Health for all? A qualitative study of NGO support to migrants affected by structural violence in northern France

The impact of social capital and social environmental factors on mental health and flourishing: the experiences of asylum-seekers in France

BACKGROUND

There is growing interest on how social capital and related social environmental factors impact overall population health and well-being. The nature of asylum-seekers' social environment alters once they migrate to a new context and these changes influence their mental health and well-being. However, there is limited scholarship on how these social environmental factors impact the mental health, well-being, and capacity to flourish of asylum-seekers.

METHODS

The aim of the study, therefore, was to examine how specific social environmental factors-social networks, social support, and social cohesion at various levels (micro, meso, and macro)-influence the mental health, well-being, and capacity to flourish of asylum-seekers in France. In collaboration with a community-based organization, we used a qualitative research design to conduct 120 semi-structured interviews with asylum-seekers in France.

RESULTS

The emerging salient themes depicted how the asylum-seekers' usual informal social networks comprised of family and friends had been disrupted since they migrated to France, which impacted their mental health and well-being. Conversely, staying connected with their informal transnational social networks via social media and developing ties with new local informal and formal social networks allowed them to receive different forms of social support, and buffered some of the negative mental health consequences. However, the lack of social cohesion due to a lack of belonging, marginalization, and current harmful migration-related policies impeded asylum-seekers' capacity to flourish.

CONCLUSION

While social support derived from social networks buffered some negative impacts on mental health and well-being, the overall lack of social cohesion ultimately impeded asylum-seekers' capacity to flourish within their host communities, which was further exacerbated by harmful migration policies of exclusion within France. Introducing more inclusive policies related to the governance of migration and an intersectoral approach that views health in all policies is key to promoting social cohesion and flourishing among asylum-seekers in France.

Study designs, measures and indexes used in studying the structural racism as a social determinant of health in high income countries from 2000-2022: evidence from a scoping review

BACKGROUND

Globally, structural racism has been well documented as an important social determinant of health (SODH) resulting in racial inequality related to health. Although studies on structural racism have increased over the years, the selection of appropriate designs, measures, and indexes of measurement that respond to SODH has not been comprehensively documented. Therefore, the lack of evidence seems to exist. This scoping review was conducted to map and summarize global evidence on the use of various designs, measures, and indexes of measurement when studying structural racism as a social determinant of health.

METHODS

We performed a scoping review of global evidence from 2000 to 2022 published in 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Web of Science, ProQuest, and relevant grey literature on structural racism. We conducted a systematic search using keywords and subject headings around 3 concepts. We included peer reviewed original research/review articles which conceived the framework of social determinants of health (SODH) and studied structural racism.

RESULTS

Our review identified 1793 bibliographic citations for screening and 54 articles for final review. Articles reported 19 types of study design, 87 measures of exposure and 58 measures of health outcomes related to structural racism. 73 indexes or scales of measurement were used to assess health impacts of structural racism. Majority of articles were primary research (n = 43/54 articles; 79.6%), used quantitative research method (n = 32/54 articles; 59.3%) and predominantly conducted in the United States (n = 46/54 articles; 85.2.6%). Cross-sectional study design was the most used design (n = 17/54 articles; 31.5%) followed by systematic review (n = 7/54 articles; 13.0%) and narrative review (n = 6/54 articles; 11.1%). Housing and residential segregation was the largest cluster of exposure with the highest impact in infant health outcome.

CONCLUSIONS

Our review found several key gaps and research priorities on structural racism such as lack of longitudinal studies and availability of structural or ecological data, lack of consensus on the use of consolidated appropriate measures, indexes of measurement and appropriate study designs that can capture complex interactions of exposure and outcomes related to structural racism holistically.

Health System Governance in Settings with Conflict-Affected Populations: A Systhematic Review

Health system governance has been recognised as critical to strengthening healthcare responses in settings with conflict-affected populations. The aim of this review was to examine existing evidence on health system governance in settings with conflict-affected populations globally. The specific objectives were: (i) to describe the characteristics of the eligible studies; (ii) to describe the principles of health system governance; (iii) to examine evidence on barriers and facilitators for stronger health system governance; and (iv) to analyse the quality of available evidence. A systematic review methodology was used following PRISMA criteria. We searched six academic databases, and used grey literature sources. We included papers reporting empirical findings on health system governance among populations affected by armed conflict, including refugees, asylum seekers, internally displaced populations, conflict-affected non-displaced populations and post-conflict populations. Data were analysed according to the study objectives and informed primarily by the Siddiqi et al. (2009) governance framework. Quality appraisal was conducted using an adapted version of the Mixed Methods Appraisal Tool. Of the 6,511 papers identified through database searches, 34 studies met eligibility criteria. Few studies provided a theoretical framework or definition for governance. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. This review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance.

Factors associated with SARS-CoV2 infection and care pathways among the most vulnerable populations living in Marseille: a case control study

BACKGROUND

The Covid-19 pandemic has led to substantial and unexpected increases in morbidity and mortality in France. Vulnerable populations housed in accommodation centres have a greater risk of infection because collective housing and their dependence on social support services mean it is more difficult to apply preventive measures. They are also at greater risk of developing severe forms of Covid-19 and waiting longer before seeking healthcare (for Covid-19 or other) treatment. We aimed to identify the factors associated with SARS-CoV2 infection in the most vulnerable populations in the city of Marseille.

