co-morbidities between February and April 2021. Patients were attending public clinics in Cape Town (Western Cape) and Bulungula (Eastern Cape). Interviews were transcribed and data analysed using qualitative framework analysis. Burden of Treatment Theory (BoTT) and the Cumulative Complexity Model (CuCoM) were used as theoretical lenses through which to conceptualise the data. Results People with multimorbidity in rural and urban South Africa experienced multi-faceted precariousness, including financial and housing insecurity, dangerous living circumstances and exposure to violence. Women felt unsafe in their communities and sometimes their homes, whilst men struggled with substance use and a lack of social support. Older patients relied on small income grants often shared with others, whilst younger patients struggled to find stable employment and combine self-management with family responsibilities. Precariousness impacted access to health services and information and peoples' ability to buy healthy foods and out-of-pocket medication, thus increasing their treatment burden and reducing their capacity. Conclusion This study highlights that precariousness reduces the capacity and increases treatment burden for patients with multimorbidity in low-income settings in South Africa. Precariousness is both accumulative and cyclic, as financial insecurity impacts every aspect of peoples' daily lives. Findings emphasise that current models examining treatment burden need to be adapted to accommodate patients' experiences in low-income settings and address cumulative precariousness. Understanding treatment burden and capacity for patients in LMICs is a crucial first step to redesign health systems which aim to improve self-management and offer comprehensive person-centred care.
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Affiliation(s)
- Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Frances S. Mair
- School of Health and Well-Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR North Thames Applied Research Collaboration, London, United Kingdom
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Shankar Mishra P, Jamadar M, Tripathy A, Anand A. Understanding the Socio-Economic Vulnerability in Child Malnutrition Between Migrants and Non-Migrants Children (12-59 Months) in India: Evidence from a Cross-Sectional Study. CHILD INDICATORS RESEARCH 2022; 15:1871-1888. [PMID: 35601140 PMCID: PMC9108133 DOI: 10.1007/s12187-022-09943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
India has witnessed increasing trends in internal migration over the last three decades. In India, migrant children are not a homogeneous group and their reasons for movement and vulnerabilities vary across socio-economic stratum. For some children, migration may open possibilities and is associated with expanding social and economic spheres, but for many others, it may bring serious risks. Therefore, the study has been carried out to understand socio-economic vulnerability in child nutrition with migration status and other contributing factors in India. This study used data from the National Family Health Survey, the fourth in the NFHS series which was conducted in 2015-2016 (NFHS-4). We were interested in looking at the children age 12-59 months for their nutritional indicators such as stunting and underweight across migrants and non-migrants children. This resulted in a sample of 199,448 children in selected age group and among them 33.1% children belongs to the migrant family as compared to 67% of non-migrant children. Overall, 44.2% of children were stunted and 39.5% were underweight among non-migrant children as compared to 37.4% & 32.8% of migrant children were stunted and underweight respectively. Further, the results showed that among the social groups, scheduled caste children were found a high variation in underweight (34% vs. 41.6%) and stunting (36% vs. 46%) between migrants and non-migrants children. Similar trend of malnourishment is found in the poor wealth quintile, for rural residents and low educated women with non-migrant status. Those children who were poor but non-migrant were more likely to be malnourished as underweight [aOR; 1.15, CI: 1.11-1.18] and stunted [aOR; 1.17, CI:1.13-1.20] as compared to migrant status children in the same category of the household. Similarly in reference to scheduled caste migrant group, the scheduled caste non-migrant were more likely to be underweight [aOR; 1.15, CI: 1.09-1.20] and stunted [aOR; 1.18, CI: 1.12-1.23] than the children with migrant status. There were huge differences between migrant and non-migrant children in nutritional statuses. Education, caste and wealth index are found to be an important variables to explain the differential between migrants and non-migrants in child's nutritional aspects. Children associated with poor socio-economic vulnerability and non-migrant category need to be taken care of more and a community targeted approach is required to understand the gaps. The programs such as ICDS, and Poshan Abhiyan need to be revamped adding the migration aspect of the families and children in terms of their health and nutritional aspects.
