Inequalities in children's health

This article explores some of the differences between adult and child health services and aims to assist readers appreciate the possible inequalities that can occur. In order to achieve this, different factors affecting child development are explored and the problems of developing policies and practices that support children's health considered.     

Inequalities in health: Evaluation and effectiveness in practice

This paper details the findings from a project that assessed the contribution made by nurses, midwives and health visitors to targeting health and social need. This is an important theme within the Northern Ireland Regional Strategy entitled 'Health and well-being into the next millennium: a regional strategy for health and social well-being 1997-2002', which is concerned with addressing inequalities in health status and social well-being. In response to this initial survey, the paper also highlights the second phase of the project that was the development of an evaluation manual specifically designed to assist health-care practitioners in establishing evaluation frameworks and in applying evaluation techniques and methods. The paper describes four research case studies that are intended to illustrate the kinds of evaluation methods necessary to cover the stages of evaluation, needs assessment, structure, process and outcome, and to reflect the experience of applied evaluation as it occurs in practice as opposed to how it appears in textbooks.     

Inequalities in dementia care across Europe: key findings of the Facing Dementia Survey

The Facing Dementia Survey was undertaken to assess the awareness of and behaviours surrounding Alzheimer's disease (AD) and dementia among all key stakeholders in Europe. Interviews were conducted with more than 2500 persons, including caregivers, members of the general population, physicians, persons with AD and influencers of health care policy. Four key messages emerged from the results. First, AD often remains undiagnosed until symptoms become moderate or severe. This delay may be because of the difficulty of recognising the symptoms of early AD and the attribution of symptoms to so-called normal ageing, the fear of AD common among older people, inadequate screening tools for use by physicians and/or a delay in the confirmation of the diagnosis once suspicion is raised. Second, a majority of respondents perceive their governments as indifferent to the economic, social and treatment burdens associated with AD. Third, a substantial majority of caregivers, physicians and the general population appreciate the wide-ranging impact that AD can have on the quality of life of people who suffer from it and their informal caregivers. While most caregivers reported life-changing negative effects, a few also noted some positive aspects to their experience. Finally, survey results revealed that most caregivers and members of the general public do not have sufficient information about the benefits of treatment and care. The findings of the Facing Dementia Survey support the development of an agenda for change in dementia care across Europe.     

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1)

Background

This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.

Methods

The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe.

Results

Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392.200 asylum applications.The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental healthDue to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care.

Comments and Remarks

Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

     

International school children's health needs: school nurses' views in Europe

Rapid globalization and the integration of national economies have contributed to the sharp rise in enrollment in international schools. How does this global nomadism affect international school children and their individual health needs? This study attempts to find an answer by interviewing 10 school nurses, with varying degrees of experience in international schools in Sweden, Germany, and Switzerland. Through qualitative semistructured interviews, the school nurses described that the international school children expressed common health needs similar to the ones faced by children in other school settings. However, children in the international schools expressed additional context-specific health needs related to their transient lifestyle, such as language and cultural difficulties, emotional distress, vulnerability, homesickness, alienation, and increased physical health needs related to their expatriate lifestyle. These factors often present a challenge for the school nurse whose profession is to interpret the child's health needs, which may be obscured by cultural diversity.     

Intercultural education of nurses and health professionals in Europe (IENE)

TAYLOR G., PAPADOPOULOS I., DUDAU V., MAERTEN M., PELTEGOVA A. & ZIEGLER M. (2011) Intercultural education of nurses and health professionals in Europe (IENE). International Nursing Review 58 , 188–195 This paper presents the results of a needs analysis carried out during a 2‐year European Union‐funded project titled ‘Intercultural education of nurses and health professionals in Europe’. Aims: The study aimed to explore the perceived learning and teaching needs of students and practitioners of health‐care professions in relation to preparation for working in another European country and/or in a multicultural environment. The participating countries were: Belgium, Bulgaria, Germany, Romania and the UK. Methods: Questionnaires, consisting of open questions, were completed by a total of 118 participants. Data analysis adopted both a priori and inductive approaches. The predetermined constructs of cultural awareness, cultural knowledge, cultural sensitivity and cultural competence were used to structure suggestions for theoretical input and practical activities and experiences. Inductive analysis revealed other emergent themes that underpin all four of these constructs. Results: Practical experiences form a fundamental part of preparation for labour mobility and/or for practice within a multicultural environment. However, health‐care practitioners need to be adequately prepared for such experiences and value the opportunity to learn about culture, to explore values and beliefs, and to practise intercultural skills within the safe environment of an educational establishment, facilitated by skilled teachers.     

Nursing and public health in Europe -- a new continuous education programme

The aim of this paper is to describe the development of a new education programme in public health for nurses in the European Union (EU). The project, 'Development of a Continuous Professional Education Programme for Nurses in Public Health', is described together with its background and aim, which is to contribute to the development of new competencies of nurses in nursing and public health. For the development of these competencies, the framework for the programme's guidelines is organized around core modules common for all EU countries and elective modules, based on national health needs and policies proposed by each country. An example of the implementation of the programme from Sweden, where the programme has already been offered, is also presented. In addition to the educational programme itself, the opportunities for networking for nurses and teachers from different countries resulting from this effort are discussed. Finally, the evolving nature of public health in nursing is presented in relation to the roles that nurses/midwives already perform in various countries and situations, in order to point out the potential of this programme's contribution to the promotion of health of all European citizens.     

