Conceptual Approach at an International Level on Social and Health Care with a Gender and Cross-Cultural Perspective. Special Attention to European Intercultural Approaches
Health equity is the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g., gender, ethnicity, disability, or sexual orientation). Health equity is achieved when everyone can attain their full potential for health and well-being. Insufficient access of female migrants to healthcare services can be a major obstacle to integration and inclusion, affecting virtually all areas of life, including employment and education. Factors that can impact health outcomes include the effects of the migratory process, social determinants of health, and risks and exposures in origin, transit, and destination environments. These factors interact with biological and social factors, leading to different health outcomes. Townsend et al. (1992:358) argue that access to health services is divided into three types: Economic access is associated with the equal provision of goods regardless of the economic capacity of the individual and by offering social goods based on needs and not on the cost of the institution and economic contribution of the individual. Health services offered to patients from financially disadvantaged groups cost more than average as they tend to suffer from chronic diseases for long periods. A lengthier period of recovery is required due to poor nutrition, bad living conditions and lack of social/welfare support and tend to have higher rates of diseases in relation to the more prosperous. Geographic access is usually associated with the equitable distribution of services in different areas, and particularly with the possibility of movement of the patient. Cultural access is associated with the relationship between patients and healthcare professionals or employees of agencies and the extent to which differences in education, gender, culture, religion or nationality create barriers to communication and effective use of social/welfare services. Female migrants are confronted with specific persistent barriers to accessing healthcare services, including administrative hurdles, fears linked to uncertainties about the duration of their stay, discrimination, a lack of information and of familiarity with the healthcare system, and linguistic and intercultural obstacles. Female migrants face additional challenges as they tend to have lower proficiency in the host country language, weaker social networks, and greater responsibilities for childcare and family. Female refugees and migrants show worse outcomes with respect to pregnancy-related indicators. Female immigrants’ health is inevitably linked to their ability to find work and thus be linked to the social security system. The Covid-19 pandemic shed light on inequalities in access to healthcare services. Migrants are more likely to work in precarious, low-status/low-wage employment and undeclared jobs that do not offer low levels of insurance coverage, limited or no healthcare and social protection access, require close contact with others, which expose them and their families to a higher risk of contracting Covid-19, as well as other infectious diseases. Mental health is critical to integration of female migrants. Female migrants, especially female refugees, may be at higher risk of developing mental health problems due to trauma experienced in their country of origin, difficulties encountered during their migration journey or post-arrival experiences, such as social isolation or discrimination, they often face obstacles in accessing mental health services.
Online Resources
Bradby, H., Humphris, R., Newall, D., and Phillimore, J., 2015, Public health aspects of migrant health: a review of the evidence on health status for refugees and asylum seekers in the European Region. Health Evidence Network Synthesis Report 44. Copenhagen: WHO Regional Office for Europe.
(https://www.euro.who.int/__data/assets/pdf_file/0004/289246/WHO-HEN-Report-A5-2-Refugees_FINAL.pdf)
The objective of this report is to synthesize research findings from a systematic review of available academic evidence and grey literature to address the following question. What policies and interventions work to improve health care access and delivery for asylum seekers and refugees in the European Region?
Fouskas, T., Gikopoulou, P., Ioannidi, E. and Koulierakis, G., 2019, Health inequalities and female migrant domestic workers: Accessing healthcare as a human right and barriers due to precarious employment in Greece, Collectivus: Special Issue Migrations and gender from a transnational perspective, 6(2): 71-90.
(http://investigaciones.uniatlantico.edu.co/revistas/index.php/Collectivus/article/download/2415/2969/)
In the framework of human rights, this article revisits the legal context and examines the policy responses with reference to health, in order to reveal the weaknesses of the Greek institutional context, and present data concerning female migrant workers’ access to healthcare services.
World Health Organization (WHO), 2018, Report on the health of refugees and migrants in the WHO European Region: No PUBLIC HEALTH without REFUGEE and MIGRANT HEALTH. Copenhagen: WHO Regional Office for Europe.
(https://apps.who.int/iris/bitstream/handle/10665/311347/9789289053846-eng.pdf?sequence=1&isAllowed=y)
This report is intended to create an evidence base to aid Member States of the WHO European Region and other national and international stakeholders in promoting refugee and migrant health.