Aspetti di salute pubblica e migrazione nella Regione Europea dell OMS: buone prassi e lavoro intersettoriale

Transcription

1 Aspetti di salute pubblica e migrazione nella Regione Europea dell OMS: buone prassi e lavoro intersettoriale Workshop: Politiche e Strategie Regionali in materia di salute dei migranti. Firenze, 4 Luglio Dr. Santino Severoni MD. MHE Coordinator Public Health and Migration Division of Policy and Governance for Health and Wellbeing European Office for Investment for Health and Development WHO Regional Office for Europe Venice, Italy sev@euro.who.int http;//

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3 Concept & Numbers A globalized world defined by profound disparities, skill shortages, demographic imbalances, climate change as well as economic and political crises, natural as well as man-made disasters, migration is omnipresent Migration compensate demographic trends, skill shortages as to assist home communities with remittances

4 Concept & Numbers 214 mil International migrants in 2010 (3% of global population) and 740 mil. Internal migrants (UNPD data) We are told by newspaper, politician, academies that massive number of people are on the move in the world, there is a global migration crises leading to a clash of civilizations

5 WHO European Region 53 Member States, 886 million people 77 million migrants (36%) in WHO EURO Region Variation in GDP/person/year (2009): - Tajikistan $ 1,900 [rank192] - Luxembourg $ 79,600 [rank 3]

6 WHO EURO Region complexity

7 Population movements

8 Concept & Numbers

9 Complexity, contradictions and multidisciplinary Health is influenced by many factors and policies run by institutions out of the health sector that do not always take into account the health impact of their action While there has been an increasing harmonization of immigration policies the dominant emphasis is still on restriction, control and expulsion

10 Legal framework for health care services access In all EU countries documented migrants are entitled to access the health care system, (with specific rules depending on their legal status as permanent settlers, temporary workers, refugees, asylum seekers, etc) Key question is the legal provision of access to health care for undocumented migrants.

11 Challenges migrants access to services Health Access Security measures Human Rights National Regulations

12 Legitimacy of Action, Mandate & Opportunities Resolution WHA Calls for: Migrant-sensitive health policies Equitable access to services Information systems to assess migrant health Sharing information on best practices Raising cultural and gender sensitivity and specific training of health service providers and professionals Bi/multilateral cooperation among countries Reducing the global deficit of health professionals 12

13 Institutional Stakeholders working on public health issues related to migration Institutional organizations providing specialized health and migration services and research within the National Health System Desk Review To map who does what WHO supporting the establishment of a network and transfer of experience

14 Institutional Stakeholders working on public health issues related to migration 128 institutes identified in 53 Countries of the WHO EURO Region 19 Institutions over 12 of the 53 EURO MS specialized on health and migration Majority are: University institute, Independent research institute, Think tank, International network Underrepresentation of non-eu countries

15 Institutional Stakeholders working on public health issues related to migration Results: o Fragmented pictures o Limited or not coordination exist among these key actors o Little coherence between policies and strategies among the different countries o Need for sharing experiences, best practices and networking

16 Non-Institutional organizations working on public health issues related to migration non- institutional organizations play a key role both in directly providing health care to undocumented migrants as well as in mediating access to mainstream health services in addition to national and local governments Desk review To map who does what WHO supporting the establishment of a network and transfer of experience

17 Non-Institutional organizations working on public health issues related to migration 106 organisations identified in 39 countries of the WHO EURO region Dealing mainly with undocumented migrants Organization Type non- governmental /non profit religious or faith- based professional charities humanitarian Direct Service Provider Typology of identified healthcare providers Mediation Service Provider Network more than one type possible

18 Non-Institutional organizations working on public health issues related to migration Results: o Challenging due to the sensitivity of working with undocumented migrants, organisations providing this services do not seek publicity o Lack of information on the Internet as well as lack of description of the types of services o They are providing information, serving as an alternative healthcare provider, to acting as a mediator between the migrant and mainstream healthcare providers o Several contacted stakeholders cautioned that using such organizations to make up for the inadequacies of the mainstream health system risks perpetrating a two-tier system

19 Italian and European good practices 1. Services 2. Healthcare assistance 3. Hospitality

20 1. Services Alto Comissariado para a Imigraҫão e Dialogo Intercultural - ACIDI Portugal One Stop Shop first prize for the One-Stop-Shop in the European Public Sector Award - EPSA 2011 under the theme Opening Up the Public Sector Through Collaborative Governance SAI, Servizio Accoglienza Immigrati (Caritas) Milano - Orientation for migrants to night shelter, job finding, legal assistance and territorial services Consulenza per migranti MOCA (Caritas and Merano Municipality) Merano - Administrative assistance on

21 2. Healthcare Assistance Presidium project UNHCR, IOM, IRC, Save the Children Assessment and assistance to boat migrants arriving in Italy Progetto Italia - Emergency Providing healthcare assistance to irregular migrants and seasonal workers in Italy trough Polibus and to fixe ambulatory in Palermo and Marghera Project to prevent and early diagnose infectous diseases among mingrants CCM and Arezzo ASL Improving the intersectorial integration between migration centars, Healthcare services of prevention and therapy, GPs and pediatricians, Social services and cultural mediators, to diagnose and heal infectious diseases

22 3. Hospitality Rifugiato a casa mia Caritas Lombardia and Piemonte regions Hosting asylum seekers and refugies are hosted by italian families to facilitate their integration SPRAR - Umbria Region Structure hosting refugees and asylum seekers and facilitating their social inclusion and work finding, little dimensions and strongly coordinated at regional level SPES Caritas Roma Hospitality for migrants with psicological diseases or stress provided by the migration process. Individual pathways of reabilitation and social inclusion with the guide of individual tutors.

23 .. Siamo tolleranti e civili, noi italiani, nei confronti di tutti i diversi. Neri, rossi, gialli. Specie quando si trovano lontano, a distanza telescopica da noi. Indro Montanelli