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Devillanova C, Franco C, Spada A. Downgraded dreams: Labor market outcomes and mental health in undocumented migration. SSM Popul Health 2024; 26:101652. [PMID: 38516529 PMCID: PMC10950686 DOI: 10.1016/j.ssmph.2024.101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/02/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Undocumented immigrant workers are particularly exposed to mental health risk factors, including occupational downgrading - i.e. the loss in occupational status upon arrival. This study breaks new ground by examining the relationship between occupational downgrading and mental health among this hard-to-reach population, offering the first-ever investigation of its kind. Leveraging a unique dataset collected by a primary care outpatient clinic in Milan, Italy, which combines medical evaluations with detailed occupational information, we construct a direct measure of occupational downgrading, which adds to the literature. We employ logistic regression models to estimate odds ratios (ORs) for mental and behavioral disorders. The study also offers fresh evidence on the socioeconomic and health status of a sizable sample of undocumented migrants. The study sample consists of 1738 individuals that had their first medical examination in 2017-18. Prevalence of mental health conditions is 5.58%. Data also highlight poor labor market integration: one third of individuals in the sample is employed, mostly in elementary occupations; 66.63% of immigrant workers experienced occupational downgrading. Regression results show that undocumented immigrants who undergo occupational downgrading are at considerably higher risk of mental disorders. ORs range from 1.729 (95% CI 1.071-2.793), when the model only includes individual characteristics determined prior to migration, to 2.659 (CI 1.342-5.271), when it accounts for all the available controls. From a policy perspective, our study underscores the need to consider the broader impact of policies, including restrictive entry and integration policies, on migrant health. Additionally, ensuring access to primary care for all immigrants is crucial for early detection and treatment of mental health conditions.
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Affiliation(s)
- Carlo Devillanova
- Department of Social and Political Sciences and Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy
| | - Cristina Franco
- European Commission, Directorate-General for Neighbourhood Policy and Enlargement Negotiations, Belgium
| | - Anna Spada
- On Behalf of Naga, Organizzazione di Volontariato per l’Assistenza Socio-Sanitaria e per i Diritti di Cittadini Stranieri, Rom e Sinti, Italy
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Stevenson K, Antia K, Burns R, Mosca D, Gencianos G, Rechel B, Norredam M, LeVoy M, Blanchet K. Universal health coverage for undocumented migrants in the WHO European region: a long way to go. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100803. [PMID: 39119095 PMCID: PMC11306210 DOI: 10.1016/j.lanepe.2023.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 08/10/2024]
Abstract
The number of people on the move internationally is increasing, and a sizable number of these individuals are migrating through and to the WHO European Region. The UN Sustainable Development Goals demand that we leave no one behind and ensure equitable implementation of Universal Health Coverage (UHC), regardless of immigration status. In the WHO European region, some of the migrants in the most precarious situations are undocumented; defined as those who may have been unsuccessful in asylum applications, born to undocumented parents, continued their residence in a country after their permit or other means of stay expired, as well as those who have entered the country irregularly. These undocumented migrants face some of the biggest challenges to accessing UHC and are often left behind by systems that exclude and stigmatise them. This paper examines the literature on access to healthcare for undocumented migrants in the WHO European Region and calls for urgent action towards ensuring UHC for all migrants regardless of immigration status by 2030.
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Affiliation(s)
- Kerrie Stevenson
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street London, WC1E 7HT, United Kingdom
| | - Khatia Antia
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom
| | - Davide Mosca
- Realizing SDGs for Migrants, Displaced, and Communities, Italy
| | | | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marie Norredam
- Department of Public Health, Danish Research Center for Migration, Ethnicity and Health, Section of Health Services, University of Copenhagen, Denmark
| | - Michele LeVoy
- Platform for International Cooperation on Undocumented Migrants (PICUM), Brussels, Belgium
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Switzerland
- Lancet Migration European Region Hub, Switzerland
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Hagose M, Burton-Jeangros C, Fakhoury J, Consoli L, Refle JE, Jackson Y. Working Conditions and Self-Reported Health Among Undocumented and Newly Regularized Migrants in Geneva: A Cross-Sectional Study. Int J Public Health 2023; 68:1606394. [PMID: 38125708 PMCID: PMC10730670 DOI: 10.3389/ijph.2023.1606394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives: Most undocumented migrants are employed in so-called "dirty jobs" or "3D jobs" (dangerous, dirty and degrading) due to their lack of legal status. This study aimed to describe the self-reported health of undocumented and newly regularized migrants in relation to their working conditions. Methods: A cross-sectional study was conducted using data collected during the first phase of the Parchemins study (2017-18), a survey that monitors the socioeconomic and health impact of a regularization scheme for undocumented workers in Geneva, Switzerland. The sample consists of 395 undocumented and newly regularized migrants. Results: Overall, 147 (37.2%) rated their health as very good or excellent. Multivariable regression analysis indicated that work-related factors associated with better self-reported health included higher satisfaction with working conditions, while legal status regularization showed only a borderline association. By contrast, workers performing very demanding tasks and having more difficulties finding a new job were less likely to report very good or excellent health. Conclusion: Findings show that work-related factors had a stronger influence on self-reported health compared to legal status change. Further research is needed to evaluate the long-term impact of regularization on working conditions and self-rated health.
