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Silberzan L, Kelly-Irving M, Bajos N. [Analysing hypertension in France : A call for an intersectional approach of the cascade of care]. Rev Epidemiol Sante Publique 2023; 71:102159. [PMID: 37729691 DOI: 10.1016/j.respe.2023.102159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
In metropolitan France, estimates suggest that more than one in three adults has hypertension. Low-cost treatments are available, yet fewer than one in four hypertensive adults has a controlled level of hypertension below 140/90 mmHg. This rate is higher in other high-income countries such as Canada (65%) or Germany (52%). Using a 'cascade of care' model, that decomposes the hypertension care continuum in awareness, treatment, and control, provides a better understanding of the origins of poor control. Furthermore, the theoretical framework of intersectionality, which simultaneously considers social positions of gender, class, and ethno-racial origin, could be used to understand the complexity of the social inequalities observed in hypertension-related outcomes. In this article we conducted a critical review of the international literature to identify new lines of analyses that could be applied to examine complex inequalities in France.
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Affiliation(s)
- L Silberzan
- Inserm-IRIS (UMR8156 - U997), Inserm, Aubervilliers, France; UMR1295, Toulouse III Université, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.
| | - M Kelly-Irving
- UMR1295, Toulouse III Université, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - N Bajos
- Inserm-IRIS (UMR8156 - U997), Inserm, Aubervilliers, France
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2
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Samers M. Do welfare policies matter for immigrant entrepreneurship? An analysis in the context of France. INTERNATIONAL MIGRATION 2022. [DOI: 10.1111/imig.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Michael Samers
- Department of Geography University of Kentucky Lexington Kentucky USA
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3
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[Mediterranean syndrome and the French medical world, a racist prejudice still active. A parallel with Frantz Fanon's article about the "North African syndrome"]. Rev Med Interne 2022; 43:399-401. [PMID: 35623924 DOI: 10.1016/j.revmed.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 11/20/2022]
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4
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On the Role of Structural Competency in the Healthcare of Migrant with Precarious Residency Status. SOCIETIES 2022. [DOI: 10.3390/soc12020054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The literature on the health care of migrant patients has often emphasized the importance of cultural skills and cultural humility that caregivers must bring to their care. Recent work has emphasized the importance of adopting a structural reading of this competency. Based on two empirical surveys conducted in France and Germany in facilities providing access to care for migrants with precarious residency status, this article demonstrates the importance of competency linking in terms of what is produced by structures and institutions and what is produced during medical interactions between patients, medical professionals, and volunteers. The complexity of accessing health protection systems for migrants with precarious residency status is often the main structural and institutional barrier to care. To remove this barrier, health professionals can develop legal and administrative competency regarding residency and health rights. They can also develop institutional and practical competency regarding the possibilities of access to health care for people without health coverage in the local geographical context. Structural competency is also effective in deconstructing the stigma and discrimination that minority groups experience in the healthcare system.
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Sauvegrain P. Violences dites « gynécologiques et obstétricales » envers les femmes immigrées de l’Afrique subsaharienne en France. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; 33:627-628. [PMID: 36574509 DOI: 10.3917/spub.215.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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6
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Crouzet L, Scarlett H, Colleville AC, Pourtau L, Melchior M, Ducarroz S. Impact of the COVID-19 pandemic on vulnerable groups, including homeless persons and migrants, in France: a qualitative study. Prev Med Rep 2022; 26:101727. [PMID: 35155084 PMCID: PMC8824256 DOI: 10.1016/j.pmedr.2022.101727] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 11/02/2022] Open
Abstract
Social inequalities in health increased especially during lockdown. Homeless persons felt neglected as lockdown was designed for those with stable housing. Access to an emergency shelter had positive impacts on homeless persons. Sudden implementation of lockdown reminded prior violent or traumatic circumstances. Crisis communication should be adapted to improve adherence to preventive measures.
Social inequalities tended to increase in the context of the pandemic, particularly in relation to the measures taken to manage and reduce the risk of COVID-19. When lockdown measures required the general population “to stay home”, what were homeless people expected to do? The ECHO study is a cross-sectional, descriptive study with a convergent mixed-method design. Data were collected across shelters in France both during and immediately following the lockdown (April – June 2020). This article presents the study’s qualitative findings, with a focus on understanding both the experiences and perceptions among these populations of the measures taken to limit the COVID-19 infection. A total of 26 semi-directed individual interviews were conducted across seven shelters in both Lyon (42%) and Paris (58%). Data were analysed using thematic content analysis with partial blinded coding. Four key themes were identified: 1- Reactions to the introduction of lockdown: a sudden implementation reminiscent of prior violent or traumatic circumstances amongst participants, 2- Accommodation during lockdown: participants’ conflicting visions of the shelter, 3- Influence of the media and public communication: an abundant flow of information impacting participant’s wellbeing and representations on the pandemic, and 4- The individual impact of lockdown: perceived health and limitations to daily life activities. The most vulnerable populations have borne the heaviest burden during the pandemic. It is therefore crucial that we improve both the availability of information, and the health literacy of, all groups within the national population.
