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Health As a Fundamental Right: a Study on Migration and Healthcare in Turin

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Health As a Fundamental Right: a Study on Migration and Healthcare in Turin > 01 2012 > 01 TS LA BORATORIO DEI DIRITTI FONDAMENTALI R LA BORATORIO DEI DIRITTI FONDAMENTALI EPO H R C R ESEA F R LD HEALTH AS A FUNDAMENTAL RIGHT: URIN T A STUDY ON MIGRATION AND HEALTHCARE IN TURIN RE IN A C H LT T: A H ND HE A TION A AS A FUNDAMENTAL RIG A FUNDAMENTAL AS H STUDY ON MIGR STUDY A HEALT Digital printing: SIREA SERVICE photo: STEFANIA GIANNUZZI LDF RESEARCH REPORTS > 01 2012 LDF RESEARCH REPORTS > 01 2012 ISSN 2280-8884 cover stampa ING.indd 1 19/02/13 10:39 LABORATORIO DEI DIRITTI FONDAMENTALI HEALTH AS A FUNDAMENTAL RIGHT: A STUDY ON MIGRATION AND HEALTHCARE IN TURIN LDF RESEARCH REPORTS > 01 2012 LDF RESEARCH REPORTS > 01 2012 AUTHORS: IRENE BI GLINO, ANTHONY O LMO With the contribution of: • Eros Brunone Avena (box 7, Cultural mediators as essential players in intercultural healthcare: a socio-anthropological perspective) • Serena Coppola (para. 2.1.4. The European Union) • Elena Grasso (para. 2.1.5. The national level) • Anna Odone (Appendix 2 Migrant health: health status of migrant populations in Italy; para. 1.2.2., Quantitative epidemiologic data). Statistical data by the Servizio Sovrazonale di Epidemiologia dell’Azienda Sanitaria Locale TO3 – presented in Chapter 4, The health status of the migrant population in Turin, have been processed by • Luisa Mondo and Anna Odone. © LABORATORIO DEI DIRITTI FONDAMENTALI ALL RIGHTS RESERVED. ISSN 2280-8884 The report is available at: www.labdf.eu/pubblicazioni/rapporti “It is my aspiration that health will finally be seen, not as a blessing to be wished for; but as a human right to be fought for.” Kofi Annan “…the right to health is much more than a convenient phrase which health workers, non-governmental organisations, and civil-society groups can brandish about in the vague hope that it might change the world. The right to health is a legal instrument—a crucial and constructive tool for the health sector to provide the best care for patients and to hold national governments, and the international community, to account.” The Lancet (Editorial) The right to health can be understood as a right to an effective and integrated health system, encompassing health care and the underlying determinants of health, which is responsive to national and local priorities, and accessible to all.” Paul Hunt ACKNOWLEDGMENTS We are grateful to Giuseppe Costa, for the precious advice he provided and for agreeing to share the data of the Servizio Sovrazonale di Epidemiologia dell’Azienda Sanitaria Locale TO3. We are also grateful to Luisa Mondo for all her help, for assisting us with revising the text and for her endless patience. We further wish to thank: Matteo Bagatella, Roberto Bertolino, Alberto Biglino, Margherita Busso, Alessandra Cipparrone, Serena Coppola, Oriana Elia, Franca Fronte, Elena Grasso, Valentina Grosso Gonçalves, Chiara Marinacci, Piergiuseppe Olmo, Stefania Orecchia, Valentina Porcellana, Tania Re, Piercarlo Rossi, Guido Savio, Teresa Spadea, Manuela Spadaro, and Cecilia Tibaldi. We would like to express our gratitude to all interviewees for the time they devoted to us and for sharing their unique experiences. Finally, we wish to thank Laura Ferrero for her research assistance. LDF’s activities are funded by The present report presents the results of a research project focused FOREWORD on access to healthcare by migrants in the Turin (Italy) area, carried out in 2011 and 2012 by the Laboratorio Diritti Fondamentali (LDF). According to Vladimiro LDF’s philosophy, the study buries its roots in the law, tracing the contours Zagrebelsky of the right to health and its definition as articulated in international human rights law. At the same time, the study aims to provide an account of concrete phenomena relating to the right to health as they surfaced from a field investigation in the Turin area. To cite a phrase often found in rulings issued by the European Court of Human Rights, this study does not concern itself with rights “that are theoretical or illusory but rights that are practical and effective”. Hence, considerable attention is devoted to the so-called social determinants of health and to the way social conditions impact on the effective, non-discriminatory enjoyment of the fundamental right to health by members of a particularly vulnerable segment of the population. Aspects of the study that are grounded in legal principles are reconciled, in methodology and content, with a practical analysis of the social reality as observed ‘on the ground’. The study is by nature interdisciplinary and this aspect clearly emerges in the dialogue and exchange that the authors of the study – jurists by training – have been able to establish with a public