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Affiliation(s)
- Munire Hagose
- Faculté des Sciences de la Société, Université de Genève, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- Faculté des Sciences de la Société, Université de Genève, Geneva, Switzerland
- LIVES Swiss Centre of Expertise in Life Course Research, Geneva, Switzerland
- Centre Interfacultaire de Gérontologie et d’Études des Vulnérabilités, Université de Genève, Carouge, Switzerland
| | - Julien Fakhoury
- Faculté des Sciences de la Société, Université de Genève, Geneva, Switzerland
- LIVES Swiss Centre of Expertise in Life Course Research, Geneva, Switzerland
- Centre Interfacultaire de Gérontologie et d’Études des Vulnérabilités, Université de Genève, Carouge, Switzerland
| | - Liala Consoli
- Faculté des Sciences de la Société, Université de Genève, Geneva, Switzerland
- LIVES Swiss Centre of Expertise in Life Course Research, Geneva, Switzerland
- Centre Interfacultaire de Gérontologie et d’Études des Vulnérabilités, Université de Genève, Carouge, Switzerland
| | - Jan-Erik Refle
- LIVES Swiss Centre of Expertise in Life Course Research, Geneva, Switzerland
- Centre Interfacultaire de Gérontologie et d’Études des Vulnérabilités, Université de Genève, Carouge, Switzerland
| | - Yves Jackson
- Division de Médecine de Premier Recours, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
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Glaus H, Drewniak D, März JW, Biller-Andorno N. Blacklisting Health Insurance Premium Defaulters: Is Denial of Medical Care Ethically Justifiable? HEALTH CARE ANALYSIS 2023; 31:156-168. [PMID: 37498417 PMCID: PMC10693506 DOI: 10.1007/s10728-023-00464-w] [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] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons - who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced.
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Affiliation(s)
- Hanna Glaus
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich, Winterthurerstrasse 30, Zürich, 8006, Switzerland
| | - Daniel Drewniak
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich, Winterthurerstrasse 30, Zürich, 8006, Switzerland
| | - Julian W März
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich, Winterthurerstrasse 30, Zürich, 8006, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich, Winterthurerstrasse 30, Zürich, 8006, Switzerland.
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Gondek D, Bernardi L. Mental Health and Wellbeing of Population with Migrant Background in Switzerland - a Scoping Review and Evidence Map of Quantitative Evidence. J Immigr Minor Health 2023; 25:1108-1117. [PMID: 37237054 PMCID: PMC10509096 DOI: 10.1007/s10903-023-01490-5] [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] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
We aimed to map the evidence, based on population-based and migrant-specific datasets in Switzerland, on mental health and wellbeing of the population with migrant background. The research questions were: What is known from the existing quantitative evidence about the mental health of the population with migrant background living in Switzerland? What are the research gaps that can be addressed with existing secondary datasets in Switzerland? We used the scoping review approach to describe existing research. We searched Ovid MEDLINE and APA PsycInfo (2015 - September 2022). This resulted in a total of 1862 potentially relevant studies. In addition, we manually searched other sources, such as Google Scholar. We used a evidence map to visually summarise research characteristics and identify research gaps. In total, 46 studies were included in this review. Most studies used cross-sectional design (78.3%, n = 36) and theirs aims were descriptive (84.8%, n = 39). The studies tend to examine mental health or wellbeing of the population with migrant background in the context of social determinants (69.6%, n = 32). The most frequently studied social determinants were at the individual level (96.9%, n = 31). Out of 46 included studies, 32.6% (n = 15) included depression or anxiety, and 21.7% (n = 10) post-traumatic stress disorder and other traumas. Other outcomes were less commonly investigated. There was a lack of studies using longitudinal data investigating mental health of migrants that go beyond descriptive aims (i.e., explanatory and predictive), and have large nationally representative samples. Moreover, there is a need for research examining social determinants of mental health and wellbeing at the structural, family and community levels. We propose that existing nationally representative population-based surveys are used to a greater extent to study various aspects of migrants' mental health and wellbeing.
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Affiliation(s)
- Dawid Gondek
- Swiss Centre of Expertise in Life Course Research (LIVES), University of Lausanne, Lausanne, Switzerland.
| | - Laura Bernardi
- Swiss Centre of Expertise in Life Course Research (LIVES), University of Lausanne, Lausanne, Switzerland
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David A, Posfay-Barbe KM, Aguiar Nogueira C, Toutous Trellu L. Congenital syphilis in Switzerland: a marker of inequality? A mini-review. Front Public Health 2023; 11:1265725. [PMID: 37780442 PMCID: PMC10536148 DOI: 10.3389/fpubh.2023.1265725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals.
