Monday, October 19, 2009

[EQ] Migration and health - Challenges and trends

Migration and health
Challenges and trends

Norwegian Directorate of Health, 2009

Available online as PDF file [96p.] at:
http://www.helsedirektoratet.no/vp/multimedia/archive/00133/Migration_and_healt_133289a.PDF

 

“………. Migration has been a phenomenon throughout the ages. The reasons for migration across national borders are many and complex: fleeing war, persecution and disasters are among the key reasons, but the vast majority of migrants move in order to find work or obtain education. Many migrants also seek to be reunited with family members who emigrated before them. Migration challenges society, offers new opportunities and contributes to diversity and change. For many, migration brings positive outcomes and opportunities for a better life.….

 

People lead transnational lives. People’s identities break away from the single national identity, and many individuals have and seek to form strong ties with several countries and environments. Increasing migration and the adoption of a new sense of Norwegian national identity embodying greater diversity holds new opportunities. This also entails the interaction of cultures and religions with other traditions and perceptions of health and disease.

 

The migrant group is heterogeneous and made up of a diverse range of people: from unaccompanied asylum-seeking minors to Swedish café workers, the members of Pakistani family reunifications, Turkish grocers, British stockbrokers and Indian IT experts. It follows that there will be great variation between different patient and user groups.

At present there are some 460,000 persons residing in Norway who either immigrated themselves or were born in Norway of immigrant parents. All told, these persons make up 9.7 percent of the population…..”

 

 

Migration and health is a complex of issues and concerns, and the present document is not an exhaustive report on this field. By way of introduction,

the report presents a wide backdrop to the issues surrounding migration and health.



·          Chapter 1: “The big picture”, migration is described in terms of a global phenomenon. Here we address the problem of inequitable distribution of welfare and good health globally, and emphasise Norway’s means of influencing this state of affairs.

·          Chapter 2 “Health and ethnicity” deals with the issues surrounding health status, risk factors and the use of health services by different immigrant groups. There are great health disparities throughout the Norwegian population, and this is also true with regard to the health of immigrants. Disease patterns vary from one ethnic group to the next. The causes of health disparities are associated just as much with factors such as education, financial and social circumstances as they are with ethnic, genetic, cultural or linguistic determinants.

·          In Chapter 3 we turn our attention to the challenges associated with interaction with the health services – from the perspective of both the user and the service. The emphasis is on ensuring that the service picks up on and caters for the diversity of the population.

·          Chapter 4 deals with mental health among immigrants, with special emphasis on refugees and asylum seekers. We describe factors affecting health after fleeing and crises.

·          Chapter 5 offers input on the debate concerning the rights of paperless immigrants. The report advocates action to clarify the right of paperless immigrants to health care, and the responsibilities of the authorities.

·          Chapter 6 describes the new wave of labour immigrants. This immigration has provided Norway with much-needed labour, but has also created challenges for the health services, especially as regards the provision of information, organisation and scaling of the services.

·          Chapter 7 There is currently substantial international migration of health personnel. Here we examine the increasing demand for health and care personnel in rich countries in the years to come. Some countries will resort to recruiting health personnel from other countries which are then drained of the health personnel they themselves need. Solidarity with other nations in long-term planning and distribution of global health personnel resources will be essential.

·          Chapter 8 sheds light on ethnic Norwegians as a migrants and emigrants, and also as immigrants in another country; Norwegians in Spain. Who are they, what needs do they have for health and welfare services, and what expectations do they have of the Norwegian authorities? How do they relate to the society they live in? This chapter raises issues and challenges.

 

Main message

A new international convention on health will ensure basic health care for all The global distribution of welfare and good health is inequitable. The Directorate of Health is calling for an international convention recognizing the right to basic health care for all people.

