COVID-19 en migrantes y minorías étnicas

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.     

Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: a systematic review

Objectives  

Knowledge about self-perceived health can help us understand the health status and needs among migrants and ethnic minorities in the European Union (EU) which is essential to improve equity and integration. The objective was to examine and compare self-perceived health among migrant and ethnic minority groups in the EU countries.     

Multiculturalism and the Construction of Ethnic Identities in Labour and Health Practices: Avoiding the Culturalistic Fallacy in Applied Research

In applied health care research, an essentialised notion of culture is often used when studying ethnic disparities in health and health care access between the majority populations of Western countries and migrants, with ethnic backgrounds that differ from majority population. This notion of culture, however, is considered highly problematic in anthropology and ethnic studies. Therefore, in our research on Dutch illness certification practices, we employed a dynamic conceptualisation of culture. Our research shows that, in practice, when clients fail to meet the implicit norms of this practice, doctors ascribe this nonconformity differently when the client is a migrant than when he or she is a Dutch client. More specifically, when migrants fail to meet the norms, doctors are inclined to automatically ascribe this nonconformity to the assumed cultural background of the client. Consequently, these doctors feel less able to use the tools they normally use to coach their clients. This, in turn, results in more problematic and longer reintegration trajectories for migrants in comparison to Dutch clients in similar circumstances. In other words, framing the problems of migrants in terms of culture results in greater sick leave rates for migrants than for Dutch people. Clearly, culturalistic perspectives on ethnic differences have negative consequences. We therefore implore the application of a dynamic notion of culture in applied research.

Migrant participation in Norwegian health care. A qualitative study using key informants

Abstract

Background: Little is known about how migrants adapt to first-world public health systems. In Norway, patients are assigned a registered general practitioner (RGP) to provide basic care and serve as gatekeeper for other medical services. Objectives: To explore determinants of migrant compliance with the RGP scheme and obstacles that migrants may experience. Methods: Individuals in leadership positions within migrant organizations for the 13 largest migrant populations in Norway in 2008 participated in this qualitative study. Semi-structured interviews, with migrants serving as key informants, were used to elucidate possible challenges migrant patients face in navigating the local primary health-care system. Conversations were structured using an interview guide covering the range of challenges that migrant patients meet in the health-care system. Results: According to informants, integration into the RGP scheme and adequacy of patient-physician communication varies according to duration of stay in Norway, the patient's country of origin, the reason for migration, health literacy, intention to establish permanent residence in Norway, language proficiency, and comprehension of information received about the health system. Informants noted as obstacles: doctor-patient interaction patterns, conflicting ideas about the role of the doctor, and language and cultural differences. In addressing noted obstacles, one strategy would be to combine direct intervention by migrant associations with indirect intervention via the public-health system.

Conclusion: Our results will augment the interpretation of forthcoming quantitative data on migrant integration into the public-health system and shed light on particular obstacles.     

Depression in Europe: does migrant integration have mental health payoffs? A cross-national comparison of 20 European countries

Objectives. Depression is a leading cause of ill health and disability. As migrants form an increasing group in Europe, already making up about 8.7% of the population in 2010, knowledge on migrant-related inequalities in depression is of main public health interest. In this study, we first assess whether migrants in Europe are at higher risk for depression compared to the native population. Second, we assess whether the association between migration and depression is dependent on different forms of migrant integration. Migrant integration is looked at both from the individual and from the national level.

Design. Hierarchical linear regression analyses based on data for 20 countries in the European Social Survey 2006/2007 (N = 37,076 individuals aged 15 or more). Depression is measured using the center for Epidemiologic Depression Scale. We consider migrant integration over time (first- and second-generation migrants, differentiated according to European Union (EU) or non-EU origin), barriers to integration (low educational level, financial difficulties, being out of the labor market, ethnic minority status, discrimination), and the host country environment (national migrant integration policy). Controls are gender, age, partner relationship, social support, and welfare state regime.

Results. Natives and second-generation migrants do not differ significantly in their risk profile for depression. First-generation migrants show higher levels of depression, with those born outside of Europe to be the worst off. This higher risk for depression is not attributable to ethnic minority status but is mainly due to experienced barriers to socioeconomic integration and processes of discrimination. A country's national policy on migrant integration shows not to soften the depressing effect of being a first-generation migrant nor does it have indirect beneficial health effects by reducing barriers to integration.

Conclusion. In Europe, first-generation EU and non-EU migrants experience higher levels of depression. Second-generation migrants and natives show similar risk profiles.     