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Montagnoli C, Wanner P. Are pregnancy outcomes affected by the lack of legal status? A demographic study based on 850,288 live births in Switzerland. BMC Pregnancy Childbirth 2023; 23:567. [PMID: 37543619 PMCID: PMC10403826 DOI: 10.1186/s12884-023-05870-5] [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: 07/05/2022] [Accepted: 07/24/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND In the context of increased global mobility, it is fundamental to understand migrants' needs and how governments can ensure equal health opportunities for both regular and irregular migrants simply by applying low-cost primary health care measures. To identify health issues in which to intervene, this study analysed the impact of a mother's lack of legal status, together with available biological and socioeconomic characteristics, on four indicators of adverse perinatal outcomes in Switzerland. METHODS Based on the exhaustive records of the Swiss Federal Statistical Office (FSO) for its Vital Statistics (BEVNAT), different indicators of birth outcomes, including preterm birth (PTB), low and very low birth weight (LBW and VLBW), and small for gestational age (SGA), were analysed using logistic regressions on live births occurring from 2005 to 2018. These four adverse outcomes were defined as dependent variables. Statistical analysis was performed using the statistical package STATA, version 17. RESULTS Selected pregnancy outcomes were conversely affected by an irregular legal status. Analysis run on the final sample showed that, compared to the neonates of mothers who are non-migrant legal residents in Switzerland, newborns of irregular migrants have higher risks of PTB (aOR 1.18 95% CI [1.05-1.32], p<0.01) and VLBW (aOR 1.43 [1.13-1.81], p < 0.01]). In contrast, we observed that in both irregular and regular migrant groups, the odds of SGA were lowered (aOR .76 [.68-.85] p<0.01) and aOR .93 [.91-.94], p< 0.01, respectively). A similar effect was observed when controlling for any adverse outcome (any AOs) (aOR .90 [.83-.99] p 0.022; and aOR .93 [.91-.94] p< 0.01, respectively). CONCLUSIONS Our results, together with those from the available literature, call for a more comprehensive assessment of all pregnancy outcomes as well as of the social determinants of health for which the analysis was adjusted. Given the complexity of the migration phenomenon, future studies should account for local structural restrictions in the organization of care, the extension of a person's network as a means of health care accessibility, diverse backgrounds and cultures and the recent arrival status of migrants. This would allow researchers to understand the long-term impact of social determinants of health on the wellbeing of a mother and child and take them into account in the adoption of health policies.
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Affiliation(s)
- Caterina Montagnoli
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland.
- Midwifery Degree Programme, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland.
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
| | - Philippe Wanner
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
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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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Knudtzen FC, Mørk L, Nielsen VN, Astrup BS. Accessing vulnerable undocumented migrants through a healthcare clinic including a community outreach programme: a 12-year retrospective cohort study in Denmark. J Travel Med 2022; 29:6353013. [PMID: 34401917 DOI: 10.1093/jtm/taab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Little is known about the healthcare needs of the increasing number of undocumented migrants in Europe. We aimed to gain knowledge about undocumented migrants use of a free healthcare clinic including an outreach programme in Denmark. METHODS We conducted a retrospective cohort study of all patients registered in the database at the AmiAmi healthcare clinic in Fredericia, Denmark, 1 January 2006-30 July 2019. RESULTS In all, 579 patients from 47 different countries were included, of which 525 (90.7%) were cis-women (= assigned female sex at birth and identifies as female). They had a total of 3135 consultations (median 3, interquartile range 2-6), and 19% used the clinic over a period of >2 years. In all, 820 consultations (26%) were done as part of the outreach programme, and the number of outreach contacts increased significantly over the study period (P < 0.001). Of 738 tests for sexually transmitted infections (STIs), 76 (13.1%) patients were found positive for one or several STIs. Transgender women and cross-dressing men had significantly higher risk of STIs (25.8% vs 10.3%, P = 0.007) compared with cis-women. Of 94 patients referred to the public healthcare system, the majority (n = 64) was referred to the department of gynaecology during pregnancy or for induced abortion. A total of 52 patients (9.0%) reported being submitted to abuse or violence while in Denmark, and another 24 (4.1%) were registered as victims of human trafficking. CONCLUSIONS Our results highlight the multifaceted healthcare needs of undocumented migrants, with an increasing use of healthcare services over the study period. It underlines the importance of outreach programmes to reach this patient group at their place of work or stay. Finally, it emphasizes that transgender female and cross-dressing male sex workers are an especially vulnerable group with higher risk of human immunodeficiency virus and other STIs compared with cis-women.
