Access to Primary Care and Preventative Health Services of Migrants (eBook)

​Aldo Rosano, PhD, is senior researcher at National Institute of Health (ISS) in Rome, Italy.

​1. Foreword 2. Rights to primary care access and health prevention of non-nationals and migrants in the European Union Countries (Nadia Mignolli, Alessandra Fasano, Roberta Pace)Abstract: This chapter aims at illustrating how the different National Health Systems in the European Union (EU) countries meet the needs of both non-nationals and migrants in terms of laws regulating primary care and health prevention access. For this purpose, a comparative study is carried out using different sources of quality and quantitative information. Multidimensional and exploratory data analysis techniques are applied in order to produce clusters and to represent the different patterns of EU countries, visualising them also on detailed maps.3. Access and barriers to childhood immunization among migrant populations (Pierluigi Lopalco)Abstract: Childhood immunization is one of the most effective prevention services in public health. In high-resource countries, childhood immunization services are well established and high immunization coverage is warranted in the general population. Average vaccination coverage for childhood vaccines like diphtheria, tetanus, and pertussis (DTP) are close to 95% in Europe and North America. Some problems still exist in many European countries to reach high vaccination coverage against measles, mumps, and rubella (MMR), thus jeopardizing the measles and rubella elimination goal. In particular, sub-optimal vaccination coverage levels have been reported in disadvantaged groups like newly arrived migrants and travelling communities. Language barriers, lack of documents, are poor education are reported among the causes of missed opportunities for vaccination. This chapter reviews the situation of vaccination coverage levels among newly arrived and stable migrants in developed countries and will discuss the main determinants for access and barriers to vaccination services in this population.4. Access to medical examination for primary prevention among migrants (Alessio Petrelli, Anteo Di Napoli, Alessandra Rossi)Abstract: Use of healthcare services can differ among migrants and natives, especially in preventive care, also because of different health status perception. In this context, it is relevant to monitor access to health care, because resource limitation due to financial crisis introduced in public health policies medical copay fees and the reduction of essential medical services. We aimed to evaluate access to medical examination in the absence of disorders or symptoms by migrants, taking into account cultural and religious background, socioeconomic status, length of stay in the destination country, difficulties in learning the new language, and gender.5. Avoidable hospitalization among migrants and ethnic minorities in western countries (Laura Cacciani, Nera Agabiti, Teresa Dalla Zuanna, Cristina Canova)Abstract: Avoidable hospitalization (AH) relates to conditions for which hospital admission could be prevented by interventions in primary care. Such conditions, called Ambulatory Care Sensitive Conditions (ACSCs), have been used as a marker of accessibility and primary care effectiveness. A lack of high-quality primary and preventive care can, in fact, result in an increased AH. There is evidence of differentials on the use of healthcare services between migrants and ethnic minorities in western countries and the autochthonous populations, which may, in turn, generate differentials in the health status. The aim of this chapter is to address the issue of primary health care and preventive health services access of migrants and ethnic minorities in western countries, using hospitalization for ACSCs as an indicator. We perform a review of the existing international scientific literature that describes AH among migrants and ethnic minorities and compares the findings with those among non-migrant populations or the main ethnic groups. The quality of the selected papers as well as the AH definition considered are taken into account, and the specific context of hosting countries are considered and discussed. We will also analyse and discuss available secondary data on AH. 6.  Female migrants' attitudes and access to cervical and breast cancer screening in Europe (Sandra Buttigieg)Abstract: Despite the fact that breast and cervical cancers are the most common cancers affecting women in both the developed and less developed world, migrants adopt a rather passive attitude towards screening, namely through breast examination and mammography and cervical screening, respectively. This chapter provides a structured literature review on female migrants' cervical and breast cancer screening in Europe. The aim is to not only present epidemiological data comparing female migrants' access to screening as compared to nationals, but also to discuss reasons for female migrants' non-participation in cervical and breast cancer screening. The chapter also attempts to distinguish factors related to the adaptation of the different types of European Health Systems to diversity factors related to culture, language, and religion that may impact migrants' access to health systems and participation in prevention programs.7. Access to colorectal screening (Aldo Rosano)Abstract: In Europe, colorectal cancer is the second most common cause of cancer with over 200,000 deaths per year. Research has shown that ethnic minority groups in developed countries are less likely to participate in colorectal cancer screening than the majority population and hence less likely to be diagnosed at an early stage when treatment is potentially more successful. Previous research has indicated that ethnic groups living in EU countries perceive their risk of colorectal cancer as lower than the native population, suggesting that one explanation for lower participation in cancer screening could be lack of recognition of cancer risk. The chapter reviews the available evidence about the access to colorectal screening among migrants in EU countries. An analysis of data from the Health Interview surveys conducted in various EU countries on this topic are presented.8. Health-related lifestyles among migrants (Teresa Spadea, Raffaella Rusciani, Luisa Mondo, Giuseppe Costa)Abstract: Differences in health-related lifestyles can explain part of the