health specialist and a medical anthropologist. The study area is geographically limited to the city of Turin. The methodology used, whereby a web of social relationships is constructed through interviews with a large number of health practitioners and professionals, would have been impossible to carry out on a regional or national scale. However, this does not constitute a weakness. Detailed, careful investigation of the phenomena studied, both in legal and social terms, is a distinguishing feature of the research presented in this document. Restricting the playing field to a relatively circumscribed area made the enterprise possible. The study area and the employed methodology provided a unique experience for the authors, which I believe is worth highlighting. The actors they sought to interview were extremely responsive and demonstrated a genuine willingness to contribute to the researchers’ efforts. This readiness extended well beyond natural courtesy, to a demonstration of authentic interest (and perhaps excessive trust) towards legal discourses rooted in human rights. This, in my view, is of great significance: it reveals what occurs when jurists direct their attention to the concrete ramifications and ‘real life’ circumstances that are usually confined to the realm of theory and abstraction. The openness encountered by the researchers also reflects a need, expressed by people who work in extremely challenging physical and social contexts, to exchange and compare views and experiences. Responding to this need from a different standpoint, namely a different professional background, provided an opportunity to show recognition and respect for the role these professionals perform. It is difficult to summarize and evaluate the results of the present research in a handful of words. While highlighting possible and necessary improvements that need to be implemented in the sphere of access to health care and migration, the study also discloses the existence of a unique system, developed in the Turin area, that often succeeds in providing solutions to the numerous problems experienced by migrants. Such a conclusion, however, should be verified by comparing the findings of the study with the views of migrants. Their voice was not heard during the course of the present research, as this would have required further resources and additional time. However, investigating the direct experience of migrants will constitute a promising trajectory for future research. Overall, the information gathered throughout the study suggests that, despite some room for improvement in coordination efforts, public health facilities often work in synergy with the non-profit and voluntary sector. The latter forms of collaboration not only make up for shortcomings in the public sector, but also provide services that, because of their very nature, the public sector would experience difficulties in providing. Thus, when combined, the public and voluntary sectors constitute the core of a system that responds to the criterion of subsidiarity, notwithstanding its roots in a 19th century religious tradition which is unique to Turin. This system may be interesting not merely within the scope of the present study, but also as a future model. Comparison with different scenarios characterizing other European countries is an important facet of LDF’s work. Now that a number of obstacles to the effective realization of the right to health have been identified and some satisfactory solutions have been found in the Turin area, it would be promising and useful to perform comparative assessments. To the young researchers and authors of the report, to those who have worked on the project with them or have provided advice, it remains for me to express my thanks and appreciation. LIST OF ACRONYMS A&E Accident and Emergency AIDS Acquired Immune Deficiency Syndrome ASL Azienda Sanitaria Locale (Local Health Service Authority) CEDAW Committee on the Elimination of Discrimination against Women CERD Committee on the Elimination of Racial Discrimination CESCR Committee on Economic, Social and Cultural Rights CIE Centri di Identificazione e Espulsione (Identification and Repatriation Centres) COA Centro Operativo AIDS (AIDS Operative Centre) CRC Committee on the Rights of the Child CSDH Commission on Social Determinants of Health ECHR European Convention on Human Rights ESC European Social Charter EU European Union FGM Female Genital Mutilation HDD Hospital Discharge Documentation HIV Human Immunodeficiency Virus ICESCR International Covenant on Economic, Social and Cultural Rights ILO International Labour Organization INAIL Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro (National Occupational Safety Agency) INPS Istituto Nazionale della Previdenza Sociale (National Social Insurance Agency) ISI Informazione Salute Immigrati (Immigrant Health Information) ISTAT
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