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Affiliation(s)
- Fredrikke C Knudtzen
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark.,Clinical Center for Emerging and Vector-borne Infections, Department of Infectious Diseases, Odense University Hospital, J.B.Winsloews vej 4, entrance 18-20, 5000 Odense C, Denmark
| | - Lone Mørk
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark
| | - Vibeke N Nielsen
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark
| | - Birgitte S Astrup
- AmiAmi Outreach Work and Healthcare, Sjaellandsgade 98B, 7000 Fredericia, Denmark.,Department of Forensic Pathology, Institute of Forensic Medicine, University of Southern Denmark, J.B.Winsloews vej 17, 5000 Odense C, Denmark
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10
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Vignier N, Moussaoui S, Marsaudon A, Wittwer J, Jusot F, Dourgnon P. Burden of infectious diseases among undocumented migrants in France: Results of the Premiers Pas survey. Front Public Health 2022; 10:934050. [PMID: 35991026 PMCID: PMC9386354 DOI: 10.3389/fpubh.2022.934050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction An increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France. Methodology The Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software. Results A total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived <3 years earlier. Among the participants, 24.8% declared a poor perceived health status and 33.5% a chronic health condition. Dental infections concerned 43.2% of the participants. Apart from dental issues, 12.9% reported suffering from at least one infectious disease: HIV infection (3.5%), chronic hepatitis B virus infection (3.1%), upper respiratory tract infection (1.7%), skin mycosis (1.2%), skin and soft tissue infection (0.8%), chronic hepatitis C infection (0.8%), urinary tract infection (0.7%), lower respiratory tract infection (0.7%), scabies (0.3%), tuberculosis disease (0.2%), vaginal mycosis (0.6%), and herpes (0.1%). Regarding HIV, HBV, and HCV infections, 56, 71, and 89%, respectively, were diagnosed after their arrival. Chronic viral infections were more often reported by undocumented migrants from sub-Saharan Africa and Latin America. In multivariate analysis, a higher risk of reporting chronic viral infection was observed among people food insecure. Conclusion This original study on a large random sample confirms the frequency of infectious diseases among undocumented migrants in France and the importance of integrating their screening during a health Rendezvous and their management into early access to care and inclusive medico-psycho-social management.
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Affiliation(s)
- Nicolas Vignier
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Cayenne, French Guiana
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, Paris, France
- French Collaborative Institute on Migration, Institut Convergences Migrations, ICM, Aubervilliers, France
- Université Sorbonne Paris Nord, UFR SMBH, IAME, INSERM UMR 1137, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Department of Infectious and Tropical diseases, Bobigny, France
- *Correspondence: Nicolas Vignier
| | - Sohela Moussaoui
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, Paris, France
- Bordeaux University, Bordeaux Population Health, INSERM U1219, Economic and Management of Healthcare Organizations Team, Emos Team, Bordeaux, France
| | - Antoine Marsaudon
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
| | - Jérome Wittwer
- Bordeaux University, Bordeaux Population Health, INSERM U1219, Economic and Management of Healthcare Organizations Team, Emos Team, Bordeaux, France
| | - Florence Jusot
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Université Paris-Dauphine, PSL-Research University, Leda-Legos, Paris, France
| | - Paul Dourgnon
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
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Jones RE, Tasnim L, Cunningham SA. The Prevalence of Multimorbidity among Foreign-born Adults in the United States. Ethn Dis 2022; 32:213-222. [PMID: 35909642 PMCID: PMC9311306 DOI: 10.18865/ed.32.3.213] [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: 01/23/2023] Open
Abstract
Objective We examined multimorbidity among foreign-born adults in the United States. This population may be particularly affected by chronic conditions and limited health care access. Design Longitudinal cohort. Setting United States. Participants Foreign-born adults at the point of legal permanent residency. Main Outcome Measures Multimorbidity defined as two or more of eight chronic conditions (hypertension, diabetes, obesity, arthritis, stroke, cancer, chronic lung disease, and heart problems). Methods We estimated the prevalence of multimorbidity and patterns over time. Data are from the New Immigrant Survey (NIS), a nationally representative study of adult immigrants at green card status in 2003 (N=8,174) and reinterview in 2008. Results The prevalence of multimorbidity was 6% in 2003, and 12% in 2008. The most common condition dyad at both time points was hypertension-obesity; the largest increase over time was in combinations that included hypertension, diabetes, and obesity. The odds of having multimorbidity compared to no chronic conditions were higher among older immigrants and those who had seen a doctor in the past year. The odds of gaining one chronic condition over a 5-year period increased with age; 45-65 years: OR 2.8[CI 2.3,3.5]; aged ≥65 years: OR 3.2 CI[2.2,4.7]. Conclusions The prevalence of multimorbidity among immigrants was lower than the prevalence in the overall US population of the same age, consistent with studies showing an immigrant health advantage.
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Affiliation(s)
- Rebecca E. Jones
- Hubert Department of Global Health, Emory University, Atlanta, GA, Address correspondence to Rebecca E. Jones, PhD, MPH; Hubert Department of Global Health, Emory University, Atlanta, GA;
| | - Lubaba Tasnim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Solveig A. Cunningham
- Hubert Department of Global Health, Emory University, Atlanta, GA,Department of Sociology, Emory University, Atlanta, GA
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12
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Fakhoury J, Burton-Jeangros C, Consoli L, Duvoisin A, Jackson Y. Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study. Front Public Health 2022; 10:832090. [PMID: 35664122 PMCID: PMC9160788 DOI: 10.3389/fpubh.2022.832090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization. Methods We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors. Results Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37–5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62–6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97–1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09–1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aβ: 0.90; 95% CI: 0.31-1.77). Conclusions This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services.
