Overcoming barriers to health-care access: A qualitative study among African migrants in Guangzhou,China

Guangzhou is China's third most populous city, and the region's burgeoning manufacturing economy has attracted many young African businessmen and entrepreneurs to the city. The aims of this study were to examine strategies that African migrants in Guangzhou have adopted in response to health-care barriers, and explore their perceptions of how to address their needs. Twenty-five semi-structured interviews and two focus groups were conducted among African migrants residing in Guangzhou, China. Facing multiple barriers to care, African migrants have adopted a number of suboptimal and unsustainable approaches to access health care. These included: using their Chinese friends or partners as interpreters, self-medicating, using personal connections to medical doctors, and travelling to home countries or countries that offer English-speaking doctors for health care. Health-care providers and health organisations in Guangzhou have not yet acquired sufficient cultural competence to address the needs of African migrants residing in the city. Introducing linguistically and culturally competent health-care services in communities concentrated with African migrants may better serve the population. With the growing international migration to China, it is essential to develop sustainable approaches to improving health-care access for international migrants, particularly those who are marginalised.     

Global health diplomacy: Barriers to inserting health into Canadian foreign policy

Health opportunities and risks have become increasingly global in both cause and consequence. Governments have been slow to recognise the global dimensions of health, although this is beginning to change. A new concept – global health diplomacy (GHD) – has evolved to describe how health is now being positioned within national foreign policies and entering into regional or multilateral negotiations. Traditionally, health negotiations have been seen as ‘low politics’ in international affairs: however, attention is now being given to understanding better how health can increase its prominence in foreign policy priorities and multilateral forums. We sought to identify how these efforts were manifested in Canada, with a focus on current barriers to inserting health in foreign policy. We conducted individual interviews with Canadian informants who were well placed through their diplomatic experience and knowledge to address this issue. Barriers identified by the respondents included a lack of content expertise (scientific and technical understanding of health and its practice), insufficient diplomatic expertise (the practice and art of diplomacy, including legal and technical expertise), the limited ways in which health has become framed as a foreign policy issue, funding limitations and cuts for global health, and lack of cross-sectoral policy coordination and coherence, given the important role that non-health foreign policy interests (notably in trade and investment liberalisation) can play in shaping global health outcomes. We conclude with some reflections on how regime change and domestic government ideology can also function as a barrier to GHD, and what this implies for retaining or expanding the placement of health in foreign policy.     

Defining health diplomacy: changing demands in the era of globalization

Context: Accelerated globalization has produced obvious changes in diplomatic purposes and practices. Health issues have become increasingly preeminent in the evolving global diplomacy agenda. More leaders in academia and policy are thinking about how to structure and utilize diplomacy in pursuit of global health goals. Methods: In this article, we describe the context, practice, and components of global health diplomacy, as applied operationally. We examine the foundations of various approaches to global health diplomacy, along with their implications for the policies shaping the international public health and foreign policy environments. Based on these observations, we propose a taxonomy for the subdiscipline. Findings: Expanding demands on global health diplomacy require a delicate combination of technical expertise, legal knowledge, and diplomatic skills that have not been systematically cultivated among either foreign service or global health professionals. Nonetheless, high expectations that global health initiatives will achieve development and diplomatic goals beyond the immediate technical objectives may be thwarted by this gap. Conclusions: The deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives.     

流动人口中避孕套使用状况

目的研究流动人口中关于避孕套的知识、行为以及可接受的宣传途径。方法对北京和广州市部分18~40岁流动人口进行问卷和访谈调查,收集和分析相关信息。结果91.1%的男性问卷被访者听说过避孕套;信息的来源主要是电视、报刊杂志、医务工作者、计划生育工作者和广告;已婚男性、未婚男性有女友和未婚无女友的仅69.3%、52.6%和46.7%的人知道避孕套的避孕和防病作用;已婚男性曾用避孕套的比例(49.7%)高于未婚男性(25.2%);避孕套每次都用者为10.3%。结论男性流动人口中避孕套的相关知识不平衡,使用率低,其知识与使用的现状与农村地区计划生育活动的导向有一定的关联。应该进一步在男女流动人口中以不同内容和形式宣传避孕套的相关知识。     

Into the deep end: Incorporating a global health governance and diplomacy experience in graduate public health training

Global health governance benefits from participants well-versed in the realities of international policy-making. Consequently, educational programmes must establish more opportunities for students to engage in global health policy development. This paper examines a unique global health governance and diplomacy practicum programme at the University of Southern California, designed for Master of Public Health candidates. Through the programme, students act as official non-governmental delegates to the World Health Assembly in Geneva, Switzerland through organisational partnerships. Students and collaborating organisations were asked to complete an online post-participation survey examining the perceived quality of the experience. Through the survey, students indicated reinforcement of classroom learning, continued or heightened interest in global health policy and enthusiasm in recommending the programme to other students. Organisations perceived students to be adequately prepared and indicated their continued desire to work with students in the programme. The data collected suggest that the programme was successful in providing students with a worthwhile experience that developed skills in global health diplomacy and promoted interest and critical thinking concerning international policy-making processes. A discussion of strengths and challenges serves as a blueprint for the creation of future practicum programmes.     

