Wednesday 14th October 14h30 – 16h30
Room JDE 70, Committee of the Regions
Minutes
Welcome and introduction
Mr Karsten Uno Petersen, Chair of the Interregional Group on Health and Wellbeing opened the meeting and welcomed all participants. He welcomed the new vice-chair to the group, Elena Cebrián Calvo (Valencia, ES).
He further presented the Interregional Group on Health and Wellbeing, which was established in December 2010 to enable all interested CoR members to debate and share viewpoints on EU health and public health policy. The group also seeks to enhance the dialogue with other EU institutions. The group meets 4-5 times per year.
The Chair introduced the theme of the meeting, “Health and Migration”, stating that migrants’ access to healthcare vary between European countries and the obstacles and challenges may differ across and within countries – as well as the solutions and innovative initiatives. The topic of migrants’ health has risen on the agenda, not least in light of the migration flows to Europe and their impact on our health systems.
Key Note Speech on Health and Migration
Roumyana Petrova-Benedict, Senior Regional Migration Health Advisor, European Region Migration Health Division (MHD) Regional Office for the EEA, the EU and NATO, International Organisation for Migration (IOM), Brussels, Belgium Office.
The IOM is an intergovernmental organisation committed to the principle that a humane and orderly migration benefits migrants and the society at large. It has a migration health division since 60 years which provide direct assistance and help preparing for reallocation and resettlement. They also work on health promotion, fostering dialogue and knowledge of relevant legal frameworks and project implementation. IOM fosters vertical and horizontal partnerships.
Migration may be considered a contemporary “mega trend” – one in six people worldwide is a migrant, and 50% of migrants are children. Migration influences all sectors of society, including health. The largest part of migration is labour migration and family unification, while only around 5-10%, consist of irregular migration.
The secretariat for the Interregional Group on Health is provided by EUREGHA.
Petrova-Benedict stressed that Europe needs migration, not least because of current and foreseen labour market shortages. She deplored the fact that there is still a tendency of anti-migration attitudes in Europe, based on myths such as migrants are “carriers of diseases” or a “burden on our health systems”. On the contrary, migrants generally pay more taxes than they benefit from social systems, most migrants are healthy and those who are not often underutilize health services. Petrova-Benedict also highlighted the economic importance of migration, mentioning that the total value of remittances sent by migrants in 2015 is estimated at USD 435 billion.
Petrova-Benedict further stated that a few of the most important barriers that affect migrants’ access to health services include: a lack of commitment from health services in certain EU member states, with access to health services being provided only to citizens, political setbacks when health budgets where cut due to the financial crisis, vulnerabilities of different kinds, cultural and communication aspects and social exclusion. Another barrier mentioned was staff limitations, i.e. that health workers in many EU member states feel overwhelmed by the challenge the increasing migration to the EU’s southern boarders put on their health systems. In relation to this, Petrova-Benedict stressed the importance to provide health care staff with training so that they are better equipped with handling the sensitive conditions of migrants.
Petrova-Benedict also presented the “Equi Health project”, which is carried out by the IOM in collaboration with DG SANTE, which aims to improve the access and appropriateness of health care services, health promotion and prevention to meet the needs of migrants, the Roma and other vulnerable ethnic minority groups residing in the EU/EEA. It is a large partnership involving national and regional governments and civil society. Within Equi Health, there is a sub-project specifically focusing on Roma health. This project includes networks of Roma health mediators to share practices in affected countries. Results are available on the website.
Report: Cost of Exclusion from Healthcare – The Case of Migrants in an Irregular Situation
Ludovica Banfi, Programme Manager, Freedoms and Justice Department, European Union Agency for Fundamental Rights (FRA)
The European Union Agency for Fundamental Rights (FRA) is an independent agency providing data on fundamental rights to the EU institutions and Member States. Focus areas include discrimination, racism and children’s rights, and their work is guided by a framework, which is updated every five years.
The study “Cost from exclusion from healthcare: the case of migrants in an irregular situation” was published on 3 September and is a follow-up of two studies from 2011 on migrants’ fundamental rights and migrants’ access to healthcare. The study was conducted in response to conclusions from a 2013 meeting in Vienna with representatives from regions, policy makers, health professionals and healthcare organisations, which concluded that there is a lack of economic arguments for providing timely healthcare to migrants.
