Search results

This paper aims to first demonstrate the prevalence and methodological and theoretical limitations of approaches oriented towards either migrants entitlement or their access to health care; and, second, to demonstrate an alternative approach involving a conceptual and analytical framework that integrates these perspectives as levels of analysis within a holistic model.

The paper consists of three brief case studies each demonstrating particular difficulties in adopting either policy oriented “entitlement” approaches or practice driven orientations examining migrants access to health care. Each case study will examine briefly an aspect of the policy and legal frameworks within which health care is delivered to immigrants. The studies encompass the phenomenon of “hidden” immigrant children in Sweden, migrants crossing the Spanish border from North Africa, and asylum seekers in the UK.

The case studies form a basis for presenting an integrated model encompassing a multi‐level framework for examining the health care of migrant populations.

The international applicability of the model is discussed drawing further on the author's work as scientific advisor to the EU on immigrant health and as lead researcher in a four country EU study into refugee health and social care.

The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries.

The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy.

Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations.

This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers.

Ideas of health-related deservingness in theory and practise have largely been attached to humanitarian notions of compassion and care for vulnerable persons, in contrast to rights-based approaches involving a moral-legal obligation to care based on universal citizenship principles. This paper aims to provide an alternative to these frames, seeking to explore ideas of a human rights-based deservingness framework to understand health care access and entitlement amongst precarious status persons in Canada.

Drawing from theoretical conceptualizations of deservingness, this paper aims to bring deservingness frameworks into the language of human rights discourses as these ideas relate to inequalities based on noncitizenship.

Deservingness frameworks have been used in public discourses to both perpetuate and diminish health-related inequalities around access and entitlement. Although, movements based on human rights have the potential to be co-opted and used to re-frame precarious status migrants as “undeserving”, movements driven by frames of human rights-based deservingness can subvert these dominant, negative discourses.

To date, deservingness theory has primarily been used to speak to issues relating to deservingness to welfare services. In relation to deservingness and precarious status migrants, much of the literature focuses on humanitarian notions of the “deserving” migrant. Health-related deservingness based on human rights has been under-theorized in the literature and the authors can learn from activist movements, precarious status migrants and health care providers that have taken on this approach to mobilize for rights based on being “human”.

This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace.

Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives.

Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research.

This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace.

Purpose – Academic campuses in India in recent years have witnessed an increase in the proportion of older people due to the rise in the age of superannuation of faculty and their cohabitation with older parents. However, such campuses continue to have a skewed program which favor the needs of the younger population. For the present study, a residential academic campus equipped with a health care facility was selected to understand the challenges of the family caregivers of older people residing in it.

Methodology/Approach – Exploratory in-depth interviews were conducted with 154 family caregivers. Secondary data were obtained from the campus hospital records.

Findings – Data revealed that family caregivers experienced various challenges in providing older care in the campus due to unavailability of paid supportive caregivers, lack of community support, and inadequate housing. Though the academic campus has a health care facility, the entitlement rights to it varies among the older people in campus. While the campus health facility was not congenial for family caregiving, it was utilized as a space for providing long-term care. This chapter suggests the need to extend a public heath model of family caregiving in campus.

Research limitations/implications – The study has implication for modifying similar academic campuses in India for facilitating family caregivers of older people.

Originality/Value of Paper – This is the first study of its kind which explored the challenges of family caregiving for older people in academic campuses in India.

Refugees commonly face inequitable access to health care services in their host country. This study aimed to identify factors influence refugee access to health services and to assess perceptions of barriers to health care for different refugee groups in Jordan.

In-depth interviews were combined with document analysis and analyzed using thematic and framework methods.

Findings highlighted inequitable access to health services between different refugee groups. Unlike Palestinian refugees from the West Bank, Palestinian refugees from Gaza faced financial barriers to access health care as a result of citizenship status, which affected their health insurance, referrals for health care and legal right to work. Syrian refugees similarly lacked Jordanian citizenship and health insurance and mainly depended on UNHCR for health services, though some were able to acquire work permits and pay for private care.

This study demonstrates a need for politically and economically appropriate policies to minimize the disparity of health care access among these refugee groups.

