S. Fernando
Racism and Xenophobia
Abstract
Racism is perhaps the most serious basic problem affecting the welfare of people referred to as migrants or black people in Europe today. Racism is not just about personal racial prejudice but also about institutional processes, ways of thinking and ways of doing things that are deeply ingrained in European culture, including health care - especially mental health care. The prevention of racism in a health service requires a clear statement of intent in a race equality policy that generates monitoring systems, action plans and forward planning. Combating racism must go hand-in-hand with the promotion of cultural sensitivity in health care; equal opportunities in access to a service must be balanced by strict control of institutional racism in the quality of the service and employment practices.
M. Haour-Knipe
Aids Prevention, Stigma and Migrant Status
Abstract
This article discusses how stigma has been applied to disease and also to foreigners, especially during epidemics. Foreigners, or migrants, fit particularly well into AIDS stigma, being both objects and originators of the generalized reaction: "it's somebody else's problem'. Material is presented from an European Community concerted action assessing AIDS/HIV prevention which surveyed programmes for short- and long-term guest populations and ethnic minorities in twelve European countries. It is shown how the potential for stigmatization seriously hindered the establishment of AIDS prevention efforts directed towards migrants. Basic shifts of programme focus which help overcome stigmatization problems concerning migrants are defined, including: 1) making fine differentiations among migrant groups rather than considering "migrants" as a generalized "other", 2) basing programmes on a universal right to know rather than on the notion of risk group, and 3) working in real and effective collaboration with minority communities rather than imposing top down programmes.
J.P. Kunst
Health Care for an Immigrant Nation: Policy and Practice in Australia
Abstract
Australia is one of the most multicultural nations on earth. Over 100 different languages are spoken by Australians in the normal course of their lives. 20% of its population was born in another country and 24% of Australians have one or both parents born overseas. It is within this socio-demographic context that Australia has developed its social and institutional policies of multiculturalism provided the intellectual capital and impetus for the creation of a Migrant Health Policy. The latter, in turn, is responsible for the operational policies about language, culture, information marketing and agency operations, which govern the nature and extent of health care services to the community. This paper provides a historical view of the role of immigration in Australia's development, explains the policy creation process, its antecedents and its service outcomes, and concludes with a summary of the major challenges which confront the health care system in its quest to provide equitable, relevant and responsive services to a multilingual and multicultural community.
S. Michael, F. Gany, R. Fruchter, H. Bocanegra, S. Zug and R. Groper
Meeting Immigrant Health Challenges: an Integrated Model in New York City
Abstract
New York City has traditionally been the portal to America for millions of foreign-born. Current immigration echoes this past. Each year, tens of thousands of immigrants and migrants enter New York City. These individuals and families come from diverse cultures and health care systems which continue to impact on their health care needs. How can New York's health care system provide culturally sensitive and epidemiologically informed health services to these immigrants? In 1990, with a grant from the Aaron Diamond Foundation, an interdisciplinary group of professionals established the New York Task Force on Immigrant Health. This paper will describe the work of this unique multi-disciplinary organization as it seeks to address issues of health status and service delivery to immigrant populations. The paper will discuss specific issues and strategies with respect to a) the development of data bases, b) ethnographic investigations, c) cross-cultural and structural barriers to care, d) the creation and analysis of models to integrate traditional and Western bio-technical health care, and e) the informing and transforming of public policy and programs to result in more linguistically appropriate, culturally sensitive and effective health and social services. The successes of the New York Task Force on Immigrant Health, in a relatively brief period of time, provide both a model and a stimulus for other localities and nation-states interested in preventing illness and improving the health status of their diverse populations.
V. Bahl
The Development of a Black and Ethnic Minority Health Policy at the Department of Health
Abstract
Britain is a truly multi-racial and multi-cultural society. Immigration into Britain in 1960's and 1970's was mainly from Southeast Asia, Africa and West Indies. A large number of immigrants have now become residents of Britain and we have a second generation of Black and ethnic minority groups in this country who were born in Britain. More recently we have been joined by a number of refugee groups and asylum seekers. In the last ten years, there have been a number of initiatives which have been taken to develop appropriate policies to improve access to health services by ethnic groups and to understand their health and disease patterns. The main issues are: (1) WHAT policies have been developed; (2) The main areas of concern; (3) The differing Health and disease patterns among ethnic minority groups; (4) How the policies are being implemented at the health service level and the lessons learned; (5) How the health professionals are being trained to deliver appropriate services to these groups; (6) How volunteer groups are involved in planning services; (7) The national health services have recently been reformed and has introduced the idea of separating delivery of health care from the Planning and also introduced the idea of the purchasing of services by health authorities. It is important to examine if these have an impact in changing health services to make them more accessible to ethnic minority groups; (8) What the future plans in this area of work are.
E. Forsberg, P.-G. Svensson and B. Starrin
Ill Health and Social Conditions amongst Migrants and Refugees - the Case of Sweden
Abstract
The present article delineates the state of health and socioeconomic situation of migrants and refugees in Sweden. Special attention is given to refugees. Migrants appear to have more extensive health problems and a shorter longevity span than native Swedes. The refugees constitute an especially exposed group of migrants. Experiences in the home country that relate to organized violence is a specific problem for this group. It has been estimated that 20 to 25 per cent of all adult refugees who have arrived to Sweden during the recent years have experienced torture in their native countries. Swedish migrant and refugee policy operates according to a model of decentralization, aiming to avoid ethnic segregation in the big city areas. However, the integration policy seems, in many instances, to have had a negative affect on the situation of the refugees. During the period of time, in which the refugees wait for a residence permit, they are not permitted to work. The long period of forced inactivity - in some instances up to a couple of years - seems frequently to have aggravated the health of the refugees. In addition it appears to contribute to the ever increasing animosity towards them.
G. Schmid and L. Giorgi
Health Care Service and Ethnic Minorities: the Case of Austria
Abstract
The present article delineates the way in which a number of factors - societal as well as individual - define the health profile of ethnic minorities as well as hinder their access to and appropriation of an adequate health care service. It is based on an exploratory study - the first of its kind to be carried out in Austria - undertaken by "The Interdisciplinary Centre for Comparative Research in the Social Sciences' on the subject of `Foreigners and Health'.
P. Bollin
Health for Immigrants in the 1990s. A Comparative Study in Seven Receiving Countries
Abstract
Health policies for immigrants implemented in seven receiving countries (France, United Kingdom, Switzerland, Italy, Sweden, United States, and Canada) have been comparatively reviewed, taking into account the structure of the health system as well as immigration policy. Countries where immigrant communities have access to political representation, and whose health systems are comprehensive in scope and coverage, tend to have adopted specific health policies for immigrants, which in turn led to better access to health services and more information for planning and evaluation
