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Migrants and Health Care: Responses by European Regions (MIGHRER)

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Migrants and Health Care: Responses by European Regions (MIGHRER) World Health Organization Regional Office for Europe Regions for Health Network Migrants and Health Care: Responses by European Regions (MIGHRER) Complete reference material Edited by Marco Biocca, Benedetta Riboldi and Federica Sarti Index I. Introduction The health of migrants is a crucial and complex issue Regions for Health Network MIGHRER project Acknowledgments References used for planning the project II. Migration and Health - Ontological Security and Pluralist Inclusion 1. From the “healthy migrant effect” to the “unhealthy migrant effect” 2. Health, Migration and Ontological Security 3. Difference as normal in the health system? Institutional answers 4. Conclusions References III. Regional report Catalonia 1. Health system overview, national and regional situation 2. The migration phenomenon 3. Policy agenda, good practices and projects IV. Regional report Emilia-Romagna 1. Health system overview, national and regional situation 2. Migration phenomenon in Emilia-Romagna 3. Policy agenda, good practices and projects References V. Regional report North West England 1. Health system overview, national and regional situation 2. The migration phenomena 3. Policy agenda 4. Good practices and projects 5. Conclusions Appendices References (continues) VI. Regional report Sicily 1. Health system overview, national and regional situation 2. The migration phenomenon 3. Political agenda: the generations of resources and continuing medical education 4. Good practices and projects 5. Conclusions VII. Regional report Szabolcs-Szatmár-Bereg County 1. General characteristics 2. Regulations and legal framework 3. The policy agenda 4. Projects and experiences VIII. Regional report Ticino 1. Health system overview, national and regional situation 2. Regulations and legal framework 3. The migration phenomenon 4. Policy agenda 5. Good practices 6. Conclusions References IX. Regional report Tuscany 1. Health system overview, national and regional situation 2. Regulations and legal framework 3. The migration phenomenon 4. Policy agenda 5. Good practices and projects 6. Conclusions Annexes References (continues) X. Regional report Varna 1. Health system overview, national and regional situation 2. The migration phenomenon 3. Regulations and legal framework 4. Policy agenda 5. Good practices and projects 6. Conclusions References XI. Regional report Västra Götaland 1. Health system overview, national and regional situation 2. The migration phenomenon 3. Policy agenda 4. Good practices and projects 5. Conclusions References XII. Regional report Veneto 1. A view of the National and Regional Health System 2. The migration phenomenon 3. Policy agenda 4. Projects and good practices XIII. Regional report Wales 1. Context and terminology 2. Health systems overview, national situation 3. Regulations and legal framework 4. The migrant phenomena in Wales 5. Policy agenda 6. Good practices and projects 7. Conclusions Appendix (continues) XIV. WHO and the health of migrants in the European Region 1. The context for WHO action on migrant health 2. WHO action on migrant health in the European Region 3. Migrant health in the context of health system strengthening References XV. PICUM: Platform for International Cooperation on Undocumented Migrants 1. PICUM’s research on “Access to Health Care for Undocumented Migrants” 2. Knowledge base regarding undocumented migrants’ lack of access to health care 3. Collaboration among civil society, health care providers and local authorities 4. Identification and dissemination of good practices 5. Strategies to promote social inclusion of undocumented migrants 6. Anti-discrimination and human rights 7. Conclusions XVI. International Organization for Migration: selection of field programme on migrant health 1. Programmes at the “migrants approach” versus the “mobility system” 2. Europe and Neighbourhood countries References XVII. Migrant-friendly and culturally competent health care: a task force of the Health Promoting Hospitals network 1. Introduction 2. Priority areas of concern in accessibility of health services and quality of care for migrants 3. Language and communication barriers in clinical encounters 4. Effective interventions to reduce language barriers 5. Low level of patient information and participation 6. Effective interventions to improve patient information and participation 7. Cultural barriers and lack of cultural competence 8. Effective interventions to improve staff cultural competence 9. Conclusions References I. Introduction MIGHRER Report - WHO RHN I. Introduction “Migrants and Healthcare: Responses by European Regions” (MIGHRER) is a project of the Regions for Health Network (RHN) of the World