Human cargo: health conditions of Chinese migrants interdicted offshore by U.S. authorities

During the eight month period between April and December 1999, the United States Coast Guard intercepted seven boats carrying migrants from the People's Republic of China destined for the United States. These migrants were processed by the United States Immigration and Naturalization Service in three locations: Tinian Island, Midway Island, and Guatemala. Emergency Medical Response Teams from the United States Public Health Service, Division of Immigration Health Services, were deployed to conduct initial health screenings of the 913 migrants on board these ships and provide on-going health care until the individuals were repatriated or relocated. The distributions of demographic characteristics of the population and the health conditions observed are presented. Differences in health conditions observed by temporary detention location, sex, and age group were assessed.The majority of migrants were males younger than age 30. Few serious illnesses were observed. The most prevalent conditions included skin rashes, fungal rashes, upper respiratory infections, abdominal discomfort, scabies, abrasions, skin lesions, headache, pain and/or injuries, dental problems, and ear problems. For many health conditions, statistically significant differences were observed by location. For nearly all conditions for which differences were observed by sex, these differences were accounted for by a greater proportion of females presenting with the condition.     

绍兴县581名流动人口职业卫生现状调查

目的了解浙江省绍兴县流动人口职业卫生现状。方法 2010年5—6月通过问卷形式,对绍兴县581名流动人口进行调查。调查内容主要包括流动人口的居住及职业卫生状况等。计数资料采用χ2检验和非参数检验,P<0.05为差异有统计学意义。结果本次调查中流动人口自己租用的居民房及农民房分别占41.0%和25.3%。居住的地方有自来水和厕所的分别占95.1%和83.7%。仅11.6%的流动人口认为自己的生活条件好,不同住房类型的流动人口与生活条件的自我感受比较差异无统计学意义(χ2=2.072 P>0.05),而基础设施的多少与生活条件的自我感受比较差异有统计学意义(χ2=29.400,P<0.05)。流动人口中平均每周工作达到了63 h,其中91.6%的流动人口每周工作时间多于劳动法规定的44 h。认为自己工作累的占37.3%,感到工作强度一般的占52.5%。21.0%和34.1%的流动人口存在病休和工作损伤的情况。流动人口工作时间按8 h分类时,工作时间与工作劳累程度、病休、工作损伤比较差异均有统计学意义(均P<0.05)。当工作时间按44 h分类时,工作时间与病休及工作损伤比较差异均无统计学意义(均P>0.05)。结论相关企业应重视流动人口的劳动权益,同时政府部门应加强监督机制,加大对流动人口的教育扶助,改善流动人口居住环境。     

城市务工青少年生殖健康状况与知信行分析

目的:了解城市务工青少年性与生殖健康知信行水平及其生殖健康实际状况。方法:采用自编结构式匿名问卷对北京、广州、济南市4477名务工青少年进行自填式问卷调查,并对其10%(446人)进行体格和生殖道医学检查。结果:男女对象总知识得分较低,平均分别为42.8分、40.0分;性行为发生率分别为43.9%,28.8%;男性务工青少年性态度相对女性开放,务工青少年生殖健康的自我感知情况与实际状况差距悬殊。体检结果显示,女性检出问题主要为宫颈糜烂12.0%,阴道炎11.6%,早孕4.5%等;男性主要为包茎26.0%,生殖道感染11.0%等,发育畸形占3.8%。结论:务工青少年的生殖健康状况不容乐观,且自我感知情况差,相关教育及服务的重要性及必要性更为突出。     

The effect of health on urban-settlement intention of rural-urban migrants in China

Previous studies have not paid enough attention to the effect of health on urban-settlement intention of rural-urban migrants in China. Using survey data from the Rural Urban Migration in China project, this article examines how self-rated physical and mental health influence rural-urban migrants’ intention to settle down in cities. First, the results show that both self-rated physical and mental health are significant factors influencing the migrants’ intention to permanently move to cities. Second, the effect of physical health on rural-urban migrants’ intentions to permanently reside in cities can be moderated by their length of urban residence. Third, the impact of health on rural-urban migrants’ urban-settlement intention shows no generational differences. According to the research findings, this paper discusses how urban-settlement intention of rural-urban migrants based on health selection might impair urbanization, exacerbate health disparity between the rural and urban areas, and aggravate the burden on healthcare system in rural areas of China in the long run.     