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Affiliation(s)
- Julien Fakhoury
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- *Correspondence: Julien Fakhoury
| | - Claudine Burton-Jeangros
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
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13
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Page KR, Genovese E, Franchi M, Cella S, Fiorini G, Tlili R, Salazar S, Duvoisin A, Cailhol J, Jackson Y. COVID-19 vaccine hesitancy among undocumented migrants during the early phase of the vaccination campaign: a multicentric cross-sectional study. BMJ Open 2022; 12:e056591. [PMID: 35301211 PMCID: PMC8931801 DOI: 10.1136/bmjopen-2021-056591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES The marginalisation of undocumented migrants raises concerns about equitable access to COVID-19 vaccination. This study aims to describe migrants' hesitancy about the COVID-19 vaccination during the early phase of the vaccination campaign. SETTING This multicentric cross-sectional survey was conducted in health facilities providing care to undocumented migrants in the USA, Switzerland, Italy and France in February-May 2021. PARTICIPANTS Eligibility criteria included age >16 years, being of foreign origin and living without valid residency permit in the country of recruitment. A convenience sample of minimum 100 patients per study site was targeted. PRIMARY AND SECONDARY OUTCOME MEASURES Data were collected using an anonymous structured questionnaire. The main outcomes were perceived access to the local COVID-19 vaccination programme and demand for vaccination. RESULTS Altogether, 812 undocumented migrants participated (54.3% Geneva, 17.5% Baltimore, 15.5% Milano and 12.7% Paris). Most (60.9%) were women. The median age was 39 years (interquartile range 1). Participants originated from the Americas (55.9%), Africa (12.7%), Western Pacific (11.2%) Eastern Mediterranean (7.9%), Europe (7.6%) and South-East Asia (4.7%). Overall, 14.1% and 26.2% of participants, respectively, reported prior COVID-19 infection and fear of developing severe COVID-19 infection. Risk factors for severe infection were frequently reported (29.5%). Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, comorbidity and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%). Participants mainly searched for information about vaccination in the traditional and social media. CONCLUSIONS We found a mismatch between perceived accessibility and demand for the COVID-19 vaccination. Public health interventions using different communication modes should build on trust about vaccination in general to tackle undocumented migrants' hesitancy for COVID-19 vaccination with a specific attention to men, younger migrants and those at low clinical risk of severe infection.
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Affiliation(s)
- Kathleen R Page
- Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eleonora Genovese
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Matteo Franchi
- Medical Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Silvano Cella
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Rim Tlili
- Infectious and Tropical Diseases Department, Hôpital Avicenne, Bobigny, France
| | - Sebastian Salazar
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aline Duvoisin
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Johann Cailhol
- Infectious and Tropical Diseases Department, Hôpital Avicenne, Bobigny, France
- Laboratoire Education et Pratiques de Santé, Universite Paris 13 Nord, Bobigny, France
| | - Yves Jackson
- Department of community health and medicine, University of Geneva, Geneva, Switzerland
- Division of primary care medicine, Geneva University Hospital, Geneva, Switzerland
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Carnino L, Schwob JM, Neofytos D, Lazo-Porras M, Chappuis F, Eperon G. Screening for Parasitic Infection and Tuberculosis in Immunosuppressed and Pre-Immunosuppressed Patients: An Observational Study. Trop Med Infect Dis 2021; 6:tropicalmed6030170. [PMID: 34564554 PMCID: PMC8482080 DOI: 10.3390/tropicalmed6030170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Reactivation of latent tuberculosis infection (LTBI) or latent parasitic infection (LPI) during drug-induced immunosuppression can have serious consequences. The Division of tropical and humanitarian medicine of the Geneva University Hospitals runs a specific consultation for parasitic screening of immunosuppressed or pre-immunosuppressed patients. We sought to determine the seroprevalence of LTBI and LPI in such patients and explore its relationship with country of origin or previous travel in a retrospective, single-centre observational study from 2016 to 2019. Demographic data, travel history, ongoing treatments and results of the parasitological (Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus multilocularis, Entamoeba histolytica and Leishmania spp.) and TB screening were collected to calculate LPI or LTBI prevalence. Risk factors for LTBI and strongyloidiasis were analysed using Poisson regression with robust variance. Among 406 eligible patients, 24/353 (6.8%) had LTBI, 8/368 (2.2%) were positive for Strongyloides stercoralis infection, 1/32 (3.1%) was positive for Entamoeba histolytica and 1/299 (0.3%) was positive for Leishmaniasis. No cases of Trypanosoma cruzi (0/274) or Echinococcus multilocularis (0/56) infection were detected. Previous travel to or originating from high-prevalence countries was a risk factor for LTBI (PR = 3.4, CI 95%: 1.4–8.2 and 4.0, CI 95%: 1.8–8.9, respectively). The prevalence of serological Strongyloidiasis in immunosuppressed patients is lower in comparison to those without immunosuppression (PR = 0.1, CI 95%: 0.01–0.8). In conclusion, screening before immunosuppression needs to be individualized, and LTBI and LPI need to be ruled out in patients who originate from or have travelled to high-prevalence countries. The sensitivity of strongyloidiasis serology is reduced following immunosuppression, so an algorithm combining different tests or presumptive treatment should be considered.