Health Organization Regional Office for Europe (WHO-Euro). The aim of the project is to describe, in a systematic way, strategies and actions adopted in particular at the regional level in the European Countries concerning the health of migrants and health services provided in order to improve it. The basic rationale for the project is the assumption that there is a role for the regions - which should be studied and emphasized because of its relevance - in ensuring that national policies and strategies for migrants health are sensitively interpreted at local level and in promoting the actions needed for creating the proper conditions (health service organizations, coordination and integration of activities, resources for project, etc.). The first phase of the project was dedicated to gathering data from participating regions of the RHN and the results are presented in two versions: - this general report on the web - which includes the 11 regional reports with detailed information on the health systems, rules and initiatives relating to the migrants health and also an introductive chapter by Sandro Cattacin of the University of Geneva, and chapters on the work of PICUM (Platform For International Cooperation on Undocumented Migrants), the International Organization for Migration (IOM) and the Task Force on Migrant-Friendly and Culturally Competent Hospitals set up within the framework of the Health Promoting Hospital Network (HPH) of WHO Europe; - a short publication - which includes a general overview of the project and short summaries of the regional chapter particularly focused on “promising actions” planned at a regional level in order to improve migrants health. The health of migrants is a crucial and complex issue Migration is radically modifying human geography of societies in the entire world. Migrants are part of the society and are also the most vulnerable group of it, presenting a greater difficulty in accessing adequate care. Therefore to address this challenge of social cohesion we have to face a problem of innovation and promote a process of development of the current structure. Particularly the healthcare systems have to consider differences in needs, beliefs and attitudes and make a step forward in the field of communication as one of the great barrier for migrants. They have to became, as stated in the Resolution of the World Health Assembly 61.17 on the Health of Migrant1, “migrant sensitive” ensuring that health services are delivered in a culturally and linguistic appropriate way, in a comprehensive, coordinated and financially sustainable way, 1 http://apps.who.int/gb/ebwha/pdf_files/A61/A61_R17-en.pdf (.pdf, 16 Kb) Updated April 2010 I - 1 I. Introduction MIGHRER Report - WHO RHN and that the health and relevant non health workforce understand and address the health and social issues associated with migration. In this project migrants have been considered as people from EU and non-EU countries which can be permanent, temporary and irregular. Health personnel mobility and Cross border health care were not taken into account. Providing an overview of the demography of migration in Europe is complicated due to heterogeneity of data and definitions. Some statistics are based on nationality, others on place of birth and some others on legal status. However, no matter how the data is reported, it is clear that the number of migrants in Europe is large and growing. Using International definitions, the UN estimates that in 2005, there were more than 190 million global migrants. This is an increase of approximately 50 million individuals since 1950. Of that total, just over 64 million or 34% of them resided in Europe. The enlarged EU was home to 44.1 million international migrants- some 70% of the total in Europe. Migration in the EU has been strongly affected by geographic proximity. In fact, 30% of the migrants living in the EU are originally from other EU countries. Furthermore, net migration accounted for almost 85% of European total population growth. It is observed a substantial variability in size and diversity of migrant groups across nations of the WHO European Region. The proportion of migrants in the European population was estimated to be 8.9% in 2005 while in 1960 was 3.4%. The percentages of migrants vary across European region with Western European nations reporting levels of 10-15% of the total population. In terms of numbers, the largest populations of migrants are found in 5 countries: Germany (10.1 million), France (6.5 million), the United Kingdom (5.4 million), Spain (4.8 million) and Italy (2.5 million). In the ‘90s, the contemporaneous economical growth and population decrease has favoured the immigration also in Mediterranean Europe (Italy, Spain, Portugal, Greece), that previously had only been a transit area towards North Europe. It should be noted that also Ireland,
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