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Affiliation(s)
- Prem Shankar Mishra
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
| | - Mudassar Jamadar
- Centre for Research in Urban Affairs, Institute for Social and Economic Change, Bangalore, 560072 Karnataka India
| | - Abhipsa Tripathy
- Department of Statistics, Utkal University, Bhubaneswar, Odisha 751004 India
| | - Ankit Anand
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
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6
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Roberti J, Alonso JP, Blas L, May C. How do social and economic vulnerabilities shape the work of participating in care? Everyday experiences of people living with kidney failure in Argentina. Soc Sci Med 2021; 293:114666. [PMID: 34952327 DOI: 10.1016/j.socscimed.2021.114666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A new chronic patient has emerged, with a burden of symptoms and treatment. Patients with kidney failure (KF) require complex and expensive treatments, and in underresourced contexts, they struggle to obtain quality and timely care, even in countries with universal health coverage. We describe how, in such a setting, social structural factors and control over services placed by the system affect the burden of treatment of patients. METHOD This qualitative study was undertaken in Buenos Aires, Argentina. Semistructured interviews were conducted with patients with KF (n = 50) and health professionals (n = 14) caring for these patients. Additionally, three types of health coverage were included: public health, social security and private healthcare, with diverse socioeconomic backgrounds. FINDINGS Patients' agency to meet demands is extended by relational networks with redistributed responsibilities and roles. Networks provided logistical, financial, emotional support; indeed, patients with limited networks were susceptible to rapid health deterioration, as treatment interruptions could not be identified in time. Control over services translated into scarce information about treatment options, changing dialysis schedules, lack of contact with transplant teams, and new rules to access medication or make requests. For any type of coverage, there was an economic burden related to noncovered medication, copayments, travel, caregivers, specialized diets, and moving to a city offering treatment. Many patients reported economic difficulties that prevented them from even affording meals. Hardships worsened by unemployment because of the disease. Some patients had migrated seeking treatment, leaving everything behind, but could not return without risking their life. Transplanted patients often needed to re-enter the labor market against a background of high unemployment rates. CONCLUSION While health policy and practices encourage self-management, the patient may not have the capacity to meet the system's demands. A better understanding of BoT could contribute to improving how patients experience their illness.
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Affiliation(s)
- Javier Roberti
- Qualitative Research in Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; CIESP / National Scientific and Technical Research Council (CONICET), Argentina.
| | - Juan Pedro Alonso
- Qualitative Research in Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; Gino Germani Research Institute, Buenos Aires, Argentina
| | - Leandro Blas
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Carl May
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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7
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Onarheim KH, Wickramage K, Ingleby D, Subramani S, Miljeteig I. Adopting an ethical approach to migration health policy, practice and research. BMJ Glob Health 2021; 6:e006425. [PMID: 34321236 PMCID: PMC8319989 DOI: 10.1136/bmjgh-2021-006425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022] Open
Abstract
Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an 'all things considered' approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions - from 'bedside rationing' to collection of big data or in policy making - that can ensure that migrants' interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.
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Affiliation(s)
| | - Kolitha Wickramage
- Migration Health Division, International Organization of Migration, Manila, Philippines
| | - David Ingleby
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Ingrid Miljeteig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland Universitetssjukehus, Bergen, Norway
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Fiorini G, Cerri C, Magri F, Chiovato L, Croce L, Rigamonti AE, Sartorio A, Cella SG. Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy. J Public Health (Oxf) 2021; 43:302-307. [PMID: 31705141 DOI: 10.1093/pubmed/fdz123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking. METHODS Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country. RESULTS Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits. CONCLUSIONS Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.
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Affiliation(s)
| | - Cesare Cerri
- Department of Medicine and Surgery, University of Bicocca, 20100 Milano, Italy
| | - Flavia Magri
- Department of Internal Medicine and Medical Therapy, University of Pavia, Internal Medicine and Endocrinology, ICS Maugeri, 27100 Pavia, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Medical Therapy, University of Pavia, Internal Medicine and Endocrinology, ICS Maugeri, 27100 Pavia, Italy
| | - Laura Croce
- Department of Internal Medicine and Medical Therapy, University of Pavia, Internal Medicine and Endocrinology, ICS Maugeri, 27100 Pavia, Italy
| | - Antonello E Rigamonti
- Department of Clinical Sciences and Community Health (Pharmacology), University of Milan, 20129 Milan, Italy
| | - Alessandro Sartorio
- Auxo-Endocrinological Department, IRCCS Istituto Auxologico Italiano, 20100 Milan and Verbania, Italy
