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Kuhlmann E, Ungureanu MI, Thilo N, Fehr LM, Cosma NC, Brînzac MG, Dopfer-Jablonka A. Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID-19. Int J Health Plann Manage 2024; 39:1081-1096. [PMID: 38348510 DOI: 10.1002/hpm.3789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers' experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy. METHODS Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed. RESULTS AND DISCUSSION Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.
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Affiliation(s)
- Ellen Kuhlmann
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt Am Main, Germany
| | - Marius-Ionuț Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Nancy Thilo
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Leonie Mac Fehr
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Nicoleta-Carmen Cosma
- Department for Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Monica Georgina Brînzac
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research, Hannover-Brunswick, Hannover, Germany
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Kuhlmann E, Ungureanu MI, Behrens GMN, Cossmann A, Fehr LM, Klawitter S, Mikuteit M, Müller F, Thilo N, Brînzac MG, Dopfer-Jablonka A. Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study. Front Public Health 2023; 11:1152862. [PMID: 37533524 PMCID: PMC10393282 DOI: 10.3389/fpubh.2023.1152862] [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] [Received: 01/28/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study. Methods An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics. Results Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers. Conclusions COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.
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Affiliation(s)
- Ellen Kuhlmann
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Marius-Ionut Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj Napoca, Romania
| | - Georg M. N. Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner-Site Hannover-Braunschweig, Hannover, Germany
| | - Anne Cossmann
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Leonie Mac Fehr
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Sandra Klawitter
- Department of Computer Science, Ostfalia University of Applied Science, Wolfenbüttel, Germany
| | - Marie Mikuteit
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Nancy Thilo
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Monica Georgina Brînzac
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj Napoca, Romania
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner-Site Hannover-Braunschweig, Hannover, Germany
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Humphries N, Byrne JP, Creese J, McKee L. 'Today Was Probably One of the Most Challenging Workdays I've Ever Had': Doing Remote Qualitative Research with Hospital Doctors During the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2022; 32:1557-1573. [PMID: 35672272 PMCID: PMC9184831 DOI: 10.1177/10497323221106294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this article we outline how a team of qualitative researchers responded to the challenging circumstances of the COVID-19 pandemic, describing how we successfully and speedily adopted remote/digital methods to research the experiences of hospital doctors. In 2020, we used Zoom to conduct qualitative interviews with 48 hospital doctors; in 2021, we used Zoom and WhatsApp to conduct a Mobile Instant Messaging Ethnography with 28 hospital doctors. We explain how we adapted to a virtual setting and provide clear insights (case study vignettes) into the additional demands on researchers and respondents, in particular, the impact on the research team. Finally, we analyse the positive and negatives of using remote qualitative methods and highlight the potential of hybrid data collection models that combine remote and face-to-face methods. We also highlight our success in communicating findings to a policy audience, important in time-critical situations, such as the COVID-19 pandemic.
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Affiliation(s)
- Niamh Humphries
- RCSI Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - John-Paul Byrne
- RCSI Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Jennifer Creese
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
- SAPPHIRE (Social Science Applied to Healthcare Improvement Research), University of Leicester, Leicester, UK
| | - Lorna McKee
- University of Aberdeen, Aberdeen, Scotland, UK
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4
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Gum AM, Green O, Dassa A, Klausner K, Gewirtz-Meydan A, Ayalon L. Behavioral activation for live-in migrant home care workers and care recipients in Israel: a pilot study. Home Health Care Serv Q 2022; 41:219-235. [PMID: 35383537 DOI: 10.1080/01621424.2022.2054393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In a growing global trend, individuals are migrating to other countries to live with and care for older adults with dementia. Although this trend addresses the geriatric workforce shortage, workers and older adults often experience distress. In a pilot study in Israel, six migrant care workers participated in a six-week group intervention in which they learned to increase valued, enjoyable activities for themselves and the older adult with whom they lived (behavioral activation). After the intervention, workers reported that they increased activities for themselves and the older adult and were satisfied, and quality of life and sense of achievement showed medium and large effect sizes, respectively. Participants suggested adapting the intervention to an online format for greater access. Although findings are tentative, the study points to promising strategies for migrant home care workers: focusing on the worker and older adult and offering online interventions.