Inequalities in health care provision: the relationship between contemporary policy and contemporary practice in maternity services in England

AIM: The project Addressing Inequalities in Health: new directions in midwifery education and practice (Hart et al. 2001) was commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB). Here, we draw on those research findings to consider current midwifery policy and practice in England. BACKGROUND: Little guidance on providing equality of care exists for midwives. The Code of Conduct [United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 1992] makes no specific requirement for midwives to address issues of inequalities of health in their practice. Recent policy documents emphasize the need to work towards reducing inequalities and to target practice to 'disadvantaged clients' without giving guidelines on how to identify and care for target groups. METHODS: In-depth studies of midwifery education and service provision were conducted in three very different parts of England. Three months of fieldwork were undertaken at each site, comprising a series of interviews with midwifery educators, managers, students, midwives and service users. Focus groups were also held and observation of classroom sessions and midwifery practice undertaken. Findings. A lack of clear and specific strategies concerning inequalities in health was evident at managerial level. Patchy knowledge of current policy was also evident amongst practising midwives. Specific projects with disadvantaged clients usually resulted from a particular midwife's personal interest or evident local need. All midwives emphasized the importance of 'equality of care'. How this was operationalized varied, and 'individualized' or 'woman-centred' care was assumed to encompass the concept. In the few examples where care was systematically targeted in accordance with policy directives, the midwife's public health role was increased. CONCLUSION: In the absence of a co-ordinated strategic vision driven by managers, practitioners find difficulty in prioritizing care and targeting resources to disadvantaged clients in line with policy directives. Tensions between policy and practice in the care of 'disadvantaged' women clearly exist. Successful implementation of policy at practice level needs: commitment from managers; clarity of purpose in documentation; and provision of specific targets for practitioners. However, the latter should remain flexible enough for the delivery of care to be appropriate and sensitive to individual needs.     

Inequalities regarding death in the past

Was mortality differentiated socio-economically in past centuries, as it is nowadays? The issue has been hotly debated. Certain demographers admitted that, periods of famine excepted, the death risk was evenly distributed among the ancient populations, regardless of wealth, instruction or social status. On the other hand, the research project currently carried out at the French National Institute of Demographic Studies is evidencing wide mortality social differentials in the 19th century. In Paris, male life expectancy at the age of 40 reached 29.7 years for the nobility and bourgeoisie, but decreased to 25.6 years among merchants and 23.7 years among workers and day-labourers. Generally speaking, regional differentials were less pronounced than socioeconomic differentials. Mortality decline was found among the elites: life expectancy at 40 of the Knights of the Holy Spirit, for instance, increased to 30.8 years in the 18th century, from 27.8 years in the 16th century. The same life expectancy today (at 40 years of age) reaches 35.7 years among French professionals. The main problem with this kind of research is how to identify and collect relevant information. The researchers make use here of marriage registers from the past century. These registers recorded not only particulars of the married couple but also those of their parents (occupation, age, and date of death, if any). This information allows the calculation of mortality rates (and life expectancy) of ancient birth cohorts in various occupational groups. The primary condition is that the registers have been well kept and soundly stored until now. This is the case in certain city halls: the 4th arrondissement of Paris (1860-1863), Ivry-sur-Seine (1817-1823)... etc...     

Implications of the Facing Dementia Survey for health care professionals across Europe

Approximately 600 general practitioners, primary care physicians and specialists in six European nations (France, Germany, Italy, Poland, Spain and UK) who treat patients with Alzheimer's disease (AD) were interviewed during the Facing Dementia Survey. Compared with generalists, specialists displayed the most optimism regarding the effects of age, believing that health and memory do not inevitably deteriorate as one grows older. Most physician respondents agreed that the diagnosis of AD is too often delayed. A primary reason cited for this delay was the difficulty experienced by both physicians and the general public in identifying early signs of AD. Many physicians believed treatments are available that can slow the disease course. The vast majority surveyed in each nation believed that early treatment of AD can delay disease progression [mean, 87%; range, 68% (United Kingdom) to 96% (Poland)]. More than half of physicians who initiate treatment in France (66%), Germany (59%), Italy (82%), Poland (82%) and Spain (69%) said they institute treatment for AD immediately after diagnosis. The exception was the United Kingdom, where 48% initiated treatment immediately, whereas more than half waited at least a month to start therapy. To a large extent, physicians saw the governments of their countries as a hindrance rather than a help in caring for persons with AD.     

Family health nursing: the education programme for the WHO Europe Scottish Pilot

This article outlines the development of the family health nurse (FNH) programme, which was delivered by the University of Stirling in the highlands and islands of Scotland as part of a World Health Organization European pilot project. An outline of the structure of the programme and its key features is described. The concept of the FHN emerged from the WHO's initiative to develop a practitioner who has the family as the organizing focus of their practice (WHO, 2000). An insight is provided into the experience of the first students to undergo this programme, along with a brief summary of the main findings of the external evaluation of both the education programme and the implementation of the role in the remote and rural communities of the highlands and islands of Scotland. Suggestions are made that will hopefully influence the second phase of this project that the Scottish Executive are supporting in an urban setting, which is due to begin in September 2004.     

Chaplaincy in Europe

Chaplaincy is organized in Europe in various ways, depending on the cultural, religious, social and governmental aspects which shape healthcare. One of the uniting forces in bringing national chaplaincies together into one united body has been the European Network of Health Care Chaplaincy (ENHCC). Chaplaincy in Europe faces two major difficulties: 1) the professional status of the chaplain within the healthcare community; 2) preserving the patient's rights for spiritual care. These difficulties are described and note is given to how the ENHCC is dealing with them. Finally, special attention is given to how chaplaincy in Europe and the medical community interact and what is needed to bridge the gap between the two worlds of science and faith.