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Affiliation(s)
- Luisa Carnino
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-(0)223729611; Fax: +41-(0)223729626
| | - Jean-Marc Schwob
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
| | - Dionysios Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland;
| | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
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15
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Mona H, Andersson LMC, Hjern A, Ascher H. Barriers to accessing health care among undocumented migrants in Sweden - a principal component analysis. BMC Health Serv Res 2021; 21:830. [PMID: 34404416 PMCID: PMC8369752 DOI: 10.1186/s12913-021-06837-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Undocumented migrants face many hardships in their everyday life such as poor living conditions, discrimination, and lack of access to healthcare. Previous studies have demonstrated considerable health care needs for psychiatric disorders as well as physical diseases. The aim of this paper was to find out the main barriers that undocumented migrants experience in accessing the Swedish healthcare system and to explore their relation with socioeconomic factors. METHODS A cross-sectional study with adult undocumented migrants was performed in the three largest cities of Sweden in 2014-2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed including 22 barriers to health care. Trained field workers conducted the interviews. A principal component analysis was conducted of all barriers to reveal central components. Then, Pearson's chi-squared test was used to explore the characteristics of undocumented migrants experiencing barriers to care. RESULTS Two main components/barriers were extracted: "Fear of being taken by police/authorities", which was related to fear of disclosure by or in relation to seeking health care, and "Structural and psychosocial factors" which was related to practical obstacles or shame of being ill. Lower age (74.1 % vs 56.0 %), lower level of education (75.0 % vs. 45.1 %), and having no children (70.3 % vs. 48.1 %) were significantly related to a higher likelihood of experiencing a barrier. CONCLUSION Fear of deportation and practical and psychosocial factors constitute hinderance of access to healthcare for undocumented migrants in Sweden. This highlights the importance of clear instructions, both to undocumented migrants and health professionals about the right to health care according to the international law on human rights as well as the law of confidentiality.
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Affiliation(s)
- Hatem Mona
- School of Public Health and Community Medicine, The Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Lena M C Andersson
- Department of Social Work, University of Gothenburg, Sprängkullsgatan 23, PO Box 720, SE- 405 30, Gothenburg, Sweden.
| | - Anders Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Centre of Health Equity Studies (CHESS), Karolinska Institute, and Stockholm University, Stockholm, Sweden
| | - Henry Ascher
- School of Public Health and Community Medicine, The Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
- Research Department, Angered Hospital, Gothenburg, Sweden
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16
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Fakhoury J, Burton-Jeangros C, Guessous I, Consoli L, Duvoisin A, Jackson Y. Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study. BMC Public Health 2021; 21:1198. [PMID: 34162363 PMCID: PMC8220781 DOI: 10.1186/s12889-021-11239-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration. Methods This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included. Results Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables. Conclusion At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11239-0.
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Affiliation(s)
- Julien Fakhoury
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland. .,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland.
| | | | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland.,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland.,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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17
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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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18
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Fakhoury J, Burton-Jeangros C, Consoli L, Duvoisin A, Courvoisier D, Jackson Y. Mental health of undocumented migrants and migrants undergoing regularization in Switzerland: a cross-sectional study. BMC Psychiatry 2021; 21:175. [PMID: 33794822 PMCID: PMC8012741 DOI: 10.1186/s12888-021-03149-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Undocumented migrants live and work in precarious conditions. Few studies have explored the mental health consequences of such environment. The objective of this study is to describe the mental health of migrants at different stages of a regularization program. METHODS This cross-sectional study included migrants undocumented or in the process of regularization. We screened for symptoms of anxiety, depression and sleep disturbance using validated tools. We created a composite outcome of altered mental health including these components plus self-report of a recent diagnosis of mental health condition by a health professional. RESULTS We enrolled 456 participants of whom 246 (53.9%) were undocumented. They were predominantly women (71.9%) with a median age of 43.3 (interquartile range: 15.5) years, from Latin America (63.6%) or Asia (20.2%) who had lived in Switzerland for 12 (IQR: 7) years. Overall, 57.2% presented symptoms of altered mental health. Prevalence of symptoms of anxiety, depression and sleep disturbance were 36% (95% confidence interval: 31.6-40.6%), 45.4% (95% CI: 40.8-50.1%) and 23% (95% CI: 19.2-27.2), respectively. Younger age (adjusted odd ratio: 0.7; 95% CI: 0.5-0.9 for each additional decade), social isolation (aOR: 2.4; 95% CI: 1.4-4.2), exposure to abuse (aOR: 1.9; 95% CI: 1.1-3.5), financial instability (aOR: 2.2; 95% CI: 1.4-3.7) and multi-morbidity (aOR: 3.2; 95% CI: 1.7-6.5) were associated with increased risk of having altered mental health while being in the early stages of the process of regularization had no effect (aOR: 1.3: 95% CI: 0.8-2.2). CONCLUSIONS This study highlights the need for multi-pronged social and health interventions addressing the various domains of undocumented migrants living difficulties as complement to legal status regularization policies. Protection against unfair working conditions and abuse, access to adequate housing, promoting social integration and preventive interventions to tackle the early occurrence of chronic diseases may all contribute to reduce the burden of altered mental health in this group. More research is needed to assess the long-term impact of legal status regularization on mental health.
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Affiliation(s)
- Julien Fakhoury
- grid.8591.50000 0001 2322 4988Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- grid.8591.50000 0001 2322 4988Institute of sociological research, University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- grid.8591.50000 0001 2322 4988Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- grid.8591.50000 0001 2322 4988Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Delphine Courvoisier
- grid.150338.c0000 0001 0721 9812Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Rue Gabrielle Perret Gentil 4, 1211, 14, Geneva, Switzerland.