A Review of the Dental Caries Status of Ethnic Minority Children in China

China has 55 ethnic minority groups comprised of 113 million persons, or 7.0 % of total population. Dental caries is a major health problem for children in China, and national oral health surveys currently report dental caries based on geographical location rather than by ethnic group. This study reviews the literature on dental caries in ethnic minority children in China. Publications were retrieved in Chinese and English from five electronic databases; thirty-eight studies from 1983 to 2012 met inclusion criteria and described 25 ethnic minority groups. Primary dentition median caries prevalence and experience were higher (51 % and dmft = 3.0, respectively) than permanent dentition caries prevalence and experience (39 % and DMFT = 0.8). Median caries prevalence was highest (80 %) for permanent dentition among aggregated ethnic minorities with population greater than 1 million. More work and research is needed to expand dental caries prevention and treatment measures for ethnic minority child populations in China.

     

Oral health and access to dental care – a comparison of elderly migrants and non-migrants in Germany

Objectives: To compare oral health, access barriers to dental care, oral health behavior and oral hygiene behavior of elderly German residents with and without immigration background.

Design: In this cross-sectional explorative study, a convenience sample (N?=?112, age?≥?60 years, 54% immigrants) was recruited in four dental practices in Hamburg, Germany. Oral health was assessed with Decayed/Missing/Filled Teeth (DMFT), Papillary Bleeding Index (PBI), and Approximal Plaque Index (API). Dental health was operationalized as number of decayed teeth, and poor oral hygiene based on a PBI?≥?40%. Access barriers and oral health behavior were assessed with a standardized questionnaire.

Results: While caries experience was similar in migrants and non-migrants (DMFT mean: 24.8 vs. 23.4, n.s.), significantly more teeth were decayed (5.3 vs. 2.1, p?p?=?0.002) and PBI (46.3% vs. 30.5%, p?=?0.016) were significantly higher in migrants. After adjusting for age, sex, income, education, and number of teeth, migrants still had on average 3 decayed teeth more than non-migrants. However, impact of migration background on poor oral health changed from OR?=?3.61 (p?=?0.007) to OR?=?1.05 (n.s.) after adjusting for confounders, mainly due to lower income in migrants. Fewer migrants had visited a dentist within the past 12 months, and migrants were less likely to have a regular dentist that they visit and more often indicated language or cost barriers than non-migrants.

Conclusion: Elderly German migrants have higher treatment needs than non-migrants. Likely causes are poorer oral hygiene and lower utilization of dental care services. Specific prevention programs targeting migrants are warranted to improve oral health in this disadvantaged group.     

Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia

Objective. Australia is an increasingly multicultural nation. Never before has the dental workforce been exposed to such language, cultural, religious and ethnic diversity. There is evidence that refugee and migrant children experience significantly poorer oral health than the nonmigrant population. However, little is known about the oral health knowledge, practices and beliefs of parents with young children from refugee and migrant backgrounds. The aim of this study was to identify the sociocultural influences on child oral health in these communities.

Design. Participatory and qualitative research methods were utilised. Partnerships were established with community agencies representing migrants from Iraq, Lebanon and Pakistan. Focus group discussions and semi-structured interviews were conducted with community members. Qualitative data were analysed thematically, combining focus group and interview data.

Results. Over 100 women participated in focus groups (n = 11) and semi-structured interviews (n = 7). Key findings included the knowledge, beliefs and practices concerning: caries risk factors, oral health practices and oral health literacy. Despite mothers' knowledge of the major causes of poor oral health – dietary changes, confusion about child oral hygiene practices and limited oral health literacy all influenced child oral health outcomes.

Conclusion. This culturally competent qualitative study explores the sociocultural factors influencing child oral health in refugee and migrant communities. Understanding and acknowledging these factors are a prerequisite to determining where and how to intervene to improve oral health. Furthermore, it has implications for both dental and non-dental health professionals working to reduce health inequalities within such communities.     

A qualitative systematic review of published work on disclosure and help-seeking for domestic violence and abuse among women from ethnic minority populations in the UK

ABSTRACT

Introduction: Domestic violence and abuse has been recognised as an international public health problem. However, the pervasiveness of the problem is unknown due in part to underreporting, especially among women from ethnic minority populations. In relation to this group, this review seeks to explore: (1) the barriers to disclosure; (2) the facilitators of help-seeking; and (3) self-perceived impacts of domestic violence.