The secretariat for the Interregional Group on Health is provided by EUREGHA.
The aim of the study was to compare costs of providing migrants in an irregular situation with timely access to health screening and treatment with the provision of emergency care only. The examined medical conditions were hypertension and lack of prenatal care. The study analysed the cases of Germany, Greece and Sweden.
Banfi presented the conclusions of the study which show conservative but powerful indications that governments would indeed save money by providing access to primary healthcare to migrants in an irregular situation in the cases of hypertension and prenatal care. The model holds under different scenarios and assumptions. Moreover, the results leave out many external and wider scale benefits which point to even higher cost savings.
Panel with Regional and Local Good Examples on Health and Migration
- Region Västra Götaland (SE) Malena Lau, Head of Unit, Centre for Equity in Health Care) and Ida Wernered, Director of Business Development at Angered Hospital
The right to health and equity in healthcare is a priority for regional politicians in Västra Götaland. The human right to health permeates the work at the Centre for Equity in Healthcare and at the recently established Angered hospital, located in north-eastern Gothenburg.
The creation of the hospital represents one of several steps in the work towards reducing health inequalities in the region. In the area where the hospital is located, 65% of the population are born outside of Sweden or are second generation migrants. Life expectancy in Angered is 9 years less than in the overall population in Gothenburg. The population also suffers from poorer overall health and lower economic status.
One of the challenges identified while establishing the hospital was that residents were under-consuming health services. This was found to be due to a lack of trust in the public administration and services and cultural and language barriers. To face this problems, there needs to be a dialogue with healthcare organisations and health professionals to improve communication and information and to improve accessibility, to find new and creative ways to remove barriers and to ensure participation when designing health services.
Different methods and tools to develop and reduce existing barriers were explored:
– Social innovation/communication tools have been used on major diseases. One example includes informational comics that were produced in 10 languages available in a mobile app, developed together with the local inhabitants to educate the patient about his/her own disease.
– To improve cancer screening attendance, the Centre for Equity in Healthcare gathered women from different cultural backgrounds to inform about the screenings and asked them to spread the information among their friends. In this way, the cultural and trust barriers were overcome. Other ways of spreading information was to identify places such as hairdressers and specific restaurants to spread the information. Over four years, the number of participants in the cancer screening was increased by 10%.
The secretariat for the Interregional Group on Health is provided by EUREGHA.
- Sardinia Region (IT) Silvana Tilocca, Director of the department of Preventative Medicine, Cagliari
Sardinia has faced an influx of migrants for over ten years and foreigners comprise 2,7% of the total population. The highest number of migrants reside in Cagliari. The Region of Sardinia presented three solutions implemented in Cagliari to improve migrants’ health.
– In 2005, a specific clinic for immigrants – the “STP clinic” – was established. The clinic guarantees healthcare to irregular migrants. The experience has been successful and the clinic has received around 20 000 multi-ethnic patients during the past ten years. The existence of the clinic has reduced the burden on emergency rooms, as migrants now have a special clinic with cultural and language mediation to accommodate their health needs.
– Experience from the centre shows that there has been a lack of information on how to access health services. In order to address this, Sardinia set up the Guidance Centre for the use of the Sanitary Services for Immigrants (C.O.S.S.I.) to provide orientation on the use of health services. This model has subsequently been adopted in four other Italian regions.
– A mobile clinic was developed to reach out to homeless migrants. This “street ambulance” consists of an ambulance, equipped with a doctor and a nurse, which reach out to homeless migrants in strategic city points and offer health assistance on site. Many of the people found are not migrants, but homeless Sardinian citizens, facing the same problems and health risk factors. Even though the region is generally welcoming migrants, there is a growing social resistance. It is important to show that working on immigration and health equity are not mutually exclusive.
Italy is in the process of developing guidelines on how to best accommodate health needs of unaccompanied children, and Sardinia expressed willingness to act on this issue at the European level.
- Tuscany Region (IT): Sara Albiani, Global Health Centre
Tuscany recently established a Global Health Centre, the “Centro Salute Globale” (CSG), which aims at analysing connections between globalisation and health in terms of equality. The centre is operationally linked to the paediatric hospital and has as its objectives to enhance, disseminate and apply knowledge on four thematic priorities, including migrants’ health. The centre links professors, researchers, PhD students, healthcare workers and public authorities to join together to study and apply knowledge.
