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Promoting Refugees Right 442 Report PROMOTING REFUGEES’ RIGHT TO HEALTH AND SOCIAL INCLUSION: A SYSTEMATIC APPROACH Katarina Carlzén1, Slobodan Zdravkovic2, 3 1 The County Administrative Board of Skåne, Sweden 2 Department of Care Science, Faculty of Health and Society, Malmö University, Sweden 3 Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Sweden Corresponding author: Katarina Carlzén (email: [email protected]) ABSTRACT The societal effects of forced migration are region of Sweden. The main components of different geographical areas of Sweden. The a burning topic of current political debate this process are now being disseminated to effort we describe in this report is expected in Europe. There is an obvious absence of other regions in Sweden, which is contributing to greatly contribute to providing better sustainable approaches to deal with this to national capacity-building. In addition, opportunities for all refugees in Sweden, issue. We describe a collaborative and a national educational programme is being and to empower them to control their own systemic regional effort, involving some 50 developed for those engaged in conveying civic adaptation to a new life, thus reducing the partners, towards a health-promoting and and health information to asylum seekers and risk of health deterioration often seen among inclusive integration process designed to refugees. This work involves stakeholders them. reach all refugees who settle in the southern in collaboration with six universities from Keywords: MIGRATION, REFUGEES, HEALTH PROMOTION, INTEGRATION, SWEDEN INTRODUCTION BOX 1. PARTNERSHIP SKÅNE AND THE COUNTY ADMINISTRATIVE BOARD In Europe, the societal effects of forced migration are Partnership Skåne began in 2008 with two projects and a burning topic of current political debate. The lack of 16 partners. Today, some 50 social stakeholders are active systemic measures for social inclusion and improving partners in the different activities. Partnership Skåne is the health of migrants, based on actual needs, poses an closely linked to existing formal agreements and strategic platforms for collaboration on a regional and national level, urgent challenge to policy-makers and professionals and is coordinated by the County Administrative Board in working in the field, and constitutes a threat to the Skåne. sustainability of refugee policies. The County Administrative Board acts on behalf of the national government to promote regional capacity for We describe a systematic and holistic model for an receiving refugees with a residence permit. For this, inclusive and health-promoting integration process for facilitating collaboration between different stakeholders is newly arrived refugees in Skåne in southern Sweden. crucial. The model, called Partnership Skåne, originated in 2008 and has gradually come to be recognized as a national model for refugee integration (Box 1). Its central umbrella organizations, and are being nationally components are recognized as good practices by disseminated, contributing to national policy-making authorities and organizations, as well as by civil society (1). Due to national legislation, asylum seekers are not PUBLIC HEALTH PANORAMA VOLUME 2 | ISSUE 4 | DECEMBER 2016 | 401-588 PROMOTING REFUGEES’ RIGHT TO HEALTH AND SOCIAL INCLUSION: A SYSTEMATIC APPROACH 443 covered by the model. However, this will change in 2017, The complex interaction between economic and social when they will gradually be included. vulnerability, marginalization and ill health poses serious challenges. Thus, development of the model Furthermore, additional tools for national started with several intersectoral seminars addressing capacity -building in health promotion and questions such as to what extent the integration inclusion are currently being prepared for national process was empowering, health promoting and dissemination. conducive to social inclusion. The second step focused on which procedures could be developed in support of this, followed by the production of action plans around INTERSECTORAL MODEL FOR prioritized areas of coordinated activities (shown in INTEGRATION AND HEALTH Fig. 2). The action plans are listed below: PROMOTION I. provision of culturally sensitized civic and health information to all refugees; Partnership Skåne is designed as a strategic– operational model, based on accumulated experience II. collaboration with civil society, and access to and research, that addresses the different impacts health -promoting and inclusive activities; and of forced migration on physical and mental health. Previous research indicates that refugees’ health III. collaboration with researchers for the production and well-being deteriorate over time after settling of new knowledge and its