Design: We systematically identified published qualitative studies conducted among women from ethnic minority populations in the UK. Data analysis was completed using thematic analysis approach.

Result: 562 papers were identified and eight papers from four studies conducted among women from ethnic minority populations in the UK met the inclusion criteria and were reviewed. Barriers to disclosure include: Immigration status, community influences, problems with language and interpretation, and unsupportive attitudes of staff within mainstream services. Facilitators of help-seeking were: escalation of abuse and safety of children. Self-perceived impact of abuse includes: shame, denial, loss of identity and lack of choice.

Conclusion: There is an on-going need for staff from domestic violence services to be aware of the complexities within which women from ethnic minority populations experience domestic violence and abuse.     

Impact of social factors on health status and help seeking behavior among migrants and Germans

Several studies show significant differences between Germans and migrants in health status, help-seeking behavior and utilization of health care facilities. Social factors are potential determinants partially explaining these differences. The main objective of the present cross-sectional study is to study the impact of social factors on health status and health care utilization including preventive services among Germans and migrants in the German health care system. A survey was conducted among 565 adults (mostly parents; 49% migrants, 51% Germans) accompanying their children at the compulsory medical school entry examination. The survey aimed at the self-reported health status of the adults, the help-seeking behavior, social and demographic variables as well as factors describing the ethnic background and the process of migration. As a result we found a statistically significant lower level of health care utilization for migrants compared to Germans whereas the self-reported health status was similar between Germans and migrants and not dependant on social factors. Social factors accounted for differences in health care utilization including the use of preventive services among both groups (Germans and migrants). Despite the ethnic background, a low social class was significantly associated with a decreased use of health care facilities among Germans and migrants compared to adults from a high social class. Further studies are needed to identify certain obstacles to utilizing the German health care system by adults from a low social class. Public health interventions could be suitable for addressing these difficulties.     

Journal of Agromedicine “Leader in the Field” 2008

ABSTRACT

Migrant Clinicians Network advocates for migrants and clinicians, develops appropriate resources, engages outside partners, conducts translational research, and runs programs that support clinical care on the front line of migrant health. Migrant Clinicians Network's goal is to improve health care for migrants by providing support, technical assistance, and professional development to clinicians in Federally Qualified Health Centers and other healthcare delivery sites with the ultimate purpose of providing quality health care that increases access and reduces disparities for migrant farmworkers and other mobile underserved populations. In this article the authors examine the migrant population in the United States, a brief history of clinicians working in migrant health, and the scope of current Migrant Clinicians Network activities, including occupational and environmental health.     

What do we have to know from migrants' past exposures to understand their health status? a life course approach

Empirical findings show that morbidity and mortality risks of migrants can differ considerably from those of populations in the host countries. However, while several explanatory models have been developed, most migrant studies still do not consider explicitly the situation of migrants before migration. Here, we discuss an extended approach to understand migrant health comprising a life course epidemiology perspective.The incorporation of a life course perspective into a conceptual framework of migrant health enables the consideration of risk factors and disease outcomes over the different life phases of migrants, which is necessary to understand the health situation of migrants and their offspring. Comparison populations need to be carefully selected depending on the study questions under consideration within the life course framework.Migrant health research will benefit from an approach using a life course perspective. A critique of the theoretical foundations of migrant health research is essential for further developing both the theoretical framework of migrant health and related empirical studies.     

Birds of a feather flock together – and fall ill? Migrant homophily and health in Sweden

Although studies show that health inequities between ethnic groups exist, few have expressed interest in the origins of these disparities. As homophily (the phenomenon that people principally form relationships with those who are similar to them) influences people’s norms and interactions, it might be an important property of migrants’ networks, and have implications on their health. The aim of this study is to examine health inequities between natives and immigrants in Sweden and the health consequences arising from participation in homogenous migrant networks. Using total population registers and representative survey data initial analyses show that migrants experience poorer health than native Swedes. The findings further suggest that homophily is a prominent feature of migrant social networks and that migrants in networks with a high proportion of other migrants experience poorer health than those who include a high proportion of natives in their networks. However, unhealthy behaviour and disadvantaged social conditions may account for a considerable share of their excess risk. Hence, network closure may reinforce and maintain norms leading to negative behaviour and social conditions in such networks.     

