PHBLM PROJECT Increasing Public Health Safety Alongside the New Eastern European Border Line

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1 PHBLM PROJECT Increasing Public Health Safety Alongside the New Eastern European Border Line IOM International Organization for Migration 1

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3 PHBLM PROJECT: Increasing Public Health Safety Alongside the New Eastern European Border Line Module 1, Unit 4 Antidiscrimination and Ethics Session 1. The impact of inequalities and discrimination Session 2. Ethnic minorities and discrimination in the EU Session 3. What are public health ethics? Session 4. How to apply public health ethics? Aims of Terminology Dealing with the Impact of Migration in the EU Module: 1. To become familiar with how discrimination and inequality affect migrants. 2. To recognize current issues faced by ethnic minorities in the EU. 3. To become familiar with the basics of public health ethics. 4. To grasp a basic understanding on how to apply public health ethics. 3

4 Session 1: The impact of inequalities and discrimination Methodology Participants will need Presentation Copy of slides 1.1 Inequalities in health: a global challenge Regardless of healthcare system, some degree of inequality in health outcomes is inevitable. Final outcomes, as well as access to and utilisation of health promotion and health care interventions will be influenced by individual and external factors. (EuroHealth, 2002) 1.2 How is are migrants health negatively affected? Many factors limit access to health services and, in turn, increase the risk of poor health for migrants. These include poverty, stigma, discrimination, social exclusion, language and cultural differences, separation from family and socio cultural norms, administrative hurdles and legal status. (IOM, 2010) 1.3 Rejection of that which is strange or unknown is universal The fact that something is strange makes it seem to be dangerous ORTEGA Y GASSET Wanted but unwelcome 1.4 What are Europeans saying about inequalities? 4

5 European citizens expect EU health policy to bridge health inequalities; focus on promoting health and on the social causes of ill health; mainstream health in all policies; and tackle global health issues. EPC 2010 Session 2: Ethnic minorities and discrimination in the EU Methodology Participants will need 2.1 Ethnic minorities in the EU Presentation Copy of slides Ethnic minorities often find themselves marginalized by the mainstream societies they live in. Example: The situation of Roma Community within the EU remains a cause of special concern, as this community faces racism and discrimination in employment, education and healthcare provision. (UN, 2010) 2.2 Ethnic tensions: an example within the EU region Until the early 1990s, Greece had been an extremely homogenous society, but with the collapse of communist regimes in Eastern Europe it suddenly experienced big influxes of immigrants. Recently, several public ethnic confrontations have occurred with in an occasion ending fatally. The Greek government is planning to introduce new laws to stop hundreds of thousands of immigrants living in the country facing discrimination at work and from the social security system. (BBC News, 2004) 2.3 Migrants suffering exploitation ITALY an example of problems in the region affecting migrants health 5

6 Illegal labour, especially in the agricultural sector is a widespread phenomenon in Italy, with official statistics showing that it accounts for between 15.9% and 17.6% of the country's gross domestic product. A great number of migrants involved in illegal labour face living and working conditions are unsafe, insalubrious and undignified. (IOM, 2009) 2.4 Eurobarometer on Discrimination Today's Eurobarometer survey shows that a large proportion of Europeans are of the opinion that discrimination is widespread in their country (64%). Did you know A broad majority of European citizens believe that being disabled (79%), being a Roma (77%), being over 50 (69%) or having a different ethnic origin (62%) is a disadvantage in their society. In all but four Member States, a majority of citizens find that people of a different ethnic origin than the rest of the population enrich the national culture. (Europa Press Release, 2007) 2.5 Working towards social integrity an example In line with the social cohesion model, the Plan Municipal para la Interculturalidad (City Council Plan for Inter Cultural Matters) there is a health project that aims at: Fostering the health protection of migrants by facilitating access to the medical insurance card. Ensuring that undocumented residents are not discriminated against when accessing the healthcare system. (EADE, 2005) 6

7 Session 3: What are public health ethics? Methodology Participants will need 3.1 What are public health ethics? Presentation Copy of slides Ethics that focus on the design and implementation of measures to monitor and improve the health of populations. Public health ethics look beyond health care to consider the structural conditions that affect the development of healthy societies. (WHO, 2008) 3.2 The importance of public health ethics Public health ethics is important for three main reasons the fundamental issues raised in public health over the role of governments; the shortcomings of existing models in bioethics for dealing with such issues; the global relevance of health and public health that makes these issues so pertinent. (WHO, 2008) 3.3 Why is public health ethics important in the EU? In Europe, we are living in an increasingly pluralistic society in which we can no longer simply adopt the values from a single group. Public health ethics carries with it an obligation to foster a healthy population that includes everyone. (WHO, 2008) 7