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Florian S, Ichou M, Panico L. Parental migrant status and health inequalities at birth: The role of immigrant educational selectivity. Soc Sci Med 2021; 278:113915. [PMID: 33905985 DOI: 10.1016/j.socscimed.2021.113915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/25/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Immigrants tend to exhibit better health than natives despite immigrants' more disadvantaged socioeconomic status. This paradox has often been attributed to immigrants' pre-migration selectivity. However, most empirical studies investigating the role of selectivity have focused on adult health; less attention has been paid to children's birth outcomes outside the U.S. context. Using data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a nationally representative sample of over 18000 births in France in 2011, we investigate the role of immigrant parents' educational selectivity in shaping four birth outcomes: birthweight, low birthweight, prematurity, and being born small for gestational age. Results from linear and logistic regressions confirm a health advantage for children of immigrants compared to natives despite lower parental socioeconomic status, mainly among children of Middle Eastern and North African parents. Immigrant parents' positive pre-migration educational selectivity explains most of this health advantage, predominantly among children with two immigrant parents. Further, mediation analyses indicate that the effect of educational selectivity is partially mediated by parental health behaviors, particularly smoking during pregnancy. Furthermore, analyses suggest that selectivity improves birth outcomes only for children of recent arrivals, with less than five years of residence in France. The beneficial effect of selectivity declines with length of residence, suggesting that a process of "unhealthy assimilation," coupled with the cumulative exposure to health risks and disadvantaged living conditions, may lead to the erosion of the protective effect of immigrant selectivity.
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Affiliation(s)
- Sandra Florian
- Institut National d'Etudes Démographiques (INED), 9 cours des Humanités, CS 50004, 93322, Aubervilliers, Cedex, France.
| | - Mathieu Ichou
- Institut National d'Etudes Démographiques (INED), 9 cours des Humanités, CS 50004, 93322, Aubervilliers, Cedex, France.
| | - Lidia Panico
- Institut National d'Etudes Démographiques (INED), 9 cours des Humanités, CS 50004, 93322, Aubervilliers, Cedex, France.
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Wallace M, Khlat M, Guillot M. Infant mortality among native-born children of immigrants in France, 2008-17: results from a socio-demographic panel survey. Eur J Public Health 2021; 31:326-333. [PMID: 33253357 PMCID: PMC8071600 DOI: 10.1093/eurpub/ckaa186] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Within Europe, France stands out as a major country that lacks recent and reliable evidence on how infant mortality levels vary among the native-born children of immigrants compared with the native-born children of two parents born in France. METHODS We used a nationally representative socio-demographic panel consisting of 296 400 births and 980 infant deaths for the period 2008-17. Children of immigrants were defined as being born to at least one parent born abroad and their infant mortality was compared with that of children born to two parents born in France. We first calculated infant mortality rates per 1000 live births. Then, using multi-level logit models, we calculated odds ratios of infant mortality in a series of models adjusting progressively for parental origins (M1), core demographic factors (M2), father's socio-professional category (M3) and area-level urbanicity and deprivation score (M4). RESULTS We documented a substantial amount of excess infant mortality among those children born to at least one parent from Eastern Europe, Northern Africa, Western Africa, Other Sub-Saharan Africa and the Americas, with variation among specific origin countries belonging to these groups. In most of these cases, the excess infant mortality levels persisted after adjusting for all individual-level and area-level factors. CONCLUSIONS Our findings, which can directly inform national public health policy, reaffirm the persistence of longstanding inequality in infant mortality according to parental origins in France and add to a growing body of evidence documenting excess infant mortality among the children of immigrants in Europe.