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19
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Guichard N, Tobolkina E, El Morabit L, Bonnabry P, Vernaz N, Rudaz S. Determination of antiretroviral drugs for buyers' club in Switzerland using capillary electrophoresis methods. Electrophoresis 2020; 42:708-718. [PMID: 33284492 DOI: 10.1002/elps.202000216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
Human immunodeficiency virus-acquired immunodeficiency syndrome continues to be a major global public health issue, having claimed almost 33 million lives to date. Due to the high cost of antiretroviral treatment, access to these drugs remains difficult for vulnerable populations, such as migrants and people living in prisons, who often do not have health insurance. These factors lead to poorer health outcomes and higher transmission rates. The personal importation scheme for unapproved generics from foreign countries is one option to access affordable human immunodeficiency virus treatment. However, the risk of importing falsified medicine remains high, and the quality control of unapproved drugs is lacking. In this context, three CE methods for the analysis of nine antiviral drugs found in commercial pharmaceutical formulations were evaluated. The selected compounds were emtricitabine, tenofovir disoproxil, tenofovir alafenamide, rilpivirine, efavirenz, raltegravir, dolutegravir, abacavir, and lamivudine. The developed methods were successfully applied to determine the active pharmaceutical ingredients of commercial formulations and unapproved generics. The quality control of unapproved generics by CE is an attractive approach due to its good standard of quality, low cost, ecofriendliness, and ease of implementation.
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Affiliation(s)
- Nicolas Guichard
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Switzerland
| | - Elena Tobolkina
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Switzerland
| | - Lamyae El Morabit
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Switzerland
| | - Pascal Bonnabry
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Switzerland.,Geneva University Hospitals, Geneva, Switzerland
| | | | - Serge Rudaz
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Switzerland
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20
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Gimeno-Feliu LA, Pastor-Sanz M, Poblador-Plou B, Calderón-Larrañaga A, Díaz E, Prados-Torres A. Multimorbidity and chronic diseases among undocumented migrants: evidence to contradict the myths. Int J Equity Health 2020; 19:113. [PMID: 32631325 PMCID: PMC7336489 DOI: 10.1186/s12939-020-01225-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is little verified information on the global health status of undocumented migrants (UMs). Our aim is to compare the prevalence of the main chronic diseases and of multimorbidity in undocumented migrants, documented migrants, and Spanish nationals in a Spanish autonomous community. Methods Retrospective observational study of all users of the public health system of the region of Aragon over 1 year (2011): 930,131 Spanish nationals; 123,432 documented migrants (DMs); and 17,152 UMs. Binary logistic regression was performed to examine the association between migrant status (Spanish nationals versus DMs and UMs) and both multimorbidity and individual chronic diseases, adjusting for age and sex. Results The prevalence of individual chronic diseases in UMs was lower than in DMs and much lower than in Spanish nationals. Comparison with the corresponding group of Spanish nationals revealed odds ratios (OR) of 0.1–0.3 and 0.3–0.5 for male and female UMs, respectively (p < 0.05 in all cases). The risk of multimorbidity was lower for UMs than DMs, both for men (OR, 0.12; 95%CI 0.11–0.13 versus OR, 0.53; 95%CI 0.51–0.54) and women (OR, 0.18; 95%CI 0.16–0.20 versus OR, 0.74; 95%CI 0.72–0.75). Conclusions Analysis of data from a health system that offers universal coverage to all immigrants, irrespective of legal status, reveals that the prevalence of chronic disease and multimorbidity is lower in UMs as compared with both DMs and Spanish nationals. These findings refute previous claims that the morbidity burden in UM populations is higher than that of the native population of the host country.
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Affiliation(s)
- Luis Andrés Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain. .,Aragón Healthcare Service, San Pablo Health Centre, Zaragoza, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain. .,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
| | | | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Esperanza Díaz
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
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21
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Jackson Y, Courvoisier DS, Duvoisin A, Ferro-Luzzi G, Bodenmann P, Chauvin P, Guessous I, Wolff H, Cullati S, Burton-Jeangros C. Impact of legal status change on undocumented migrants' health and well-being (Parchemins): protocol of a 4-year, prospective, mixed-methods study. BMJ Open 2019; 9:e028336. [PMID: 31154311 PMCID: PMC6549650 DOI: 10.1136/bmjopen-2018-028336] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/08/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Migrants without residency permit, known as undocumented, tend to live in precarious conditions and be exposed to an accumulation of adverse determinants of health. Only scarce evidence exists on the social, economic and living conditions-related factors influencing their health status and well-being. No study has assessed the impact of legal status regularisation. The Parchemins study is the first prospective, mixed-methods study aiming at measuring the impact on health and well-being of a regularisation policy on undocumented migrants in Europe. METHODS AND ANALYSIS The Parchemins study will compare self-rated health and satisfaction with life in a group of adult undocumented migrants who qualify for applying for a residency permit (intervention group) with a group of undocumented migrants who lack one or more eligibility criteria for regularisation (control group) in Geneva Canton, Switzerland. Asylum seekers are not included in this study. The total sample will include 400 participants. Data collection will consist of standardised questionnaires complemented by semidirected interviews in a subsample (n=38) of migrants qualifying for regularisation. The baseline data will be collected just before or during the regularisation, and participants will subsequently be followed up yearly for 3 years. The quantitative part will explore variables about health (ie, health status, occupational health, health-seeking behaviours, access to care, healthcare utilisation), well-being (measured by satisfaction with different dimensions of life), living conditions (ie, employment, accommodation, social support) and economic situation (income, expenditures). Several confounders including sociodemographic characteristics and migration history will be collected. The qualitative part will explore longitudinally the experience of change in legal status at individual and family levels. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Geneva, Switzerland. All participants provided informed consent. Results will be shared with undocumented migrants and disseminated in scientific journals and conferences. Fully anonymised data will be available to researchers.