| | - Silvano G Cella
- Department of Clinical Sciences and Community Health (Pharmacology), University of Milan, 20129 Milan, Italy.,Osservatorio Povertà Sanitaria, Banco Farmaceutico Onlus, 20100 Milan, Italy
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9
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Vearey J, de Gruchy T, Maple N. Global health (security), immigration governance and Covid-19 in South(ern) Africa: An evolving research agenda. J Migr Health 2021; 3:100040. [PMID: 34405188 PMCID: PMC8352209 DOI: 10.1016/j.jmh.2021.100040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 12/23/2022] Open
Abstract
The Covid-19 pandemic provides a stark reminder of the political tensions associated with the field of immigration and health, highlighting the central role that nationalism, racism and xenophobia play in determining responses to communicable diseases. The blurring of global health, immigration governance, and the global health security agendas has long been recognised. However, an improved understanding of the politics influencing these entanglements, specifically within the context of the Covid-19 response in low- and middle-income country contexts, is urgently needed. This includes - but is not limited to - the immediate concerns surrounding inclusive social, political and medical responses to Covid-19; vaccine nationalism - at both global and national levels; and calls for 'vaccine passports'. To this end, we draw on the Southern African Development Community (SADC) context - one associated with high levels of diverse population movements and a large burden of communicable diseases - to explore responses to Covid-19. We unpack tensions surrounding the management of migration and the ways in which sovereignty impacts attempts at building regional, coordinated responses to migration and health, and consider how this affects progress towards global health targets. With an initial focus on South Africa, we build on previous work exploring the blurring of global health, immigration governance, and the global health security agendas in SADC, and draw from ongoing research on the governance of migration and health within the region. This includes current and evolving research exploring migration and Covid-19, initiated in March 2020 when the first cases of Covid-19 were identified in Southern Africa. The aim is for these findings to catalyse a new and evolving researh agenda to inform the development and implementation of appropriate pandemic responses in a region associated with some of the highest levels of inequality globally. To this end, an evolving research agenda should be responsive to current needs. We suggest that, in SADC, priority research should focus on improving our understanding of (1) the political factors influencing the (dis)connections between migration and health governance structures in the context of Covid-19, and how to overcome these in the context of a pandemic; and (2) the motivations for and implications of a 'vaccine passport' system on movement within and beyond the SADC region. This requires a reactive, cross-disciplinary, regional research network. In a context where funding for research is increasingly inaccessible, this requires innovative, informal, collaborative engagement.
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Affiliation(s)
- Jo Vearey
- African Centre for Migration & Society (ACMS), Wits University, PO Box 76, WITS, 2050, South Africa
| | - Thea de Gruchy
- African Centre for Migration & Society (ACMS), Wits University, PO Box 76, WITS, 2050, South Africa
| | - Nicholas Maple
- African Centre for Migration & Society (ACMS), Wits University, PO Box 76, WITS, 2050, South Africa
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10
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Mougenot B, Amaya E, Mezones-Holguin E, Rodriguez-Morales AJ, Cabieses B. Immigration, perceived discrimination and mental health: evidence from Venezuelan population living in Peru. Global Health 2021; 17:8. [PMID: 33413505 PMCID: PMC7791752 DOI: 10.1186/s12992-020-00655-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/17/2020] [Indexed: 02/19/2023] Open
Abstract
Background The association between international migration and mental health is conditioned to several factors, and discrimination may play a significant role. Currently, Peru is one of the principal Venezuelan migrant-receiving countries in Latin America. There are around one million Venezuelan refugees and migrants in the country. This study evaluates the association between self-perceived discrimination and mental health problems in Venezuelan population living in Peru. Method We analyzed data from the Venezuelan Population Residing in Peru Survey 2018, a nationally representative urban sample aimed at collecting information on several dimensions of Venezuelan population wellbeing. We applied logistic regression models to assess the association between self-perceived discrimination and mental health problems. Moreover, we applied the propensity score matching method as a robustness check of our results. Results Of 9487 Venezuelans surveyed, 6806 included complete information. From this sample, 6.3% reported mental health problems related to fear, anger, anxiety, or stress. Logistic regression models showed that Venezuelans who perceived being discriminated against had 2.4 higher odds of presenting mental health problems than their non-discriminated counterparts. Moreover, propensity score matching models showed that Venezuelans who perceived being discriminated against increased by 3.5 percentage points their probability of presenting mental health problems compared to their non-discriminated counterparts. Conclusions There is evidence that self-perceived discrimination is associated with mental health deterioration in Venezuelan migrants living in Peru. Our findings are relevant in the current geopolitical context and could be useful in the decision making processes in international health. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-020-00655-3.