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Affiliation(s)
- Matthew Wallace
- Stockholm University Demography Unit (SUDA), Sociology Department, Stockholm University, Stockholm, Sweden
| | - Myriam Khlat
- Mortality, Health and Epidemiology (URO5), French Institute for Demographic Studies (INED), Paris, France
| | - Michel Guillot
- Mortality, Health and Epidemiology (URO5), French Institute for Demographic Studies (INED), Paris, France
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
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Rivenbark JG, Ichou M. Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey. BMC Public Health 2020; 20:31. [PMID: 31918699 PMCID: PMC6953466 DOI: 10.1186/s12889-019-8124-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background People in socially disadvantaged groups face a myriad of challenges to their health. Discrimination, based on group status such as gender, immigration generation, race/ethnicity, or religion, are a well-documented health challenge. However, less is known about experiences of discrimination specifically within healthcare settings, and how it may act as a barrier to healthcare. Methods Using data from a nationally representative survey of France (N = 21,761) with an oversample of immigrants, we examine rates of reported discrimination in healthcare settings, rates of foregoing healthcare, and whether discrimination could explain disparities in foregoing care across social groups. Results Rates of both reporting discrimination within healthcare and reporting foregone care in the past 12 months were generally highest among women, immigrants from Africa or Overseas France, and Muslims. For all of these groups, experiences of discrimination potentially explained significant proportions of their disparity in foregone care (Percent disparity in foregone care explained for: women = 17%, second-generation immigrants = 8%, Overseas France = 13%, North Africa = 22%, Sub-Saharan Africa = 32%, Muslims = 26%). Rates of foregone care were also higher for those of mixed origin and people who reported “Other Religion”, but foregone healthcare was not associated with discrimination for those groups. Conclusions Experiences of discrimination within the healthcare setting may present a barrier to healthcare for people that are socially disadvantaged due to gender, immigration, race/ethnicity, or religion. Researchers and policymakers should consider barriers to healthcare that lie within the healthcare experience itself as potential intervention targets.
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Affiliation(s)
- Joshua G Rivenbark
- Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27701, USA. .,Duke University School of Medicine, Duke University, Durham, USA.
| | - Mathieu Ichou
- French Institute for Demographic Studies (INED), Paris, France
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Combes SJB, Simonnot N, Azzedine F, Aznague A, Chauvin P. Self-Perceived Health among Migrants Seen in Médecins du Monde Free Clinics in Europe: Impact of Length of Stay and Wealth of Country of Origin on Migrants' Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244878. [PMID: 31817068 PMCID: PMC6950051 DOI: 10.3390/ijerph16244878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Abstract
Health of migrants is a widely studied topic. It has been argued that migrant health may deteriorate over time. Though migrants are a “hard to reach” population in survey data, this paper builds on a unique dataset provided by Médecins du Monde from five countries. We study self-perceived health (SPH) in connection with socio-economic and demographic factors and length of stay. Results differ for men and women. Compared to other documented migrants, asylum seekers have a 50–70% greater chance of having worse health. Migrants with better living conditions have a 57–78% chance of being in better health. Male migrants with a job have between a 82–116% chance of being in good health. The probability for women from poorer countries to have a better physical SPH after three months of residing in the host country is six-fold that of women from richer countries. This paper contributes widely to the knowledge of health of migrants. Contrary to other evidence, health of women migrants from poorer countries tends to improve with length of stay.
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Affiliation(s)
- Simon Jean-Baptiste Combes
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
- Correspondence:
| | - Nathalie Simonnot
- Médecins du Monde–Doctors of the World, International Network, 75018 Paris, France;
| | - Fabienne Azzedine
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
| | - Abdessamad Aznague
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
| | - Pierre Chauvin
- Department of Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France;
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11
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Crampe-Casnabet C, Franck JE, Ringa V, Coeuret-Pellicer M, Chauvin P, Menvielle G. Role of obesity in differences in cervical cancer screening rates by migration history. The CONSTANCES survey. Cancer Epidemiol 2018; 58:98-103. [PMID: 30530110 DOI: 10.1016/j.canep.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history. METHODS Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (<18.5), normal-weight (18.5-25), overweight (25-30), obese (>30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed. RESULTS The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese. CONCLUSION Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.
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Affiliation(s)
- Cyrielle Crampe-Casnabet
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Jeanna-Eve Franck
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Virginie Ringa
- CESP, INSERM U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France.
| | - Mireille Coeuret-Pellicer
- Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif, France; University of Versailles St-Quentin, UMRS 1018, Villejuif, France.
| | - Pierre Chauvin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Gwenn Menvielle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
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Cognet M. [Racism, between representations of the 'other' and nursing practices]. REVUE DE L'INFIRMIERE 2018; 67:27-30. [PMID: 29754680 DOI: 10.1016/j.revinf.2018.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The care environment, renowned for being humanistic and egalitarian, has long remained impenetrable to sociological studies. Surveys, however, reveal another side, where prejudices, unequal treatment and racism in care are expressed. Medicine is itself built on racial categories which still pervade epidemiology and genetics.