difference in health outcomes between migrant and host populations, as well as across different migrant groups. Migrants also experience profound changes in their lifestyle with time since migration, as a result of the acculturation process. The mechanisms that underlie the occurrence of risky behaviours are therefore very complex, depending on the interrelation between different cultures and different migration histories, while the scientific literature on health-related lifestyles and risk factors for chronic diseases among migrants is quite scarce. Characterizing the risk profile of migrant populations is, however, essential in order to prioritize actions for prevention and health services organization. This chapter aims to fill this gap, starting with a brief conceptual framework of the mechanisms cited above and then focusing on the review of the existing knowledge on health-related lifestyles, such as smoking habits, alcohol use, diet, and physical activity, on one side; and, on specific risk factors and intermediate health conditions, such as overweight, obesity, and hypertension, on the other side. Wherever possible, new available data are also presented.9. Adaptation of primary health care for migrants: recommendations and best practices (Marie Dauvrin, Bernadett Varga)Abstract: Adapting primary health care to the needs of migrant patients requires adaptation at individual, organizational, and structural levels. This chapter reviews the available evidence regarding adaptations of primary health for migrants and identify examples of best practices that may serve as a template for those willing to implement such interventions in their primary care facility.10. Health policies, patterns, and barriers to migrants' access to primary health care (Sonia Dias, Inés Fronteira , Ana Gama, J Coloma, Jorge Simões, Henrique Barros)Abstract: Primary health care (PHC) should be a preferential way to access the healthcare system. Access to PHC is fundamental in terms of preventive medicine but also an important health equity indicator. In Portugal, PHC has been continuously strengthened with an ongoing reform initiated in 2006. Although migrants have been recognized as a group that tends to underuse preventive healthcare services, knowledge about patterns, determinants and barriers to migrants’ access, and use of PHC are still scarce. Using data from the National Health Survey, we compare migrants' access and utilization of PHC in 2005 and 2015. Using the same time period, we explore the existing policies regarding migrants' access to healthcare services and, more specifically, to PHC. Then, using document analysis, we describe the main barriers and facilitators to migrants' access to PHC. Based on the results, we discuss how policies on migration and health, the economic crisis, and PHC reform can explain access to PHC by migrants in Portugal. Resulting recommendations inform policies and strategies that promote access to PHC by migrants and reinforce preventive and health promotion initiatives among this population at national and international levels.11. Access to primary care and preventive health services of LGBTQ+ migrants, refugees, and asylum seekers (J Namer, O Razum)Abstract: Gender identity, gender expression, sexual orientation, and their conformance to dominant societal norms contribute to the super-diversity of today's migration patterns. Regardless of whether or not the individual's gender identity, gender expression, and/or sexual orientation is behind their reason to migrate, or their refugee or asylum-seeking status, non-heteronormative identity complicates the experience in the host country.  Language and cultural barriers already reduce migrants,' refugees', and asylum seekers' access to health care, and non-heteronormative identity acts as an additional barrier between individuals' human right to health care and the access to care. Preventive health services aimed at LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) individuals tend to overly focus on HIV and other sexually transmitted infections at the risk of overlooking other health concerns. Furthermore, these services may not always appreciate the inherent heterogeneity of the LGBTQ+ community, at times failing to differentiate between the healthcare needs of non-heterosexual and transgender individuals. Hence, there is an urgent need for solid steps towards "meeting the unique health-care needs of LGBTQ people," a call that addresses primary care and preventative health care services around the world. This chapter reviews the literature in advocacy of bridging the research and policy gap between the primary and preventive care required by and the care provided for LGBTQ+ migrants, refugees, and asylum seekers.12. Concluding RemarksList of AuthorsAGABITI Nera, Department of Epidemiology, Lazio Regional Health Service, ItalyBARROS Henrique, Institute of Public Health, University of Porto, Portugal BUTTIGIEG Sandra, University of MaltaCACCIANI Laura, Department of Epidemiology, Lazio Regional Health Service, ItalyCANOVA Cristina, Department of Molecular Medicine, University of PaduaCOLOMA Jorge, Universidade Nova de Lisboa PortugalCOSTA Giuseppe, Department of Clinical and Biological Sciences, University of Turin, ItalyDALLA ZUANNA Teresa, Department of Cardiologic, Vascular and Thoracic Sciences, University of PaduaDAUVRIN Marie, Institute of Health and Society, Catholic University of Louvain, BelgiumDI NAPOLI Anteo, National Institute of Migration and Poverty, ItalyDIAS Sonia, Universidade Nova de Lisboa, PortugalFASANO Alessandra, Researcher University of Salento, ItalyFRONTEIRA Inès, Universidade Nova de Lisboa, PortugalGAMA Ana, Universidade Nova de Lisboa, PortugalLOPALCO Pierluigi, University of Pisa, Italy MIGNOLLI Nadia, National Institute of Statistics, ItalyMONDO Luisa, Epidemiology Unit, ASL 5 Piedmont Region, Italy.NAMER Judith, University of Bielefeld, GermanyPACE Roberta, University of Bari ‘Aldo Moro’, ItalyPETRELLI Alessio, National Institute of Migration and Poverty, ItalyRAZUM Oliver, University of Bielefeld, GermanyROSANO Aldo, National Institute of Health, ItalyROSSI Alessandra, National Institute of Migration and Poverty, ItalyRUSCIANI Raffaella, Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, ItalySIMÕES Jorge,Universidade de Aveiro,  PortugalSPADEA Teresa, Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy.VARGA Bernadett, Catholic University of Louvain, Belgium