 

Contents

 

Preface

Summary and main message

1 The big picture

Changes in migration flows

Opportunities and challenges

Society in a state of constant flux

Global health

Poverty and health

The UN Millennium Development Goals for health

Norwegian initiative for child and maternal health

A framework convention on global health

Effective health care is a key factor

2 Health and ethnicity

Ethnicity and life phases from a health perspective

Ethnicity and social factors

Life phases

Adults

Elderly persons

Variation between national groups

Differing incidence of risk factors

Disparities in disease patterns

Gender differences in integration

Selected issues of concern

Diseases that were formerly rare in Norway

Infectious diseases

Diabetes

Vitamin D deficiency

Consanguineous marriage in Norway

Female genital mutilation

Male circumcision

Drugs and adolescents

Prevention and public health work

3 Interaction with the Norwegian health service

An equitable health service

Migrant Friendly Hospitals

Adapted medical care

Language and communication – a special challenge

Use of interpreters improves communication

How to achieve equitable health care

Active participation

User participation and coordination in practice

Mutual comprehension

Supervision – an important tool in equitable service provision

Interaction with the Norwegian health service

Regular GP scheme

Maternal and Child Health Centres and the Schools Health Service

Midwifery services

Dental health care

Care services for elderly persons of immigrant origin

Services for persons of immigrant origin with dementia

People with special needs

People with disabilities

4 Mental health

Norway as a receiving country – a historical perspective

Statistics on refugees and asylum seekers

Places at reception centres

Mental health

Especially vulnerable groups: child refugees

Access to and use of health services at reception centres

Mental health screening in the various phases of the process

5 Paperless immigrants – and human rights

A life lived in constant fear

The right to health care is indisputable

The right to basic health care

Costs are prohibitive

6 Labour immigrants

7 Health personnel across borders

8 Emigrants – Norwegians in Spain

Norwegians in multi-cultural Spain

How many Norwegians live in Spain?

Norwegian ghettos?

Why Spain?

Permanent residents and tourists

Bibliography

 


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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

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[EQ] Correction PDF link: Norway and Health

Norway and Health -  An introduction

Reference Number: IS-1730 E : Norwegian Directorate of Health, 2009

Website:
http://www.helsedirektoratet.no/vp/multimedia/archive/00232/Norway_and_Health___232259a.pdf

“……….It is firmly anchored in the Norwegian traditional political tenet that society is collectively responsible for the welfare of its citizens. Thus, an overarching aim is to provide services of high quality, available within acceptable waiting times and distances, reaching out to everyone regardless of their financial situation, social status, age, gender and ethnic background.

During the last four decades, Norway has undergone a substantial socio-economic transformation, and is now among the wealthiest nations in the world. This development has been of great significance to the health status of the nation, the services provided and the public expectations of the health services.

A national health system is the result of a dynamic interplay between health needs, public expectations, professions, interest groups and available resources. As all these elements change over time, the system is in constant evolution.

 

To be adequate, a health system in evolution has to contain mechanisms for priority and capacity revision, quality assurance, structural adjustment, and optimal resource utilisation. One major concern in Norway as an egalitarian society is the growing disparity in health between social groups, in spite of universal access to care and services. A comprehensive policy on social determinants of health is developed in order to reduce social inequalities in health.

The principal elements of the structure and activities are outlined here, with a slight bias to the work under the responsibility of the Norwegian Directorate of Health. There have been many contributors, which is apparent in the variation in writing style of the chapters…..”

 

 

Contents

Preface

1 International cooperation on health

2 Norway, the nation

3 Health: Financial and human resources

4 Health management

4.1 Health at the national level

4.2 Health at the provincial level

4.3 Health at the local level

5 Primary health services

5.1 Scope

5.2 Roles

5.3 Financing

5.4 The general practitioners’ scheme

5.5 The health clinics

5.6 Health and care services for the elderly and disabled

5.6.1 Users

5.6.2 Personnel

5.7 Public dental health services

6 Specialist health care services

6.1 Health enterprises

6.2 Allocations

6.3 Patients rights

6.4 Priority-setting

6.5 Pharmaceuticals safe use

6.6 Mental health services

6.7 Alcohol and drug abuse

7 Public health and health promotion

7.1 Strategy to reduce social inequalities in health

7.2 Tobacco use and tobacco control

7.3 Nutrition

7.4 Physical activity

8 Universal design - The Delta centre

9 Preparedness

9.1 Aims
Links


*      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Norway and Health

Norway and Health -  An introduction

Reference Number: IS-1730 E : Norwegian Directorate of Health, 2009

Website: http://www.dh.gov.uk/en/Healthcare/Primarycare/index.htm

“……….It is firmly anchored in the Norwegian traditional political tenet that society is collectively responsible for the welfare of its citizens. Thus, an overarching aim is to provide services of high quality, available within acceptable waiting times and distances, reaching out to everyone regardless of their financial situation, social status, age, gender and ethnic background.