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Affiliation(s)
- Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Institute of sociological research, University of Geneva, Geneva, Switzerland
| | - Giovanni Ferro-Luzzi
- Haute Ecole de Gestion, University of applied sciences of Western Switzerland, Carouge, Switzerland
- Geneva School of Economics and Management, Universite de Geneve, Geneva, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pierre Chauvin
- Department of Social Epidemiology, Inserm, UMRS 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- UMRS 1136, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Institute of sociological research, University of Geneva, Geneva, Switzerland
- Swiss NCCR LIVES, Universite de Geneve, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- Institute of sociological research, University of Geneva, Geneva, Switzerland
- Swiss NCCR LIVES, Universite de Geneve, Geneva, Switzerland
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22
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Seidler Y, Novak-Zezula S, Trummer U. 'Falling off the radar' of public health: The case of uninsured Chinese patients in Vienna, Austria. Health Policy 2019; 123:840-844. [PMID: 31027851 DOI: 10.1016/j.healthpol.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/23/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
In public health policy debates, the 2015-2016 refugee crisis made visible that even in European welfare states with (close to) universal health coverage there are specific vulnerable groups with highly limited access to health care. Among them is a population of so-called 'undocumented' or 'irregular' migrants who have no regular status of residence and falls off the radar of publicly funded health care services and thus from the public health surveillance systems. The aim of our study is to provide the first-of-its-kind evidence on the characteristics, health problems and health care needs of one such vulnerable group in Austria - Chinese migrants residing in Vienna without a regular status. Medical records of 74 uninsured assumingly undocumented Chinese patients were analysed. The data was provided by a Non-governmental organisation (NGO) which delivers primary care to uninsured people in Vienna. The most frequently diagnosed health problems clustered around cardiovascular and metabolic-related diseases (hypertension and diabetics) and there was a high burden of multiple chorionic non-communicable diseases. Further efforts and resources are needed for collecting more data in a systematic way. A trusting relationship between science and practice and a cooperative relationship between and among the government agencies and NGOs are essential for evidence-based public health policy making.
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Affiliation(s)
- Yuki Seidler
- Center for Health and Migration, Wasagasse 12/3/5, 1090 Vienna, Austria; Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Sonja Novak-Zezula
- Center for Health and Migration, Wasagasse 12/3/5, 1090 Vienna, Austria.
| | - Ursula Trummer
- Center for Health and Migration, Wasagasse 12/3/5, 1090 Vienna, Austria.
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23
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Abbas M, Aloudat T, Bartolomei J, Carballo M, Durieux-Paillard S, Gabus L, Jablonka A, Jackson Y, Kaojaroen K, Koch D, Martinez E, Mendelson M, Petrova-Benedict R, Tsiodras S, Christie D, Saam M, Hargreaves S, Pittet D. Migrant and refugee populations: a public health and policy perspective on a continuing global crisis. Antimicrob Resist Infect Control 2018; 7:113. [PMID: 30250735 PMCID: PMC6146746 DOI: 10.1186/s13756-018-0403-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/07/2018] [Indexed: 02/01/2023] Open
Abstract
The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day.
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Affiliation(s)
- Mohamed Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | | | - Javier Bartolomei
- CAPPI Servette, Department of Mental Health and Psychiatry, Geneva University Hospitals, Genève, Switzerland
| | - Manuel Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - Sophie Durieux-Paillard
- Programme Santé Migrants, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), PARTNER Site Hannover-Braunschweig, Hannover, Germany
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Global Health, Geneva University, Geneva, Switzerland
| | - Kanokporn Kaojaroen
- Department of Service Delivery & Safety, World Health Organization, Geneva, Switzerland
| | - Daniel Koch
- Division of Communicable Diseases, Federal Office of Public Health, Bern, Switzerland
| | - Esperanza Martinez
- Health Unit, International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roumyana Petrova-Benedict
- International Organization for Migration (IOM), Migration Health Division (MHD), Regional office (RO), Brussels, Belgium
| | - Sotirios Tsiodras
- 4th Department of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Centre for Disease Control & Prevention, Athens, Greece
| | - Derek Christie
- Division of environmental health, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mirko Saam
- Communication in Science, Geneva, Switzerland
| | - Sally Hargreaves
- Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0HS UK
- The Institute for Infection and Immunity, St George’s, University of London, London, WC1E 7HU UK
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
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