8 Session 4: How to apply public health ethics? Methodology Participants will need Presentation Copy of slides 4.1 How to apply public health ethics? Ethical Skills examples of a number of skills needed to apply public health ethics. For further understanding on the skills that can be used for public health ethics, please visit the following website 287E CBD BD405FC60856/0/ethicsbrochure.pdf Note: the following samples of application of public ethics were obtained from the website mentioned above. 4.1 a. Public health should address principally the fundamental causes of disease and health requirements Recognizes the ethical value the public health community gives to prevention. Considers the full spectrum of the determinants of health. Identifies the range of options for interventions that correspond to the full spectrum of determinants of health. 4.1 b. Identifies the role of cultural, social, political, and behavioral factors in determining the delivery of public health services. Recognizes the diversity of views driven by the various cultures/subpopulations. Identifies issues of access and barriers to public health services. 8

9 Utilizes appropriate methods for interacting safely, effectively, and professionally with persons from diverse cultural, socioeconomic, educational, racial, ethnic and professional backgrounds, and person of all ages and lifestyle preferences. 4.1 c. Public health should advocate and work for the empowerment of vulnerable community members Recognizes appropriate ways that advocacy and empowerment can be done. Represents the needs and perspectives of all relative stakeholders with particular attention to marginalized and vulnerable populations. 4.1 d. Public health programs and policies should be implemented in a manner that most enhances the physical and social environment. Describes the full spectrum of the determinants of health. Identifies best practices for achieving a particular health objective. Articulates the health, fiscal, administrative, legal, social and political implications of each policy for vulnerable populations. 4.2 Components leading to PH Ethics For further description on the components leading to PH Ethics, please visit the following website for the Ethical Practice of Public Health pdf 4.3 Applying Public Health Ethics within Institutions/Agencies 4.3 a. Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs Should obtain the community s consent for their implementation. Identifies the range of options for obtaining consent at the individual and group level. 9

10 Recalls historical abuses of informed consent. 4.3 b. Public health institutions should ensure the professional competence Identifies best practices for one s areas of responsibility and action. Determines the range of appropriate actions for addressing unethical behavior. Helps create and maintain key values and shared vision and uses these principles to guide action. Promotes individual and organizational learning. 4.3 c. Public health institutions and their employees should engage in collaborations to build the public s trust. Identifies interests and conflicts of interest between potential partners. Articulates how public trust is built or undermined by partner collaboration. Establishes transparency about collaborations to maintain public accountability. 4.4 Exercise Try to relate the following photos to the potential needs of migrants/minorities that public health ethics can address. What public health skills would you use? 10

11 SUMMARY OF MODULE I Unit 4 1. Discrimination and inequalities continue to be a present problem in the EU. 2. Ethnic minorities often find themselves marginalized by the mainstream societies they live in. 3. Public Health Ethics: focus on the design and implementation of measures to monitor and improve the health of populations. 4. Applying public health ethics need a holistic, interdisciplinary approach that looks at the physical and social environment of the population. 11

12 References BBC News. (2004). Greek Albanians' woes fester. Retrieved April, 2010 from Eurocities Anti Discrimination Exchange. (2001). Annual Lecture: The role of ethics in shaping health policy. Retrieved April, 2010, from European Policy Centre. (2010). Retrieved April, 2010 from /CHESS6&l=14 International Organization for Migration. (2009). IOM Italy Stranded Migrants Seek Assistance. Retrieved April, 2010, from de/news/press_briefing_notes/iom_italy_stranded_migrants_seek_assi stance Public Health Leadership Society. (2004). Skills for the Ethical Practice of Public Health. Retrieved April, 2010, from for the Ethical Practice of Public Health pdf United Nations. (2010). Report on the World Social Situation 2010 Media Kit "Rethinking Poverty". Retrieved April, 2010, from United Nations Refugee Agency. (2009). Teachers Manual Not Just Numbers Educational Toolkit on Migration and Asylum in Europe. Retrieved April, 2010 from toolkit/njn MANUAL EN.pdf WHO

13 Ethical considerations in developing a public health response to pandemic influenza. Retrieved April, 2010 from 07_2c.pdf 2008 The importance of public health ethics. Retrieved April, 2010 from /en/index.html 13