During the last four decades, Norway has undergone a substantial socio-economic transformation, and is now among the wealthiest nations in the world. This development has been of great significance to the health status of the nation, the services provided and the public expectations of the health services.

A national health system is the result of a dynamic interplay between health needs, public expectations, professions, interest groups and available resources. As all these elements change over time, the system is in constant evolution.

 

To be adequate, a health system in evolution has to contain mechanisms for priority and capacity revision, quality assurance, structural adjustment, and optimal resource utilisation. One major concern in Norway as an egalitarian society is the growing disparity in health between social groups, in spite of universal access to care and services. A comprehensive policy on social determinants of health is developed in order to reduce social inequalities in health.

The principal elements of the structure and activities are outlined here, with a slight bias to the work under the responsibility of the Norwegian Directorate of Health. There have been many contributors, which is apparent in the variation in writing style of the chapters…..”

 

 

Contents

Preface

1 International cooperation on health

2 Norway, the nation

3 Health: Financial and human resources

4 Health management

4.1 Health at the national level

4.2 Health at the provincial level

4.3 Health at the local level

5 Primary health services

5.1 Scope

5.2 Roles

5.3 Financing

5.4 The general practitioners’ scheme

5.5 The health clinics

5.6 Health and care services for the elderly and disabled

5.6.1 Users

5.6.2 Personnel

5.7 Public dental health services

6 Specialist health care services

6.1 Health enterprises

6.2 Allocations

6.3 Patients rights

6.4 Priority-setting

6.5 Pharmaceuticals safe use

6.6 Mental health services

6.7 Alcohol and drug abuse

7 Public health and health promotion

7.1 Strategy to reduce social inequalities in health

7.2 Tobacco use and tobacco control

7.3 Nutrition

7.4 Physical activity

8 Universal design - The Delta centre

9 Preparedness

9.1 Aims
Links


*      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Improving Quality in Primary Care

Improving Quality in Primary Care

DH/Primary and Community Care Strategy team

UK Department of Health, NHS September 2009

 

Available online at:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_106575.pdf

 

“……….Improving the quality of care – in terms of safety, effectiveness and patient experience – is a central motivation for everyone working in the NHS, and over the past decade there has been impressive progress in improving the quality of primary care services. We need, however, to reduce variations in quality and to ensure that high quality is a consistent part of everyone’s primary care experience. This will be particularly important given the key role that primary care will need to take in driving improvements in quality and efficiency simultaneously in the light of the expected future financial context.

 

No single element or individual can improve quality in primary care alone. It involves a package of measures including:

• guidelines and standards to bring clarity to quality

• measuring quality

• publishing information on quality

• recognising and rewarding quality improvement

• providing leadership

• safeguarding essential levels of safety and quality

• staying ahead through innovation.

 

These measures and their significance to primary care services are described in the seven elements of this document, alongside practical ideas, tools and resources that Primary Care Trusts (PCTs) can use to support and enable quality improvement for patients….”

Website: http://www.dh.gov.uk/en/Healthcare/Primarycare/index.htm

 

Contents

Executive summary

Introduction

What is the purpose of this guide?

Who is this guide for?

Context

Distinctive features of primary care

World class commissioning

The Quality Framework and Primary Care

Element 1: Bringing clarity to quality

Element 2: Measuring quality

Element 3: Publishing quality information

Element 4: Recognising and rewarding quality improvement

Element 5: Providing leadership for quality

Element 6: Safeguarding quality

Element 7: Staying ahead

Making it happen

Questions for the PCT Board

Links to the World Class Commissioning Assurance

Framework

 




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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.