METHODS

The study sample comprised users of various services provided by the association AAJT in Marseille, France, some presenting symptoms suggestive of Covid-19 and others not. All had routine health surveillance provided by AAJT's dedicated healthcare team between March 2020 and May 2020. Using univariate and multivariate analyses, we studied the influence of several variables on morbidity associated with Covid-19.

RESULTS

The study included 64 participants, 29 of whom tested positive for Covid-19 and 35 control subjects. Median age was 21.16 years old. Individuals in the 'Covid-19 case' group (p < 0.005) - which included persons testing positive and those suspected of being infected - were younger. The study sample's male/female ratio was seven. In our multivariate analyses, living in a shared apartment and poor adherence to social distancing measures were factors associated with Covid-19 infection. Furthermore, mental health problems - such as anxiety disorder - were very frequent in the study sample.

CONCLUSIONS

Allocating more and specific housing units to structures providing accommodation services to the most vulnerable people would seem to be a decisive factor in controlling the spread of SARS-CoV2, and deserves more attention from public authorities.

Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review

In recent years, there has been a revival of the term “structural violence (SV)” which was coined by Johan Galtung in the 1960s in the context of Peace Studies. “Structural violence” refers to social structures—economic, legal, political, religious, and cultural—that prevent individuals, groups and societies from reaching their full potential. In the European context, very few studies have investigated health and well-being using an SV perspective. Therefore, this paper sought to systematically and descriptively review studies that used an SV framework to examine health-related outcomes across European countries. The review included two studies each from Spain and France, one each from the UK, Ukraine and Russia, and another study including the three countries Sweden, Portugal and Germany. With the exception of one mixed-method study, the studies used a qualitative design. Furthermore, the eight studies in the review used different conceptualizations of SV, which indicates the complexity of using SV as a concept in public health in the European context. Future research that attempts to identify and standardize measures of SV is needed; the knowledge gained is hoped to inform appropriate interventions aiming to reduce the effects of SV on population health.

Health equity during COVID-19: A qualitative study on the consequences of the syndemic on refugees' and asylum seekers' health in reception centres in Bologna (Italy)

Background

As coronavirus infection spread across the world, the dramatic consequences of Sars-CoV-2 and confinement measures highlighted the disparities within our society, impacting more severely on the wellbeing of the most disadvantaged groups of people, such as migrants. The structural characteristics of reception centres create many challenges in the implementation of measures to contrast the diffusion of the virus, putting refugees and asylum seekers (RAS) even more at risk. For these reasons, we carried out a qualitative study to analyze the impact of the syndemic on the health of RAS who reside in reception facilities in Bologna (one of the cities with the highest number of migrants in Italy) and the measures that were introduced to contrast the diffusion of Sars-CoV-2.

Methods

Between April and September 2020, we interviewed 25 professionals and volunteers who were critical in the management of the COVID-19 epidemic in reception centres. Key-informants were selected through a snowball sampling process and covered various professions (i.e. doctors, nurses, social workers, psychologists, cultural mediators, anthropologists, lawyers). The semi-structured interviews explored the consequences of COVID-19 on the health of RAS living in reception centres, the measures implemented to contrast the diffusion of the epidemic and the challenges that interviewees had in handling the emergency. After transcription, the interviews were analyzed using deductive and inductive approaches.

Results

All key-informants agreed to participate in the study. Even though various measures were implemented in reception centres (i.e. mass quarantine, supply of personal protective equipment, risk communication campaigns and specific governance tools) they often had a discriminatory approach towards migrants and only considered the biomedical aspects of COVID-19, excluding its social roots and repercussions. This factor, together with the lack of an effective governance system at both the local and the national level, was the most relevant issue associated with the management of the syndemic in reception facilities and affected all the social determinants that shape the health profile of RAS.

Conclusions

The study revealed the importance of social factors in the management of the syndemic in reception centres. It also highlighted how the underlying causes of the impact of COVID-19 are tightly correlated to the political and social approaches of local and national institutions to migration. In order to guarantee the well-being of society as a whole and successfully control the epidemic, it is necessary to consider migration as a human reality rather than an emergency, and demolish all the policies and bureaucratic systems that act as structural violence on RAS. This process brings into play different levels of responsibility and many action plans. We need to develop intersectoral collaborations for more holistic and interconnected practices, while investing the resources to build a worthy reception system and effective social protection programs. This way it will be possible to develop more inclusive approaches to public health and guarantee the conditions for RAS' empowerment.

Health System Response during the European Refugee Crisis: Policy and Practice Analysis in Four Italian Regions

The decentralization of the provision of health services at the subnational level produces variations in healthcare offered to asylum seekers (ASs) across the different Italian regions, even if they are entitled to healthcare through the national health service. The present study aims to map the healthcare path and regional policies for ASs upon arrival and identify challenges and best practices. This is a multicentric, qualitative study of migrant health policies and practices at the regional level within four Italian regions. For the analysis, a dedicated tool for the systematic comparison of policies and practices was developed. The collection and analysis of data demonstrated the presence of many items of international recommendations, even if many gaps exist and differences between regions remain. The analysis of practices permitted the identification of three models of care and access. Some aspects identified are as follows: fragmentation and barriers to access; a weakness in or lack of a governance system, with the presence of many actors involved; variability in the response between territories. The inclusion of ASs in healthcare services requires intersectoral actions, involving healthcare sectors and other actors within local social structures, in order to add value to local resources and practices, reinforce networks and contribute to social integration.