HPH TF MFH TF MFH Task Force on Migrant-Friendly Hospitals and - - PowerPoint PPT Presentation

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 1

HPH TF MFH

Task Force on Migrant-Friendly Hospitals and Health Services REDUCING STRESS THROUGH MIGRANT FRIENDLY HEALTH CARE

Antonio Chiarenza Regional HPH Network Emilia-Romagna AUSL di Reggio Emilia 21st International HPH Conference Gothenburg, 22-24 May 2013

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Challenges for the health system

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 2

IMPACT OF NEW MIGRATION ON WELFARE PROVISION

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Total number of migrants in Europe, 1960-2010 10 20 30 40 50 60 70 80 1 9 6 1 9 6 5 1 9 7 1 9 7 5 1 9 8 1 9 8 5 1 9 9 1 9 9 5 2 2 5 2 1 Year Migrant stock (millions)

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 3

Marked rise in migration

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 4

Diversification in countries of origin

“too many”, “too fast”, “to diverse” 1980s onward small numbers from many places to many places 1950-70s Large numbers from a few places to a few places

(Vertovec, 2012)

NEW MIGRANTS ALONGSIDE LONG-STANDING ETHNIC GROUPS

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Reggio Emilia

13.6% of the population - non-national residents

More than 140 nationalities More than 200 languages

Morocco; 14,7 Albania; 10,7 India; 9,4 China; 7,6 Pakistan; 7 Romania; 6,9 Ukrania; 5,7 Ghana; 4,3 Tunisia; 4,3 Moldova; 4,2 Others; 25,2 HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 5

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 6

Diversity and diversification

Intra-group diversity: diversity within the same national or ethnic group. Increased diversity: different ethnicity, migration category, legal status, language, gender, age, social status,..) Different immigration status and legal status:

• Economic migrants
• Refugees
• Spouses and family
• Undocumented migrants
• Asylum seekers
• Unaccompanied minors
• Migrants held in reception

and detention centres

• Involuntary migrants
• Students

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Differentiation of rights and complexity of regualtions

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 7

Being migrant puts extraordinary stress on individuals and their families also in the health care system

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Barriers in migrant patient-provider interaction produce stress

Language and communication barriers Patients’ information and health literacy Specific competence to respond to diversity Organisation and service delivery barriers

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 8

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 9

Language and communication

Clinical interviews can be misleading and only minimal medical information may be obtained. Migrant patients may not understand explanations, and adherence to care might not be ensured. At discharge migrant patient may leave not well informed regarding follow-up treatment and continuity of care Example: Migrants often report they don’t trust providers with their problems because of the difficulties expressing themselves to the medical profession. Language barriers have adverse effects on the quality and safety of treatment received and patient outcomes.

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Interpreting error

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 10

As a result of an interpreting error, Willie’s brain hemorrhage was misdiagnosed and he was left

• quadriplegic. 18-year-old Willie Ramirez

ate a fast food hamburger, he fell down unconscious and his Cuban family thought it was the hamburger that made him sick. They explained to the emergency room doctor that he was “intoxicado” which in Cuban Spanish means “ill due to something one ate.” The medical history was provided in a chaotic and confused manner with various family members using limited English to describe what

• happened. The teenage girlfriend

mentioned that she and Willie had been

• arguing. The ER doctor pieced together

a story that was completely wrong. He thought Willie was “intoxicated” – that he had taken an intentional drug overdose because he was upset about the fight with his girlfriend.

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Interpreting and intercultural mediation

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 11

Eliciting patients’ information and medical history Providing for information and explanation on diagnosis and treatment Obtaining informed consent Providing discharge information Informing on health behaviours and life style

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 12

Patients’ information and health literacy

Migrants have difficulty in understanding how the system works and in accessing information. Written material only partially reach migrant patients if it is perceived as insensitive to their culture or literacy needs. New arrivals have difficulty in locating and making sense of medical information and in navigating the needed services. Example: Migrants from outside the EU struggle to understand the registration process even if explained in their own language

Low level of patients’ health literacy has adverse effects on effective patient-provider cooperation; utilisation of information and participation in prevention and health promotion programmes.

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Information and Health Literacy interventions

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 13

Use of Patient Navigators and Community Health Educators Signage in different languages Migrant-friendly food menus and spiritual support Issue-focussed education programmes (e.g. pregnancy, child

birth, cancer screening, diabetes,…)

Migrants’ involvement in the production of information material

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 14

Intercultural competence

Health providers may not be able to effectively elicit patients’ explanation of illness. Health providers may not be able to identify the patient’s needs according to individual and family characteristics, ideas, and situations. Health providers may not be able to recognise the patient’s beliefs and behaviours; their own beliefs and behaviours may impact on effective care. Example: asylum seekers who had traumatic experiences say that doctors often don’t understand their explanation of symptoms.

Low levels of intercultural competence have adverse effects on the ability of health staff to negotiate effective and safe treatment with the patient.

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Health staff education & training

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 15

To enable the patient to tell his/her story and explanation on illness. To work across differences. To invest in the relationship with the patient To use the narrative medicine approach (learn from the patient). To engage the patient in the co- production of the meaning of the illness experience.

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HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 16

Organisation and service delivery barriers

Organisational policies and monitoring systems may not address the different needs of the population. Health care delivery may not be appropriate to effectively respond to diversity. Service availability and accessibility may not be able to respond to the needs of the most marginalised migrants. Example: Lack of specific services for Asylum Seekers; lack of health care for migrants who are ineligible or without insurance.

Low level of adaptation to diversity of the health care

• rganisation has adverse effects on effective access and

utilisation of services.

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Concluding remarks

New migrant groups: diverse, small and fragmented Multiple identities: People do not belong to just one social

• r ethnic group.

Dimensions of diversity: Interaction of variables: individual characteristics, social situation and immigration and legal status Health policies: Multicultural approaches to health care service provision risk not ensuring equity for all. Multiple-diversity needs: people’s needs are expressed by the intersections of differences (race, ethnicity, gender, age, sexual orientation, class, religion, ability).

HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 17

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Equity approach

Task Force Migrant-friendly Hospitals and Health Services

HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

To encourage staff to focus on the uniqueness of the individual, recognising and valuing differences; To ensure equity of treatment for all as the major strategy to reduce disparity in health care.

TF MFH The project aims at developing a comprehensive framework for measuring and monitoring the capacity of healthcare organisations to improve accessibility to appropriate and effective health services; health promotion and preventive care for migrants and other vulnerable groups.

HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 19

Project to develop standards for equity in health care

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EQUITY IN POLICY EQUITABLE ACCESS AND UTILISATION EQUITABLE QUALITY OF CARE EQUITY IN PARTICIPATION PROMOTING EQUITY

HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 20

Standards for equity in healthcare Five main domains

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21 HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 21