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Affiliation(s)
- Benoît Mougenot
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru.,Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima, Peru
| | - Elard Amaya
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
| | - Edward Mezones-Holguin
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru.,Epi-gnosis Solutios, Piura, Peru
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.,Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Báltica Cabieses
- Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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11
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Cailhol J, Lebon MC, Sherlaw W. Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France. BMC Med Ethics 2020; 21:59. [PMID: 32660550 PMCID: PMC7359478 DOI: 10.1186/s12910-020-00500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant's physician and complementary evidence. MAIN BODY The writing of medical certificates by a physician would seem straightforward. This is far from the case since it raises a number of ethical dilemmas. These occur within a physician-patient relationship embedded within a social contract between the State, the physician and the migrant patient. To clarify the ethical issues arising 3 vignettes based on practice within an infectious disease unit at a large Paris hospital have been developed. The vignettes highlight ethical dilemmas in the care for migrants with tuberculosis (dilemma in defining health and disease), chronic hepatitis (dilemma between beneficence and do not harm), and HIV / AIDS (issue of deservingness). We will go on to reflect on issues of social justice and responsibility for the health of migrants within a globalized world. CONCLUSIONS Criteria for residence permit delivery appear less than clear-cut and are interpreted in a restrictive way. Neither are the consequences of refusing a residence permit taken into account. We call for an empirical transnational ethics study involving countries implementing similar TRPMR policies. We also call for inclusion of lobbying competences into the medical undergraduate curricula, in order to breed future generations of physicians skilled in defending social justice.
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Affiliation(s)
- Johann Cailhol
- Laboratoire Educations et Pratiques de Santé, Université Paris 13, 74 rue Marcel Cachin, Bobigny, France.
- Infectious diseases unit, Avicenne teaching hospital, APHP, 125 route de Stalingrad, 93000, Bobigny, France.
- Institut Convergences Migrations, Campus Condorcet, Hôtel à projets, 8 cours des Humanités, 93300, Aubervilliers, France.
| | - Marie-Christine Lebon
- Infectious diseases unit, Avicenne teaching hospital, APHP, 125 route de Stalingrad, 93000, Bobigny, France
| | - William Sherlaw
- Laboratoire d'Etudes et de Recherche en Sociologie, Université de Bretagne Occidentale, 20 rue Duquesne, 29200, Brest, France
- Ecole des Hautes Etudes en Santé Publique, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
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12
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Dangmann CR, Solberg Ø, Steffenak AKM, Høye S, Andersen PN. Health-related quality of life in young Syrian refugees recently resettled in Norway. Scand J Public Health 2020; 48:688-698. [PMID: 32613905 PMCID: PMC7604933 DOI: 10.1177/1403494820929833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aims: Millions have fled from the civil unrest in Syria, and half of these are children and youth. Although they are a population with an elevated risk of health problems due to adverse pre-migratory and post-migratory experiences, few studies have explored their health-related quality of life (HRQoL). This is considered a fundamental construct in public health and might provide complementary descriptions of their health and well-being after resettling in a new country. Methods: This was a cross-sectional study of 160 Syrian youth aged 13–24 years. Using KIDSCREEN-27, the results for five dimensions of HRQoL was compared to population norm data. Demographic factors and war-related adverse events were used to predict HRQoL in hierarchical regression. Results: For most participants, the overall HRQoL was good, but it was lower in the dimensions for friends, physical well-being and psychological well-being compared to population norms. Scores in the dimensions for autonomy/parental relation and the school environment were high and were the main contributors to a positive HRQoL. Age and number of reported stressful events (SE) had the greatest impact on HRQoL, but the final regression model only accounted for 21% of the total variance. Conclusions: HRQoL is a relevant and non-invasive measure for refugee youth. Contributors to lower scores in physical and psychological well-being should be explored further and indicate the potential for future interventions focussing on general psychological well-being and networks, regardless of the SE that have been experienced. These interventions could potentially be based in schools or in families in order to benefit from these being seemingly safe environments for the majority of the group.
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Affiliation(s)
| | - Øivind Solberg
- Norwegian Centre for Violence and Traumatic Stress Studies, Norway
| | | | - Sevald Høye
- Inland Norway University of Applied Sciences and Nord University, Norway
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13
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Pratt B, Wild V, Barasa E, Kamuya D, Gilson L, Hendl T, Molyneux S. Justice: a key consideration in health policy and systems research ethics. BMJ Glob Health 2020. [PMCID: PMC7245410 DOI: 10.1136/bmjgh-2019-001942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Health policy and systems research (HPSR) is increasingly being funded and conducted worldwide. There are currently no specific guidelines or criteria for the ethical review and conduct of HPSR. Academic debates on HPSR ethics in the scholarly literature can inform the development of guidelines. Yet there is a deficiency of academic bioethics work relating to justice in HPSR. This gap is especially problematic for a field like HPSR, which can entail studies that intervene in ways affecting the social and health system delivery structures of society. In this paper, we call for interpreting the principle of justice in a more expansive way in developing and reviewing HPSR studies (relative to biomedical research). The principle requires advancing health equity and social justice at population or systems levels. Drawing on the rich justice literature from political philosophy and public health ethics, we propose a set of essential justice considerations to uphold this principle. These considerations are relevant for research funders, researchers, research ethics committees, policymakers, community organisations and others who are active in the HPSR field.
