Getting Multicultural Health Care off the Ground: Britain and The Netherlands Compared

Cultural minority students' experiences with intercultural competency in medical education

CONTEXT

Medical schools increasingly value and focus on teaching students intercultural competency within present-day multicultural society. Little is known about the experiences of cultural minority students in intercultural competence activities.

OBJECTIVES

This article discusses the intercultural competence activities of medical education in a Dutch university from the perspective of cultural minority students. We will formulate recommendations for how to stimulate intercultural competency in, as well as inclusiveness of, medical education.

METHODS

A qualitative evaluation was performed within a medical school in the Netherlands. Data were collected through interviews (n = 23), a focus group (six participants) and participant observations (20 hours). Thematic analysis was performed.

RESULTS

Cultural minority students experienced a lack of respect and understanding by cultural majority students and teachers. Education activities intended to transfer intercultural knowledge, address personal prejudice and stimulate intercultural sensitivity were perceived as stigmatising and as creating an unsafe climate for cultural minority students. Cultural minority and majority students on campus seemed segregated and the intercultural awareness of minority students was not integrated in intercultural competence activities.

CONCLUSIONS

As cultural minority students were confronted with microaggressions, the medical school did not succeed in creating a safe education environment for all students. Contrary to their aims and intentions, intercultural competence activities had limited effect and seemed to support the polarisation of cultural minority and majority students and teachers. This can be seen as pointing towards a hidden curriculum privileging majority over minority students. For structural integration of intercultural competency in medical education, the focus must penetrate beyond curricular activities towards the critical addressing of the culture and structure of medical school. Collective commitment to creating a safe and inclusive education climate is vital. This requires fostering social cohesion between minority and majority students and teachers, raising awareness and the practice by all involved of critical (self-)reflexivity on cultural prejudice and dominant, exclusionary norms in academic medicine.

Building Responsive Health Systems to Help Communities Affected by Migration: An International Delphi Consensus

Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration.

MATERIALS AND METHODS

An international Delphi consensus process was used to identify policy approaches to improve health systems for populations affected by migration. Participants were leading migrant health experts from Americas, Europe, Middle East, Asia, and Australasia. We calculated average ranking scores and qualitatively analyzed open-ended questions.

RESULTS

Participants identified the following key areas as priorities for policy development: health inequities, system discrimination, migrant related health data, disadvantaged migrant sub-groups, and considerations for disadvantaged non-migrant populations. Highly ranked items to improve health systems were: Health Equity Impact Assessment, evidence based guidelines, and the International Organization for Migration annual reports.

DISCUSSION

Policy makers need tools, data and resources to address health systems challenges. Policies need to avoid preventable deaths of migrants and barriers to basic health services.

Migration and health in an increasingly diverse Europe

The share of migrants in European populations is substantial and growing, despite a slowdown in immigration after the global economic crisis. This paper describes key aspects of migration and health in Europe, including the scale of international migration, available data for migrant health, barriers to accessing health services, ways of improving health service provision to migrants, and migrant health policies that have been adopted across Europe. Improvement of migrant health and provision of access for migrants to appropriate health services is not without challenges, but knowledge about what steps need to be taken to achieve these aims is increasing.

Responding to diversity: an exploratory study of migrant health policies in Europe

There has been growing international attention to migrant health, reflecting recognition of the need for health systems to adapt to increasingly diverse populations. However, reports from health policy experts in 25 European countries suggest that by 2009 only eleven countries had established national policies to improve migrant health that go beyond migrants' statutory or legal entitlement to care. The objective of this paper is to compare and contrast the content of these policies and analyse their strengths and limitations. The analysis suggests that most of the national policies target either migrants or more established ethnic minorities. Countries should address the diverse needs of both groups and could learn from "intercultural" health care policies in Ireland and, in the past, the Netherlands. Policies in several countries prioritise specific diseases or conditions, but these differ and it is not clear whether they accurately reflect real differences in need among countries. Policy initiatives typically involve training health workers, providing interpreter services and/or 'cultural mediators', adapting organizational culture, improving data collection and providing information to migrants on health problems and services. A few countries stand out for their quest to increase migrants' health literacy and their participation in the development and implementation of policy. Progressive migrant health policies are not always sustainable as they can be undermined or even reversed when political contexts change. The analysis of migrant health policies in Europe is still in its infancy and there is an urgent need to monitor the implementation and evaluate the effectiveness of these diverse policies.

Monitoring migrant health in Europe: a narrative review of data collection practices

BACKGROUND

Data on the health of migrants, including on health determinants and access to health services, are an essential pre-condition for providing appropriate and accessible health services to this population group. This article reviews how far current data collection systems in the European Union (EU) allow to monitor migrant health.

METHODS

We searched the academic literature using PubMed and reviewed the results of recent EU-funded research projects on migrant health.

RESULTS

Most EU member states lack information on the health of migrants, limiting the possibility for monitoring and improving migrant health. National death registers allow for disaggregation according to migrant status in 24 of 27 EU member states. Registry data on health care utilization by migrant status are available in only 11 of 27 member states, although in most cases this only covers secondary and not primary care. Only few countries collect large-scale survey data on migrant health and health care utilization.

CONCLUSION

Many EU countries need to step up their organizational and regulatory efforts to monitor migrant health if the current lack of data on migrant health should be overcome. This could be done through the inclusion of improved questions on migration in existing data collection processes.