Best Practices in Responding to Refugee and Migrant Health - - PowerPoint PPT Presentation

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Best Practices in Responding to Refugee and Migrant Health - - PowerPoint PPT Presentation

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14th Summer Institute on Migration and Global Health, July 2019 Best Practices in Responding to Refugee and Migrant Health Challenges in Europe Report on the Health of Refugees and Migrants in the WHO European Region Dr. Santino Severoni,

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14th Summer Institute on Migration and Global Health, July 2019

Best Practices in Responding to Refugee and Migrant Health Challenges in Europe «Report on the Health of Refugees and Migrants in the WHO European Region»

  • Dr. Santino Severoni,

Director a.i. Division of Health System and Public Health Coordinator Migration and health programme Division of Policy and Governance for Health and Well-being

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Setting the scene:

Migration in the WHO European Region

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Migration and health in the international and regional agenda

  • WHA 70.15
  • WHO Global action

plan to promote refugee and migrant health

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Voted for Voted against Abstention from voting Did not attend

Result of the United Nations General Assembly vote for the endorsement of the Global Compact on December 2018

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WHO Migration and Health Programme (MIG)

Biennial Summit Policy dialogue Flagship Courses/Summer Schools Webinars on health challenges faced by migrants and the host populations Knowledge repository

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  • Aim: to create an evidence base to support

the Member States to promote refugee and migrant health by implementing the Strategy and Action Plan.

  • Results
  • Migratory trends in the region
  • Health profile
  • Healthcare organization and delivery
  • Progress in the region
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Age structure of the national and non-national populations in the EU 1990–2017

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Comm mmunicable diseases

  • Vulnerability to infectious diseases can stem from

lack of health care or exposure in transit and poor living conditions in the destination country

  • Risk of transmission from refugee and migrant to

host population is very low

  • May have lower uptake rate of new vaccinations
  • Originating from a country with a high prevalence
  • f TB puts migrants at greater risk
  • A significant proportion of migrants who are HIV

positive acquire infection after arrival in the Region

  • Tropical and parasitic infections may enter the

Region through refugees, migrants and travelers from endemic areas

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CDs - TB

Overall 30% of all TB notifications within the WHO European Region are in migrant patients

  • In low TB incidence countries including the United

Kingdom, Germany, Italy, and France, over 50% of all TB cases occur in migrants

  • Countries such as Hungary, Slovakia and Poland, which

have a higher incidence of TB in the native population and with migrants accounting for less than 5% of the total proportion of TB cases

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CDs - HIV

Worldwide

  • 1.8 million newly infected
  • 36.7 million people living with

HIV

  • 1.0 million AIDS deaths

WHO European Region

  • 153, 407 newly infected
  • 2.4 million people living with HIV
  • 4,651 AIDS deaths

500 000 1 000 000 1 500 000 2 000 000 2 500 000 3 000 000 3 500 000 4 000 000

People newly infected with HIV globally People dying from HIV related causes globally

ECDC/WHO EURO - HIV/AIDS surveillance in Europe 2015

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Member States of the WHO European Region with a national immunization programme that includes refugees and migrants

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Comparison of Migrants’ SMR at Global and WHO Regional Level

1 2 3 4 5 6 7 8 9 WHO EURO ALL Source: Aldridge et al., 2018 (17)

Mortality estimates tend to be lower in migrants than in the European host population for neoplasms, mental and behavioral conditions, injuries, endocrine, and digestive conditions

StandardisedMortality Ratios (SMR)s are estimated

to be higher for infections, external causes, and cardiovascular disease. The remaining categories showed no evidence of a difference between migrants and the European host population. Contextual factors influence health outcomes such as country

  • f origin.
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Migrant-Specific Risk Factors

  • Pre-migration stage
  • During the journey
  • Low-levels of integration,

discrimination and disadvantaged socioeconomic positions in country of destination

Source: Reuters 2015

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Noncommunicable diseases

  • Refugees and migrants appear to have lower prevalence rates

compared with the host population for many NCDs on arrival

  • Prevalence rates, especially for obesity, begin to converge with longer

duration of stay

  • In general, refugees and migrants in Europe have a higher incidence,

prevalence and mortality rate for diabetes than the host population, with higher rates in women, depending on the country of origin

  • Although refugees and migrants have a lower risk for all neoplasms

except cervical cancer, they are more likely to be diagnosed at a later stage in their disease than the host population in Europe

  • There is no clear pattern for cardiovascular diseases and prevalence

may be linked as much to socioeconomic factors as to migration- specific factors.

  • Refugees and migrants experience worse pregnancy-related

indicators than host populations

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Mental Health

  • Risk factors for mental health problems may be experienced during

all phases of the displacement and migratory process and in settling in the host country.

  • Prevalence of PTSD among refugees is higher than in the host

populations.

  • Prevalence of depression and anxiety tends to be higher than in

host.

  • Poor socioeconomic conditions are associated with increased rates
  • f depression in refugees after resettlement.
  • Migration was also found to be a risk factor for children’s mental

condition

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Key issues; access to health systems

  • Ensure entitlements and access to

services for all migrants throughout the migration trajectory

  • Implement structural changes as

needed, and develop a multi- stakeholder approach

  • Ensure provisions for migrants are

incorporated into general health system planning and future strategy documents

  • Strengthen health information systems

Degree of access to health services

Access only to emergency services Greater access to some services or for some categories of undocumented migrants Full access under specified conditions

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Progress in the region

32 8

Explicit component on migration and health in national …

Yes No 20 20

Assessment been conducted on the health needs of refugees & migrants?

19 21

Assessment on the health service coverage for refugees and …

26 14 Has a regional or national contingency plan for large arrivals of refugees & migrants? Yes No 20 20 Routinely collect and include data

  • n migration-related variables?

25 15 Involvement of non-health sectors in conducting assessments of health needs?

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Conclusions

While communicable diseases are commonly linked with displacement and migration, there is a growing awareness that a range of acute and chronic conditions also require attention Research limitations include the lack of routinely collected , disaggregated and comparable data and definitions, as well as a tendency for studies to focus on

  • ne specific disease

Most evidence suggests that multiple factors, including migration, influence the health status of refugees and migrants False myths Access to social and health services varied across the Region, with legal status, language barriers and discrimination generally being influential factors

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There is no public health without refugee and migrant health

THANK YOU!