On migrants’ health, the main objective is to collaborate with public institutions to promote equity and efficacy in the provision of healthcare to the migrant population. The CSG functions as a bridge between local organisations and NGOs working with immigrants and asylum seekers and responsible regional public institutions.
The secretariat for the Interregional Group on Health is provided by EUREGHA.
During the past months, the centre has worked together with NGOs and the political level of Tuscany Region to develop an integrated model providing information to migrants adapted to each local health unit in Tuscany. The aim is to set a minimum standard for treatment and prevention going beyond the national minimum standards. NGOs and local organisations also aim at guaranteeing access to health for everyone through facilitating communication to the political level of misapplications of the law through the development of an alert system. The CSG connect these misapplications and report the episodes to the political level to be able to adapt policies and create a monitoring system.
Moreover, Tuscany has promoted dissemination and information activities for the immigrant population on their right to health, as well as training for health staff. They work with the local health units to find innovative ways to communicate to migrants of different cultural backgrounds. Further, they have organised a workshop cycle on the “right to health and access to social health services”, which was attended by health staff and NGOs.
A website and online platform were launched in July 2015 and are still under construction. The website will share data on immigrants in the region of Tuscany and their access to health services, to provide information on the laws regarding the matter of migration and health and to create linkages between regional relevant stakeholders.
Projects under implementation include:
– The prevention and fight against the phenomenon of female genital mutilations among immigrants in Tuscany. The project is funded by the Italian department for equal opportunities and entails a development of an intervention protocol at regional level as well as training for health staff and awareness campaigns among immigrants’ communities.
– A project on the integration of migration and development which aims at establishing a comprehensive approach to migration at local level as well as the sound management of migration across regions in order to maximise its development impacts. It aims at improving the social and health development in the Governorate of Kasserine (Tunisia), using and enhancing the contribution of the immigrants and the Tunisian community residing in Tuscany.
Q&A with the speakers
The Region of Valencia stressed the importance and transformative potential of regional best practices. It was also suggested that rather than to create specific programmes or actions for different population groups, ordinary health services need to be aware and open to the migrant population. Access to healthcare is a way to reach out and to integrate people in the society as migrants enter into relationships with the community in health spaces, which serve as a powerful tool for inclusion. Valencia announced that they are keen to participate in all kinds of initiatives.
Sardinia agreed that the regular healthcare services need to promote inclusion. However, Tilocca insisted on the need for the healthcare system to accommodate people with different problematics, and that it might be easier for health systems to adapt gradually to welcome patients from multiple cultural background, with multiple language needs etc. The Sardinian case, with a specific clinic as the
The secretariat for the Interregional Group on Health is provided by EUREGHA.
first point of entry to the broader healthcare system, has proven very useful a way of guaranteeing the migrants their fundamental rights and to put them in a position where they are able to make choices.
Tuscany agreed that it is important to have a process enabling “normal” health services to welcome and treat different kinds of users. European societies are gradually becoming increasingly multicultural. It is important to have institutions to facilitate improvement and capacity for the social and health staff. Albiani further recommended that the experience of the Global Health Centre could be transferable to other regions, using staff already existing in the regions. She reminded that it is a low cost improvement to coordinate all stakeholders working on migration.
Västra Götaland stressed that many barriers are found within our own organisations and that there is a need to become self-conscious and to look into our organisations and within ourselves. The barriers faced by migrants are often the same barriers facing people of different sexual orientation and different socioeconomic status, which is way it is necessary to adopt a broader equity approach.
Banfi stressed the potential of the FRA report to provide policy makers with a powerful framework and rationale regarding the economic benefits of providing irregular migrants with healthcare. Banfi further thanked EUREGHA and the CoR Interregional Group on Health for the invitation to participate in the event, stressing that out of the fundamental rights’ areas where she works, the health area is the area where the regional and local level play the most crucial role in implementing policy.
Close of meeting
The Chair closed the meeting and informed that the next meeting of the CoR Interregional Group on Health will be held on 4 December 08h00-09h00 on the theme of “Active and Healthy Ageing” with interpretation available in Spanish, Italian and English.