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Affiliation(s)
- Amber M Gum
- Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, Florida, USA
| | - Ohad Green
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel.,Department of Social Policy and Intervention
| | - Ayelet Dassa
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Keren Klausner
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Ateret Gewirtz-Meydan
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel.,Department of Social Policy and Intervention
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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Islamoska S, Petersen JH, Benfield T, Norredam M. Socioeconomic and demographic risk factors in COVID-19 hospitalization among immigrants and ethnic minorities. Eur J Public Health 2022; 32:302-310. [PMID: 34718522 PMCID: PMC8586727 DOI: 10.1093/eurpub/ckab186] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Immigrants and ethnic minorities have been shown to be at increased risk of hospitalization from COVID-19. Our aim was to analyse the contribution of socioeconomic and demographic risk factors on hospital admissions for COVID-19 among immigrants and ethnic minorities compared to the majority population. METHODS We used nationwide register data on all hospitalized COVID-19 cases between February and June 2020 (N = 2232) and random controls from the general population (N = 498 117). We performed logistic regression analyses and adjusted for age, sex, comorbidity, and socioeconomic and demographic factors. The main outcome measure was hospitalization with COVID-19 and was estimated using odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Among 2232 COVID-19 cases, the OR of hospitalization with COVID-19 among immigrants and descendants of non-Western origin was 2.5 times higher (95% CI: 2.23-2.89) compared with individuals of Danish origin with most pronounced results among individuals from Iraq, Morocco, Pakistan and Somalia. The OR was largely attributed to comorbidity and socioeconomic factors, especially household size, occupation, and population density. CONCLUSION There is a significantly higher OR of hospitalization with COVID-19 among non-Western immigrants and ethnic minorities compared with ethnic Danes. This knowledge is crucial for health policymakers and practitioners in both the current and future pandemics to identify more vulnerable groups and target prevention initiatives.
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Affiliation(s)
- Sabrina Islamoska
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark
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Role and Characteristics of Personal Care Assistants of Frail Older People with Functional Limitations Ageing in Place in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073969. [PMID: 35409652 PMCID: PMC8997560 DOI: 10.3390/ijerph19073969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023]
Abstract
When older people become frail with functional limitations, and age alone in place, caring support is fundamental for performing daily living activities. The present study aimed to explore the current role and characteristics of privately hired Personal Care Assistants (PCAs) of older people in Italy, in light of the decreasing care availability of the family and the low provision of public services. In the study “Inclusive ageing in place” (IN-AGE), 120 qualitative interviews were carried out in 2019, involving frail older people living at home in three Italian regions: Lombardy, Marche, and Calabria. A content analysis was conducted, in addition to some simple quantifications of statements. Results showed the support of PCAs in 27 cases, mainly when health issues of seniors were referred. In addition, informal and irregular employment contracts were reported. Moreover, a comparison between PCA and Domestic Home Help (DHH, 44 cases), highlighted how they even more provide very similar functions (i.e., home and personal care). The role of PCA emerged as crucial in Italy, especially in the South. Thus, to boost up home services seems necessary for allowing ageing in place, also by integrating PCAs in formal public Long-Term Care (LTC), and by providing incentive systems for regular hiring.
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Cheng Q, Zheng S, Xiong Z, Lin M. Characterizing the Dynamic Evolution of Interagency Collaborative Decision-Making Networks in Response to COVID-19 in China: A Policy Document Analysis. Healthcare (Basel) 2022; 10:healthcare10030590. [PMID: 35327067 PMCID: PMC8950421 DOI: 10.3390/healthcare10030590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 01/02/2023] Open
Abstract
Collaborative decision-making across multiple government agencies is considered a critical and effective strategy to combat public health crisis; however, we know little about how the collaborative decision-making works and evolves during periods of crisis. To fill this lacuna, this study uncovers the structure and evolving dynamics of the network by employing a policy document analysis. Based on the policy documents, jointly issued by the agencies of Chinese central government in four phases regarding COVID-19 control, we first constructed a co-occurrence matrix of policy-issuing agencies to outline the network structure, then drew a breadth–depth matrix to identify the role evolution of agencies, and lastly built a two-mode network consisting of policy topics and agencies to determine the evolution mechanisms of policy attentions for each agency. It was found that the network structure of interagency collaboration involves three forms: discrete structure in the early phase, subgroup structure in the middle phase, and connected structure in the latter phase. Agencies embedded in the network can be categorized into three types: leading agencies, key agencies, and auxiliary agencies, with their constituent members changed as the pandemic risks are gradually becoming under control. Furthermore, each type has its own primary policy attentions, but shares some common foci in all four phases and shifts attention in the emergency management process. This study contributes to shedding light on the formation of and variations in collaborative networks in health emergencies and provides policy implications for other countries that have struggled against COVID-19.