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Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Verina Wild
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Edwine Barasa
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tereza Hendl
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
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14
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Bradby H, Lebano A, Hamed S, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Sherlaw W, Christova I, Karnaki P, Zota D, Riza E. Policy Makers', NGO, and Healthcare Workers' Accounts of Migrants' and Refugees' Healthcare Access Across Europe-Human Rights and Citizenship Based Claims. FRONTIERS IN SOCIOLOGY 2020; 5:16. [PMID: 33869425 PMCID: PMC8022609 DOI: 10.3389/fsoc.2020.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/25/2020] [Indexed: 05/25/2023]
Abstract
Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalized streams of the twenty-first century, new challenges to fulfilling these ideals have emerged. The principle of freedom of movement, together with large-scale forced migration have led to large scale movements of people, making new demands on European healthcare systems which had previously been largely focused on meeting sedentary local populations' needs. Drawing on interviews with service providers working for NGOs and public healthcare systems and with policy makers across 10 European countries, this paper considers how forced migrants' healthcare needs are addressed by national health systems, with factors hindering access at organizational and individual level in particular focus. The ways in which refugees' and migrants' healthcare access is prevented are considered in terms of claims based on citizenship and on the human right to health and healthcare. Where claims based on citizenship are denied and there is no means of asserting the human right to health, migrants are caught in a new form of inequality.
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Affiliation(s)
- Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Adele Lebano
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | | | | | | | - William Sherlaw
- École des Hautes Etudes en Santé Publique (EHESP), Rennes, France
| | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Marousi, Greece
| | - Dina Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Marousi, Greece
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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15
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Uygun E. The Life Condition of Syrian Asylum Seekers in Turkey and the Effect of These Conditions on the Desire to Migrate to Europe. Psychiatry Investig 2020; 17:55-60. [PMID: 31995972 PMCID: PMC6992858 DOI: 10.30773/pi.2018.0275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 10/01/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In recent years, many Syrian asylum seekers has died while they were crossing over sea to migrate to Europe. We aimed to identify the determinants of choice of Syrian asylum seekers for emigration to Europe; therefore, we selected the sample from refugee mental health clinic in Turkey. METHODS Our sample consists of 100 Syrian who applied to the refugee mental health branch polyclinic. Participants filled out the (e1) sociodemographic form, WHO-5 well-being index, and WHOQL. Then their future plans assessed by the interviewer. RESULTS It was seen that people who prefer to emigrate to Europe have higher level education level, lower income status, and had worse physical conditions at home. Also, They live generally in urban area, they do not have close relatives living in Syria, have poor mental well-being and have low quality of life scores. Job duration, absence of close relatives living in Syria, having low WHOOL score and physical conditions of home were found significant in regression analysis. CONCLUSION We found that their economic circumstances significantly predicted their preference, unlike clinical variables. We believe in that, improving their economic conditions and the life quality of Syrian asylum seekers can prevent illegal migration by dangerous routes to Europe and policy makers over the world should consider this situation.
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Affiliation(s)
- Ersin Uygun
- Refugee Mental Health Outpatient Clinic, University of Health Sciences, Bakırkӧy Mental Health and Nervous Diseases Training and Research Hospital, İstanbul, Turkey
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17
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Dawson A, Jordens CFC, Macneill P, Zion D. Bioethics and the Myth of Neutrality. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:483-486. [PMID: 30488184 DOI: 10.1007/s11673-018-9885-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Angus Dawson
- Sydney Health Ethics, Faculty of Medicine and Health, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Christopher F C Jordens
- Sydney Health Ethics, Faculty of Medicine and Health, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia
| | - Paul Macneill
- Sydney Health Ethics, Faculty of Medicine and Health, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia
| | - Deborah Zion
- Human Research Ethics Committee, Victoria University, Footscray Park Campus, Victoria, 3011, Australia
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18
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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19
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Chung RY, Griffiths SM. Migration and health in the world: a global public health perspective. Public Health 2018; 158:64-65. [PMID: 29709249 DOI: 10.1016/j.puhe.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Y Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
| | - S M Griffiths
- The Chinese University of Hong Kong, The Institute of Global Health Innovation, Imperial College London, UK.
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