Ethnic density effects on health and experienced racism among Caribbean people in the US and England: A cross-national comparison

Studies indicate an ethnic density effect, whereby an increase in the proportion of racial/ethnic minority people in an area is associated with reduced morbidity among its residents, though evidence is varied. Discrepancies may arise due to differences in the reasons for and periods of migration, and socioeconomic profiles of the racial/ethnic groups and the places where they live. It is important to increase our understanding of how these factors might promote or mitigate ethnic density effects. Cross-national comparative analyses might help in this respect, as they provide greater heterogeneity in historical and contemporary characteristics in the populations of interest, and it is when we consider this heterogeneity in the contexts of peoples' lives that we can more fully understand how social conditions and neighbourhood environments influence the health of migrant and racial/ethnic minority populations.     

Social change, migration and sexual health: Chilean women in Chile and Australia

Cultural beliefs, norms and values regarding sexuality and gender roles forge people's sexual behaviour and understanding of sexual health risk. Acknowledging a person's cultural background is a key challenge for the promotion of sexual health programs and strategies for the prevention of sexually transmitted diseases (STDs) and HIV/AIDS. This challenge acquires larger dimensions when health promotion programs are directed towards migrant communities. This article examines narratives about past and present life experiences of Chilean women living in Australia and Chilean women in Chile. We inquire about social changes and exposure to education women experienced in their own country and in Australia and the ways in which migrant women define and articulate their experiences in relation to sexual health prevention. In comparing these experiences, we raise a number of questions about sexual health promotion and programs, including the prevention of STDs and HIV/AIDS targeted to specific migrant communities in Australia. Very few sexual health policies and strategies in Australia take into account the impact that the social and cultural background of migrants, social changes and the 'settlement process' has on the cultural construction of gender identity of migrants in the new country. We propose that these cultural constructs are key in the formulation of migrants' beliefs and attitudes towards sexuality and sexual health. We suggest that there is a need to build effective and culturally appropriate sexual health promotion and prevention strategies that build upon the social and cultural background and the present and past life experiences of migrant women and men.     

Prevention among immigrants: the example of Germany

Background  

A large and increasing part of the European population has a history of migration. Germany, for example, is home to about 15 million people with migrant background, which amounts to 19% of its population. Migrants may have differences in their lifestyle, health beliefs and risk factors compared to the autochthonous populations.     

Mindestindikatorensatz zur Erfassung des Migrationsstatus

Data on the health status of migrants are still scarce. One of the reasons for this is that migration status has not been well recorded in official statistics and epidemiological studies. In order to obtain an adequate and standardised operationalisation of migrant status, we first need an exact definition of the terms "migrant" and "migration background". We discuss approaches to the definition of terms and the surveying of ethnic minorities and migrants, and then develop a basic set of migration status indicators for use in epidemiological research. This set of indicators includes country of birth of the father and mother, year of immigration, mother tongue, German language skills and status of residence. The key indicator for the identification of migrants is the country of birth of the parents and not the nationality as was previously often the case. Thus, the classification based on the judicial category of nationality is replaced by a classification based on the biographical event "migration". Migration brings with it specific life conditions and challenges that can impact health across several generations. An instrument for surveying migrant status must be further developed both to reflect the special conditions of the life situation resulting from the migration experience and to take as full account as possible of all aspects of a migrant's history.     

Addressing alcohol and other drug use among young people from migrant and ethnic minority backgrounds: Perspectives of service providers in Melbourne,Australia

Young people from migrant and ethnic minority backgrounds are recognised as emerging priority populations for reducing alcohol and other drug (AOD)-related harms in Australia. Limited research has investigated how service providers address AOD challenges in migrant communities. In this qualitative study, we interviewed 15 service providers from AOD, migrant support, community and other health services in a diverse region of Melbourne. Interviews explored the challenges that service providers faced and the strategies they implemented to engage with young migrants in relation to AOD use. Thematic analysis was used to generate four themes: stigma as a barrier to service delivery, intergenerational differences between young people and parents, the need for outreach and establishing trust and understanding over time. Service providers believed that stigma prevented many young people from migrant backgrounds having open conversations about their AOD use with family members and professionals. Participants perceived that some parents had less AOD-related knowledge and lower English language proficiency than their children creating challenges for effective communication. Service providers recognised the importance of engaging with young people in settings where they felt comfortable rather than expecting them to approach their service. Participants also acknowledged the need to invest time in establishing trust and understanding with young migrants so they could facilitate conversations about AOD use as relationships evolved. Although service providers had a strong understanding of young people's needs, they found it challenging to build relationships in the context of funding and time constraints. Our results indicate the need for long-term funding and timelines that enable service providers to build strong relationships with young migrants, their families and their broader cultural communities to facilitate access to AOD support.