Equity is an issue that pervades all aspects of primary care provision for children and as such is a recurring theme in the Models of Child Health Appraised project. All European Union member states agree to address inequalities in health outcomes and include policies to address the gradient of health across society and target particularly vulnerable population groups. The project sought to understand the contribution of primary care services to reducing inequity in health outcomes for children. We focused on some key features of inequity as they affect children, such as the importance of good health services in early childhood, and the effects of inequity on children, such as the higher health needs of underprivileged groups, but their generally lower access to health services. This indicates that health services have an important role in buffering the effects of social determinants of health by providing effective treatment that can improve the health and quality of life for children with chronic disorders. We identified common risk factors for inequity, such as gender, family situation, socio-economic status (SES), migrant or minority status and regional differences in healthcare provision, and attempted to measure inequity of service provision. We did this by analysing routine data of universal primary care procedures, such as vaccination, age at diagnosis of autism or emergency hospital admission for conditions that can be generally treated in primary care, against variables of inequity, such as indicators of SES, migrant/ethnicity or urban/rural residency. In addition, we focused on the experiences of child population groups particularly at risk of inequity of primary care provision: migrant children and children in the state care system.

The purpose of this paper is to investigate how nurses’ working in emergency health care in Sweden experience their encounter with undocumented migrants.

A total of 16 qualitative interviews were conducted and analyzed using a phenomenographic approach, aiming at describing various ways in which nurses experienced undocumentedness.

The process of assessment involves formal regulations as well as interpersonal features, leading to uncertainty, conflicts and dilemmas when judging such situations. Nurses’ conceptions concerned the undocumented migrants’ migrant status and social existence; second, conflicts in encountering undocumentedness pertaining to an identification systems and judgments and emotional reactions; and thrid, shifts within and between arbitrary boundaries, with unclear conditions for interaction and creative maneuvering.

Further research is needed to develop guidelines or other structures to support nurses who deal with this kind of assessment in their daily work, to reduce ethical dilemmas and the risk of inequitable treatment.

Guidelines to support nurses need to be further debated and discussed and implemented in health care education, as well as in clinical contexts.

Increased knowledge and awareness among nurses concerning migrants’ status and rights, might lead to better working conditions for nurses and thus more secure judgments.

Research with a specific focus on emergency nurses’ conceptions of undocumentedness and their strategies for handling the ensuing practical and ethical dilemmas has not been conducted in Sweden before using a qualitative method.

The purpose of this paper is to examine how access to health care for (rejected) asylum seekers in an eastern German state is structured and experienced and to consider the implications for their human rights.

The paper is based on 12 in-depth interviews with rejected black African asylum seekers and also draws on ethnographic research undertaken at a grassroots refugee organisation and asylum homes. The analysis of the interview data are framed by theorisations of “everyday practices” as “tactics” of resistance to an imposed order.

Accomplishing health care access involved a range of structural barriers and humiliating interactions with administrative and health care staff, which had adverse consequences for their health status and were injurious to their human rights and dignity. The study participants used a range of oppositional and discursive tactics in an effort to secure certain (health) outcomes, mediate social relations and resist their domination as asylum seekers.

Further research should focus on the cumulative micro-level effects of asylum policies on health care access and how they create health inequities and violate asylum seekers’ rights and dignity.

Policy priorities should include the provision of human rights education as well as training and support for administrative and health staff.

There is limited qualitative research on the health care experiences of asylum seekers in Germany. This paper makes policy recommendations and identifies areas for further research and human rights advocacy.

Following the introduction of user fee for interpreting in Danish health care, a considerable decrease in interpreter services has been shown. This study aims to explore the experiences of language minority patients with health-care encounters when an interpreter was needed but not present.

Semistructured, in-depth interviews were conducted with 13 language minority patients with limited Danish proficiency. All interviews were conducted with interpreters in the participants’ native language. Data were analyzed using an inductive thematic approach.

Most participants experienced communication difficulties and difficulties participating actively in their own health care. The experience of unresolved language barriers led to a high degree of uncertainty and left the participants with unanswered health concerns. Participants expressed a reluctance to seek health care, which consequently limited the utilization of health care services.

Although the findings only represent a small sample of patients, the results still reveal major challenges that minority-language patients encounter when seeking health care. Future studies should explore, if the intention of the law is met through the user fees.

Despite having the same entitlements as native Danish-speaking patients, minority-language patients experienced difficulties accessing and using health care services due to the user fee and unresolved language barriers. The study elucidates patient perspectives and points to important ways of improving the quality of health care.

To the best of the authors’ knowledge, no investigation into the communicative consequences of the introduction of the user fee for interpreting services exists. Thus, this study seeks to address that gap.