我国流动人口的公共卫生现状

目的 了解青年流动人口基本公共卫生服务的利用现状及其影响因素,为制定青年流动人口健康保障相关政策提供依据。 方法 采用2014年全国流动人口卫生计生动态监测数据中的29 281名15～24岁青年人群资料,用分层线性回归模型和logistic回归对青年流动人口基本公共卫生服务利用及影响因素进行分析。 结果 青年流动人口基本公共卫生服务利用总体水平较低,15～24岁的青年流动人口中只有18.0 %的人建立健康档案;28.5 %的人接受过职业病防治的健康教育,分别有43.0 %、22.6 %的人接受过艾滋病防治和结核病防治的健康教育,分别有38.4 %和31.6 %的人接受过生殖与避孕和性病防治的健康教育;多因素分析显示,青年流动人口基本公共卫生服务利用的影响因素为性别（OR = 1.101）、年龄（OR = 1.153）、文化程度（OR = 0.937）、婚姻状况（OR = 1.300）、单位性质（国企OR = 1.666、外企OR = 1.494;私企及其他等OR < 1）、流动地区（OR = 2.132、2.716、2.248）、是否有长期居住打算（否、没想好OR < 1）、是否有医疗保险（OR = 1.704）。 结论 青年流动人口对基本公共卫生服务可及性差,应加强健康教育的宣传,重视青年流动人口的职业病防治、性别防治、生殖保健方面的健康教育。     

天津青年流动人口健康知识和卫生服务利用调查

目的了解天津市经济技术开发区(简称泰达)青年流动人口的健康状况、健康知识知晓,以及卫生服务的利用情况。方法采用整群抽样方法 ,通过自填式问卷,对在泰达居住满3个月但不足3年的976名年龄为15～24岁的流动人口进行调查。结果超过80%调查对象自认为比较健康,最近2周患病率为13.7%;调查对象在结核病、健康饮食和生殖健康方面的知识知晓率低,均不足50%;70%调查对象近一年内患病主要为感冒,患病后未就诊率为51.2%,就诊医院以社区卫生服务中心和服务站为主。结论有必要采取措施提高天津泰达青年流动人口的卫生知识知晓率和自我保健意识,以改善他们的卫生服务利用情况。     

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51 055 households for a quantitative survey through interviewer‐administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2 years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as“outsiders.” These findings warrant developing migrant‐specific health‐care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.     

惠州地区未婚流动人口生殖健康知识知晓率调查

目的:了解惠州地区未婚流动人口的生殖健康知识水平,为有效开展生殖健康教育提供科学依据。方法:采用集中发放问卷、匿名填写后回收的方法对惠州地区不同性别未婚流动人口进行流行病学问卷调查。结果:被调查者具有一定的生殖生理、避孕及性病知识,但明显不足,男性、女性答题情况有明显差别。被调查者大部分在单位从未接受过健康教育,他们现有的生殖健康知识主要来自学校教育、同学、同事、朋友及父母。结论:未婚流动人口的生殖健康知识缺乏,应该通过多种渠道、多种形式进行灵活的生殖健康教育。     

Reporting mental health problems of undocumented migrants in Greece: A qualitative exploration

Background: Mental health problems are highly prevalent amongst undocumented migrants (UMs), and often part of their consultations with general practitioners (GPs). Little empirical data are available of how GPs and UMs engage around mental health in Greece, a country with a lack of balance between primary and secondary care and limited healthcare provisions for UMs.

Objectives: To acquire insight in the barriers and levers in the provision of mental healthcare for UMs by GPs in Greece.

Methods: This was a qualitative study using semi-structured interviews with 12 GPs in Crete, Greece with clinical expertise in the care of UMs. All interviews were audio-taped and transcribed verbatim and were analysed using thematic content analysis.

Results: Greek GPs recognized many mental health problems in UMs and identified the barriers that prevented them from discussing these problems and delivering appropriate care: growing societal resistance towards UMs, budget cuts in healthcare, administrative obstacles and lack of support from the healthcare system. To overcome these barriers, Greek GPs provided UMs with free access to care and psychotropic drugs free of charge, and referred to other primary care professionals rather than to mental healthcare institutions.

Conclusion: Greek GPs experienced substantial barriers in the provision of mental healthcare to UMs and political, economic and organizational factors played a major role.     