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Affiliation(s)
- Quan Cheng
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (S.Z.)
| | - Shulin Zheng
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (S.Z.)
| | - Zheng Xiong
- Department of Foreign Languages, Zhicheng College, Fuzhou University, Fuzhou 350002, China;
| | - Minwang Lin
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (S.Z.)
- Correspondence:
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Burau V, Falkenbach M, Neri S, Peckham S, Wallenburg I, Kuhlmann E. Health system resilience and health workforce capacities: Comparing health system responses during the COVID-19 pandemic in six European countries. Int J Health Plann Manage 2022; 37:2032-2048. [PMID: 35194831 PMCID: PMC9087528 DOI: 10.1002/hpm.3446] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The health workforce is a key component of any health system and the present crisis offers a unique opportunity to better understand its specific contribution to health system resilience. The literature acknowledges the importance of the health workforce, but there is little systematic knowledge about how the health workforce matters across different countries. AIMS We aim to analyse the adaptive, absorptive and transformative capacities of the health workforce during the first wave of the COVID-19 pandemic in Europe (January-May/June 2020), and to assess how health systems prerequisites influence these capacities. MATERIALS AND METHODS We selected countries according to different types of health systems and pandemic burdens. The analysis is based on short, descriptive country case studies, using written secondary and primary sources and expert information. RESULTS AND DISCUSSION Our analysis shows that in our countries, the health workforce drew on a wide range of capacities during the first wave of the pandemic. However, health systems prerequisites seemed to have little influence on the health workforce's specific combinations of capacities. CONCLUSION This calls for a reconceptualisation of the institutional perquisites of health system resilience to fully grasp the health workforce contribution. Here, strengthening governance emerges as key to effective health system responses to the COVID-19 crisis, as it integrates health professions as frontline workers and collective actors.
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Affiliation(s)
- Viola Burau
- Department of Political Science, University of Aarhus Denmark, Aarhus, Denmark.,Department of Public Health, University of Aarhus Denmark, Aarhus, Denmark
| | - Michelle Falkenbach
- Department of Public and Ecosystem Health, Cornell University, New York, New York, USA
| | - Stefano Neri
- Department of Social and Political Sciences, University of Milan Italy, Milan, Italy
| | - Stephen Peckham
- Centre for Health Service Studies, University of Kent, Canterbury, England.,Department of Health Services and Policy Research, London School of Hygiene and Tropical Medicine, London, England
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ellen Kuhlmann
- Hannover Medical School, Clinic for Rheumatology and Immunology, Hannover, Germany.,Institute of Infection Control and Infectious Diseases, University Medical Centre, Georg August University, Göttingen, Germany
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Disability in Older People and Socio-Economic Deprivation in Italy: Effects on the Care Burden and System Resources. SUSTAINABILITY 2021. [DOI: 10.3390/su14010205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivariate and multivariate analyses, from bivariate correlation, through multiple linear regression to principal component factor analysis, were used to reduce the number of the variables and compute the indicators. The multivariate analysis underlines how ADL disability impacts on a household’s poverty, confirming the existence of statistical correlation between them. Moreover, the study identifies and measures two answer capability models to cope with household poverty. The answer capability of the formal system is the main tool for reducing poverty due to one family member’s ADL disability. Integration and collaboration between the formal system and family capabilities remains the main solution.
