The Geneva Health Forum Abstracts

B. Gushulak1 1Migration Health Consultants, Vienna, Austria

Key issues: Limits to health care; adverse health outcomes; public health implications of restricted access.
Meeting challenges: Improving health access through relevant health polices for migrants and mobile populations. Better identifi cation of groups in need.
Conclusion and recommendations: It is currently estimated that the number of people who live and work outside of their country of origin comprise a global population in excess of 190 million individuals. Frequently, health matters in migrant populations have been addressed in terms of the legal or administrative status of the community. This approach can result in situations where access to some health services may be limited or restricted. If migrants were considered as a nation they would represent the fi fth largest country in the world in terms of population. Approaching migrants in this context can assist in the appreciation and management of migrant health concerns through a different lens. In common with national populations, migrants are diverse and health and demographic characteristics vary among migrant subpopulations. Risks of adverse health outcomes and need for services vary as a consequence of the interaction of social, medical and economic factors. Some health and disease issues relate to the environment at the migrants? origin while others result from the process of migration itself. Addressing migrants as a global community can allow for the standardized identifi cation of groups at risk of adverse health outcomes and those in need of preventive or therapeutic intervention. In a manner analogous to that in which nations determine health resource allocations on the basis of risk and need, this approach can provide a uniform, globally applicable basis upon which health policies for migrants can be developed. The presentation will review this framework and provide examples of how it could assist national and global initiatives directed towards the management of infectious and non-infectious diseases and illnesses.

P.F. Walker1 1Department of Internal Medicine, University of Minnesota, St Paul, USA

Key issues: Complex interactions between the patient, the health care delivery system and providers all impact satisfaction and outcomes for immigrants to America. 99.3% of Americans are first-generation immigrants or children of immigrants, and yet the struggle of the immigrant to receive high quality care in America has yet to be resolved. This presentation will provide an overview of demographic changes in America, and key barriers to care for immigrants. Highlights of key national and statewide initiatives to provide high quality, effective care for immigrants will be described. What does a migrant-friendly hospital or health system consist of in the US? specific examples from Minnesota, the state which receives more refugees as a percentage of immigration than any other state in the USA, will be detailed.
Meeting challenges: Well documented disparities in health care and disease outcomes exist for immigrants, even after correcting for access to care, which in and of itself is a fundamental barrier to care in the USA. Issues of language and culture are key determinants of use of health services. Utilization is also impacted by gender, age, race and ethnicity, as well as experiences within the health care delivery system in an immigrant?s country of origin. Prevalence rates for chronic diseases vary by race/ ethnicity, country of origin and time since immigration, and make it challenging for clinicians to have an adequate set of skills and knowledge to care for patients from many different countries, ethnic and cultural backgrounds. Medical schools and graduate training programs struggle with implementing educational models adequate to train the next generation of physicians in global health. Clinician attitudes and behaviors, skills and knowledge base also play a role in contributing to health disparities for immigrants. The tragedy of global inequity persists in the developed world.
Conclusion and recommendations: Providing a common framework for addressing immigrant disparities issues is critical to programmatic success. That framework must be the language of quality. Using the Institute of Medicine?s Quality Chasm and Unequal Treatment Reports, the author will describe groundbreaking work on demographic data collection, and quality measures for minority communities. specific examples will include: 1) the work of a large integrated care delivery system, HealthPartners, in reducing disparities; 2) implementation of a 3-year program in best practices in care for hospitalized patients with limited English profi ciency, in a large urban hospital; 3) description of a nationally recognized Center for International Health; 4) recommendations from a best practices expert panel report on refugee and immigrant health; and 5) development of an academic Global Health Pathway at the University of Minnesota. Participants will receive resource materials, and hear live stories from the front lines of the US experience with refugee and immigrant health care.

F. Castelli1, C. Pezzoli1, A. Matteelli1, I. El Hamad1, S. Geraci2 1Infectious and Tropical Diseases, University of Brescia, Brescia, 2Area Sanitaria, Caritas, Rome, Italy

Key issues: During the 1970s, the labour needs of European States favoured intensive legal migration to sustain growing economic growth. Afterwards, economic recession in Europe caused higher unemployment rates and legal migration into Europe has become increasingly difficult, resulting in a growing number of undocumented migrants from Southern and Eastern countries into Europe.
Meeting challenges: Host European countries are usually reluctant to promote health care programmes for undocumented migrants, fearing to give incentive to further migration fl ows, yet forgetting the basic human right of every person to access health regardless of his/her legal status. Furthermore, discrimination and internal inequalities in health care for marginalized minorities often have an impact also on the economic, social and health status of the host population, possibly generating public health problems. Some European countries have set up legal systems to offer illegal migrants the right to health care, but wide variations exist among the different countries as to the quality and quantity of access to care according to legal status. Furthermore, even a signifi cant proportion of legal migrants may not have access to health care because of their ignorance of basic rights.
Conclusion and recommendations: It is our hope that the European and international bodies, including the newly created United Nations Human Rights Council, may soon address the increasingly important issue of guaranteeing every human being the right to access care.