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Affiliation(s)
- Marguerite Cognet
- Laboratoire Urmis (UMR IRD 205), Université Paris Diderot, UFR de sciences sociales, 8 place Paul Ricœur, 75013 Paris, France.
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Kashnitsky D, Demintseva E. "Kyrgyz Clinics" in Moscow: Medical Centers for Central Asian Migrants. Med Anthropol 2018; 37:401-411. [PMID: 29257903 DOI: 10.1080/01459740.2017.1417280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Social isolation limits migrants' access to health care, providing the context for the emergence of migrants' own medical infrastructure. In this article, we explore the so-called Kyrgyz clinics, private medical centers in Moscow founded by doctors from Kyrgyzstan and targeted specifically for labor migrants from Central Asian countries, particularly Kyrgyzstan, Uzbekistan, and Tajikistan. These Kyrgyz clinics both provide affordable medical services and enable migrant doctors to guide migrant patients through Russia's medical infrastructure, in the context of limited resources, lack of health insurance, low awareness of available services, and other barriers to care.
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Affiliation(s)
- Daniel Kashnitsky
- a Institute for Social Policy , National Research University, Higher School of Economics (HSE) , Moscow , Russia
| | - Ekaterina Demintseva
- a Institute for Social Policy , National Research University, Higher School of Economics (HSE) , Moscow , Russia
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14
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Sauvegrain P, Azria E, Chiesa-Dubruille C, Deneux-Tharaux C. Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study. BJOG 2017; 124:1858-1865. [DOI: 10.1111/1471-0528.14658] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 12/14/2022]
Affiliation(s)
- P Sauvegrain
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Department of Obstetrics and Gynecology; Hôpital de la Pitié-Salpêtrière; AP-HP; Paris France
| | - E Azria
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Notre Dame de Bon Secours Maternity Unit; Groupe Hospitalier Paris Saint-Joseph; DHU Risks in Pregnancy; Paris France
| | - C Chiesa-Dubruille
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Department of Obstetrics and Gynecology; Groupe Hospitalier de Rambouillet; Rambouillet France
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
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15
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André JM, Azzedine F. Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance. Public Health Rev 2016; 37:5. [PMID: 29450047 PMCID: PMC5809954 DOI: 10.1186/s40985-016-0017-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022] Open
Abstract
In France in 2012, of the total population of 65.2 million, 8.7 % were migrants. After being the third principal host country, France is now the 6th highest host country in the OECD. Since the 1980's numerous Acts have been passed by parliament on immigration issues. In 2000 the Universal Health Cover (Couverture Maladie Universelle) was created as health coverage for all residents of France. At the same time the State Medical Assistance (Aide Médicale de l'Etat) was created as health protection for undocumented migrants. Since the creation of this scheme, it has been the object of many political debates which call it into question, on account of its cost, perceived fraud, and the legitimacy of a social protection for undocumented migrants. Recently, access to State Medical Assistance has been made difficult by introducing conditions of residence and financial contributions. After a reports' analysis on institutional, associative, research studies and European recommendations, we note that all reports converge on the necessity of health protection for undocumented migrants. The major reasons are humanitarian, respect of European and International conventions, for public health, and financial. Moreover, fraud allegations have proved to be unfounded. Finally, State Medical Assistance is underused: in 2014 data from Médecins du Monde shows that only 10.2 % of undocumented migrant patients in their health facilities have access to this scheme. We conclude that the political debate concerning the State Medical Assistance should be about its under-utilisation, its improvement, its merger with the Universal Health Cover, and not its elimination. Moreover, the current debates regarding this scheme stigmatize this population, which is already precarious, making it more difficult for migrants to access healthcare, and generally, weaken national social cohesion.
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Affiliation(s)
- Jean-Marie André
- 1EHESP French School of Public Health, Rennes, Sorbonne Paris Cité, Rennes, France.,CNRS (National Center of Scientific Research), UMR CRAPE (Research Center on Politic Action in Europe), Rennes, 6051 France
| | - Fabienne Azzedine
- 1EHESP French School of Public Health, Rennes, Sorbonne Paris Cité, Rennes, France.,CNRS (National Center of Scientific Research), UMR CRAPE (Research Center on Politic Action in Europe), Rennes, 6051 France
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