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Kuhlmann E, Brînzac MG, Burau V, Correia T, Ungureanu MI. Health workforce protection and preparedness during the COVID-19 pandemic: a tool for the rapid assessment of EU health systems. Eur J Public Health 2021; 31:iv14-iv20. [PMID: 34751366 PMCID: PMC8576297 DOI: 10.1093/eurpub/ckab152] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. The study aims to strengthen health workforce preparedness, protection and ultimately resilience during a pandemic. We argue for a health system approach and introduce a tool for rapid comparative assessment based on integrated multi-level governance. We draw on secondary sources and expert information, including material from Denmark, Germany, Portugal and Romania. The results reveal similar developments across countries: action has been taken to improve physical protection, digitalization and prioritization of healthcare worker vaccination, whereas social and mental health support programmes were weak or missing. Developments were more diverse in relation to occupational and organizational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strongest in Demark and weak in Portugal and Romania. Major governance gaps exist in relation to education and health integration, surveillance, social and mental health support programmes, gendered issues of health workforce capacity and integration of migrant healthcare workers (HCW). There is a need to step up efforts and make health systems more accountable to the needs of HCW during global public health emergencies.
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Affiliation(s)
- Ellen Kuhlmann
- Clinic for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Institute of Infection Control and Infectious Diseases, University Medical Centre, Georg August University, Göttingen, Germany
| | - Monica-Georgiana Brînzac
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Viola Burau
- Department of Political Science, University of Aarhus, Aarhus, Denmark
- Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Tiago Correia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marius-Ionut Ungureanu
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
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Onarheim KH, Phua KH, Babar ZR, Flouris AD, Hargreaves S. Health and social needs of migrant construction workers for big sporting events. BMJ 2021; 374:n1591. [PMID: 34353809 PMCID: PMC8340932 DOI: 10.1136/bmj.n1591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Kai Hong Phua
- Graduate School of Public Policy, Nazarbayev University, Kazakhstan and Institute of Policy Studies, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | | | - Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Greece
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
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12
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Côté D, Durant S, MacEachen E, Majowicz S, Meyer S, Huynh A, Laberge M, Dubé J. A rapid scoping review of COVID-19 and vulnerable workers: Intersecting occupational and public health issues. Am J Ind Med 2021; 64:551-566. [PMID: 34003502 PMCID: PMC8212119 DOI: 10.1002/ajim.23256] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND This article reports the results of a rapid scoping review of the literature on COVID-19 transmission risk to workers in essential sectors such as retail, health care, manufacturing, and agriculture, and more particularly the experiences of workers in precarious employment and social situations. METHODS Following scoping review methods, we included 30 studies that varied in terms of methodology and theoretical approaches. The search included peer-reviewed articles and grey literature published between March and September 2020. RESULTS Based on the studies reviewed, we found that COVID-19 infection and death rates increased not only with age and comorbidities, but also with discrimination and structural inequities based on racism and sexism. Racial and ethnic minority workers, including migrant workers, are concentrated in high-risk occupations and this concentration is correlated to lower socioeconomic conditions. The COVID-19 pandemic appears in the occupational health and safety spotlight as an exacerbator of already existing socioeconomic inequalities and social inequalities in health, especially in light of the intersection of issues related to racism, ethnic minority status, and sexism. CONCLUSIONS This review provides early evidence about the limitations of institutions' responses to the pandemic, and their capacity to provide a safe and decent working environment for all workers, regardless of their employment status or the social protections they may enjoy under normal circumstances. It is also important to think about these issues in the postpandemic context, when conditions of precariousness and vulnerability persist and possibly worsen.