公共卫生人才全球化视野的内涵与培养

随着中国在国际舞台上的重要性不断提高,培养具有全球化视野的公共卫生人才成为关键问题。全球化视野包括对全球政治、经济、社会发展的深入理解,对全球卫生问题的历史、现状与发展趋势的掌握,对公共卫生全球治理与公共卫生专业本身关系的理解和感悟,在多元文化环境中对多元价值的理解、适应和自我发展,以及通过外交谈判手段获得问题解决方案的能力和向全球卫生治理提供中国案例的能力。培养这些能力,既需要打造理论与实践相结合的师资队伍,选择适宜人才进行后备队伍培养和教育,也需要提供多种多样的实践与培训,如到国外留学、到国际组织或者跨国机构任职、参与中国政府对外援助项目等。     

宁夏南部山区生态移民心理健康状况的比较研究

目的探讨生态移民心理健康水平随移居时间的变化情况。方法采用多级整群抽样的方法抽取≥16岁移民223人,利用症状自评量表测定移民心理健康状况,比较移民在不同时期心理健康水平。结果移民在搬迁后不同时期内,在强迫症状、人际敏感、抑郁、焦虑、敌对和精神病性等因子得分有明显不同(P0.05),在移居6个月时,上述因子得分最高,移居18个月后,各因子得分逐渐接近移民前。在移居后一年内,发生心理障碍者所占比例高于移民前(P0.05)。结论移民在迁入移居地初期心理水平变化较大,随着在移居地居住时间的延长,其心理健康水平有逐步回归的趋势。     

Improving health services in India: a different perspective

Two papers in this volume focus on public finance and decentralization as central to resolving India's systemic public health crisis. However, some states and districts have achieved success despite serious financial and administrative deficits; this suggests that factors such as political commitment, community participation, human resource management, women's empowerment, and governance may be as or more important. The success of the National Rural Health Mission will depend on state and local institutional capacity, including strong partnerships with civil society organizations and private-sector actors. Increased resources and decentralization will not be sufficient by themselves.     

Improving resource allocation decisions for health and HIV programmes in South Africa: Bioethical,cost-effectiveness and health diplomacy considerations

The escalating expenditure on patients with HIV/AIDS within an inadequately funded public health system is tending towards crowding out care for patients with non-HIV illnesses. Priority-setting decisions are thus required and should increasingly be based on an explicit, transparent and accountable process to facilitate sustainability. South Africa's public health system is eroding, even though the government has received extensive donor financing for specific conditions, such as HIV/AIDS. The South African government's 2007 HIV plan anticipated costs exceeding 20% of the annual health budget with a strong focus on treatment interventions, while the recently announced 2012–2016 National Strategic HIV plan could cost up to US$16 billion. Conversely, the total non-HIV health budget has remained static in recent years, effectively reducing the supply of health care for other diseases. While the South African government cannot meet all demands for health care simultaneously, health funders should attempt to allocate health resources in a fair, efficient, transparent and accountable manner, in order to ensure that publicly funded health care is delivered in a reasonable and non-discriminatory fashion. We recommend a process for resource allocation that includes ethical, economic, legal and policy considerations. This process, adapted for use by South Africa's policy-makers, could bring health, political, economic and ethical gains, whilst allaying a social crisis as mounting treatment commitments generated by HIV have the potential to overwhelm the health system.     

青年流动人口对公共卫生服务的利用与满意程度调查

目的了解青年流动人口对公共卫生服务的利用及满意情况,为探寻有效改善该人群公共卫生服务利用的途径提供科学依据。方法采用随机整群抽样的方法,抽取天津市和陕西省西安市青年流动人口1838人进行问卷调查,采用Epi Data 3.02软件进行数据录入,PASW Statistics 17.0软件进行统计分析。结果分别有53.4%和40.6%的青年流动人口接受过健康教育和常规体检服务,其中对生殖健康服务利用率最低（12.3%）,满意程度也最低（66.2%）,而对计划免疫服务的利用率（77.3%）及满意程度（90.2%）情况均最高,差异有统计学意义（P〈0.01）。男性青年流动人口对公共卫生服务的利用率（32.2%）高于女性（27.0%）,但女性对服务的满意度（82.1%）高于男性（76.1%）,差异有统计学意义（P〈0.01）。青年流动人口未利用公共卫生服务的主要原因是感觉不需要（47.6%）;不满意的主要原因是收费高（56.3%）及服务态度不好（29.6%）。结论青年流动人口对公共卫生服务利用不足,应提高该人群对公共卫生服务的认识,并探索适宜的服务机制,提升公共卫生服务质量,促进其对公共卫生服务的利用。     

三峡移民健康状况及医疗卫生服务可及性调查

目的调查三峡外迁移民的健康状况及医疗卫生服务可利用性。方法采用自编一般情况调查表对外迁至山东省的320名三峡移民进行问卷调查。结果三峡外迁移民的健康状况明显差于搬迁前,与当地居民比较也有明显偏差,差异均有统计学意义(P<0.05)。与搬迁前相比,移民医疗卫生服务可及性和医疗保障情况均有较大改善。结论与搬迁前相比,移民健康状况有所下降,政府部门应加大对移民健康的关注。