implementation in in Sweden (2). Refugees are at a higher risk of poor practice. health compared with the general population; this is obviously partly tied to their experiences before and The activities all started as single projects but during the flight. Nevertheless, another important today constitute joint collaborative platforms for explanatory factor is how the initial period in the development. host country plays out at the individual and family FIG. 2. MODEL OF THE THREE FUNDAMENTAL PRINCIPLES level. The theoretical model illustrates how a number AND INTERLINKED COMPONENTS OF PARTNERSHIP SKÅNE. of risk factors may interact, resulting in the gradual deterioration of health for a period after settlement The needs and perspectives of the target group (Fig. 1). This changes only when some form of integration into society takes place. FIG. 1. MODEL OF CHANGE IN HEALTH DURING THE FIRST II. Collaboration with civil society PHASE AFTER A REFUGEE HAS RECEIVED A RESIDENCE PERMIT (3). THE ILLUSTRATION IS BASED ON A TIMELINE OF BETWEEN 7 AND 10 YEARS, WHICH IS CURRENTLY CONSIDERED TO BE THE AVERAGE TIME FOR INTEGRATION INTO SWEDISH SOCIETY (4). Health curve for a new arrival I. Civic and health information The migration process Health PARTNERSHIP ASYLUM Settled in begins SKÅNE a new country to improve Language III. MILSA – support platform for migration Crisis and health Mental/physical ill health Identity Lack of contacts Altered relationships Established in society Holistic and Knowledge Altered inclusive based lifestyle Lack of trust ПАНОРАМА ОБЩЕСТВЕННОГО ЗДРАВООХРАНЕНИЯ ТОМ 2 | ВЫПУСК 4 | ДЕКАБРЬ 2016 Г. | 401-588 PROMOTING REFUGEES’ RIGHT TO HEALTH AND SOCIAL INCLUSION: A SYSTEMATIC APPROACH 444 I. CIVIC AND HEALTH INFORMATION: refugees. The programme is regularly evaluated on A KEY TO HEALTH AND EMPOWERMENT an informal individual, as well as a scientific, level A praxis that constitutes the basis of the system (see Box 2) (8). is to provide refugees soon after settlement with quality-assured and culturally sensitized II. CROSS-SECTORAL COLLABORATION information about health- and society-related issues TO OPEN UP SOCIAL ARENAS THAT in their mother tongue. Research shows that health FACILITATE INCLUSION AND HEALTH literacy is a factor to consider when conveying Creating a supportive setting in order to promote health -related information. Health literacy concerns inclusion, well-being and health is a crucial objective people’s knowledge, motivation and competencies of Partnership Skåne, regardless of the specific with regard to accessing, understanding, focus of the different activities that are carried out. appraising and applying information in order to Therefore, a main component of the model is to enable make judgements and decisions in everyday life access to environments that facilitate networking concerning health care, disease prevention and and language practices within civil society. On health promotion (5, 6). It has been shown that a strategic level, civil society is involved in planning a majority of newly arrived refugees in Sweden and decision-making, while on an organizational and have inadequate health literacy (7), which reinforces operational level, civil society actors are engaged in the need for systematic, accessible and culturally providing services to refugees in conjunction with sensitized information. Conveyed through dialogue, the public support system. Refugees are involved in such information provides a basis for empowerment, already existing activities and associations (11), but and for taking care of one’s health. Through the also in the development of new activities designed civic and health communicators tied to the platform, to meet their special needs, such as the need for nearly all refugees in Skåne partake in a programme psychosocial support (4). covering 32 different thematic areas adapted to suit refugees’ specific needs in an environment III. MILSA – SUPPORT PROGRAMME FOR conducive to trust and participation. The civic MIGRATION AND HEALTH and health communicators all have personal A fundamental goal of the work described above backgrounds of forced migration and previous is to create a foundation for close practice-based education in either the civic or health field but also collaboration with the research sector. This is receive extensive continuous training. Being at the important, partly in order to gain from mutual centre of the system, i.e. Partnership Skåne, they are learning processes and partly to produce new uniquely placed to help ensure that the continuous practice -based knowledge and scientific evidence development work is adapted to the actual needs of to underpin policy development. MILSA recently concluded its first programme period of four BOX
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