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Affiliation(s)
- Daniel Côté
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), MontréalQuébecCanada
- Department of AnthropologyUniversité de Montréal, MontréalQuébecCanada
| | - Steve Durant
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Ellen MacEachen
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Shannon Majowicz
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Samantha Meyer
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Ai‐Thuy Huynh
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), MontréalQuébecCanada
| | - Marie Laberge
- School of RehabilitationUniversité de MontréalQuébecCanada
| | - Jessica Dubé
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), MontréalQuébecCanada
- School of ManagementUniversité du Québec à Montréal (UQAM)QuébecCanada
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Cross-sectional study of SARS-CoV2 clinical characteristics in an immigrant population attended in a Hospital Emergency Department in the Catalunya Health Region in Spain. J Migr Health 2021; 4:100055. [PMID: 34151311 PMCID: PMC8204845 DOI: 10.1016/j.jmh.2021.100055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/02/2021] [Accepted: 06/13/2021] [Indexed: 11/24/2022] Open
Abstract
Aim The COVID pandemic has been the biggest health challenge faced in decades. The aim of this study is to assess the characteristics of immigrant patients who attended a Hospital Emergency Department during the first three waves of the coronavirus pandemic. Methods A retrospective, descriptive study of immigrant patients treated in a Hospital Emergency Department between March 15 and November 30, 2020. A descriptive analysis and a comparative analysis were carried out according to place of origin, gender and age. For the comparative analysis, the chi-square test for qualitative variables was used. For the comparative analysis according to gender, Student's t test or the Mann-Whitney U test was used for normal or non-normal quantitative variables, respectively. The Kruskal-Wallis test was used for normal or non-normal quantitative variables according to age. Results We have analyzed 633 immigrant patients who visited the emergency department during the study period. Of the sample, 50.1% patients were women and 78% of all patients came from Africa. The mean age of the patients was 44.1 years. Most patients (72.5%) were discharged to home after evaluation in the emergency department, especially European patients. One-quarter of patients required social resources to be able to comply with quarantine measures, of whom 87% were African. Forty-seven percent of patients became infected at home and 41% in the workplace. Conclusions The immigrant population is generally younger and less infected than the population at large. In addition, the use of social resources to guarantee patient isolation has often proved essential in controlling outbreaks that have arisen in these communities.
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Hayward SE, Deal A, Cheng C, Crawshaw A, Orcutt M, Vandrevala TF, Norredam M, Carballo M, Ciftci Y, Requena-Méndez A, Greenaway C, Carter J, Knights F, Mehrotra A, Seedat F, Bozorgmehr K, Veizis A, Campos-Matos I, Wurie F, McKee M, Kumar B, Hargreaves S. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J Migr Health 2021; 3:100041. [PMID: 33903857 PMCID: PMC8061095 DOI: 10.1016/j.jmh.2021.100041] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. METHODS We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. RESULTS 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. CONCLUSIONS Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cherie Cheng
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Alison Crawshaw
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | | | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Manuel Carballo
- International Centre for Migration, Health, and Development, Geneva, Switzerland
| | | | - Ana Requena-Méndez
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | | | - Jessica Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anushka Mehrotra
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Kayvan Bozorgmehr
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ines Campos-Matos
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
| | - Fatima Wurie
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - on behalf of the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
- Institute for Infection and Immunity, St George's University of London, London, UK
- Institute for Global Health, University College London, London, UK
- Faculty of Business and Social Sciences, Kingston University, London, UK
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- International Centre for Migration, Health, and Development, Geneva, Switzerland
- Doctors of the World UK, London, UK
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
- Department of Medicine, McGill University, Montreal, Canada
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Medecins Sans Frontieres Greece, Athens, Greece
- Public Health England, London, UK
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
- Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Franklin P, Gkiouleka A. A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2453. [PMID: 33801517 PMCID: PMC7967576 DOI: 10.3390/ijerph18052453] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
The Covid-19 pandemic has exposed health workers to a diverse set of hazards impacting their physical, psychological and social wellbeing. This review aims to provide an overview of the categories of the psychosocial risk factors and hazards affecting HCWs during the Covid-19 pandemic and the recommendations for prevention. We used the scoping review methodology to collate categories of psychosocial risks, the related health outcomes, interventions, and data gaps. The review was conducted on global peer-reviewed academic and authoritative grey literature, published between 1. January-26. October 2020; in total, 220 articles were included into the review and the subsequent analysis. Analysis of the extracted data found PSRs related to four sources: personal protective equipment (PPE), job content, work organisation, and social context. is. Women health workers and nurses reported worst health outcomes. Majority of the research to date concerns health workers in secondary care, while data on psychosocial risks at primary and community-based settings are scarce. However, the emerging research implies that the pandemic creates psychosocial risks also to non-clinical health workers. The intervention and mitigation measures address individual and organisational levels. Preventative and mitigating measures for social and societal risks-such as staff shortages, intersecting inequalities, and financial stressors require further research.
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Affiliation(s)
- Paula Franklin
- Occupational Safety & Health and Working Conditions Unit, European Trade Union Institute (ETUI), Boulevard du Roi Albert II, 1210 Brussels, Belgium
| | - Anna Gkiouleka
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK;
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