Resources - International

Arctic Region

Lisa Adams, Dalee Sambo Dorough and the Executive Committee of the Lancet Commission on Arctic and Northern Health. (Lancet)

There is an urgent need to address persistent health disparities in Arctic Indigenous communities. These reflect the destructive legacy of colonialism, forced displacement, inadequate health systems, systemic racism, and infrastructure deficits. To address this concerning situation, The Lancet has convened a Commission on Arctic and Northern Health. This will examine the ways Arctic Indigenous values, worldviews, assessments, and research can inform gaps in knowledge and practice globally. Central to its work will be a recognition of the importance of self-determination and self-governance and the profound relationship of Indigenous peoples to their lands, territories, and resources.

Europe

Bernadette N. Kumar, Sally Hargreaves, Charles Agyemang, Rosemary A. James, Karl Blanchett, Laurence Gruer.  European Journal of Public Health

This paper examines the evidence for the disproportionate effect of the pandemic on migrants and ethnic minorities in Europe. It compares what should and could be done to mitigate the impact with what is actually being done (or not done). It concludes that the  most pressing priority is to ensure vaccine equity and maximise uptake in migrant, ethnic minorities and other excluded or hard-to-reach communities. 

This is the authors’ main recommendation. “Given the multi-ethnic nature of the current European population, there is a clear need for investment in research among migrant populations to gain insight into factors driving the high burden of type 2 diabetes and related complications to facilitate prevention and treatment efforts in Europe.”

This investigation  examines the bureaucratic barriers in 11 European countries that prevent several million undocumented migrants from getting vaccinated against Covid-19. Typically, people need to provide ID, a health card, proof of residence, or a social security number which many undocumented migrants can’t get or may be too afraid to seek. Given that vaccination helps protect not only the individual but also the population as a whole, this seems counter-productive. 

Southern Africa

Jo Vearey, Thea de Gruchy, Nicholas Maple. (Journal of Migration and Health)

This article describes a new research agenda to inform the development and implementation of appropriate pandemic responses in Southern Africa, a region associated with some of the highest levels of inequality globally. They suggest research “should focus on improving our understanding of (1) the political factors influencing the (dis)connections between migration and health governance structures in the context of Covid-19, and how to overcome these in the context of a pandemic; and (2) the motivations for and implications of a ‘vaccine passport’ system on movement within and beyond the region. This requires a reactive, cross-disciplinary, regional research network.  In a context where funding for research is increasingly inaccessible, innovative, informal, collaborative engagement is needed.”

World

Magwood, O., Kassam, A., Mavedatnia, D., Mendonca, O., Saad, A., Hasan, H., Madana, M., Ranger, D., Tan, Y., and  Pottie, K. (International Journal of Environmental Research and Public Health)

This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. Seventy relevant publications were identified. Programs most frequently screened for overall mental health, PTSD, and depression. Three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.

This new section of the Campbell and Cochrane Equity Methods Group website focusses on the mental health of refugees and migrants. It offers a wide range of recently published clinical guidelines and tools, reviews and commentaries.

Kathleen R Page, Eleonora Genovese, Matteo Franchi, Silvano Cella, Gianfrancesco Fiorini, Rim Tlili, Sebastian Salazar, Aline Duvoisin, Johann Cailhol, Yves Jackson. (BMJ Open) 

This study of 812 people was conducted in Geneva, Milan, Paris and Baltimore. Self-perceived accessibility to Covid-19 vaccination was generally high (86%) but demand low (41%), with confidence in the Covid-19 vaccine much lower than for established vaccines. The authors concluded: "Public health interventions using different communication modes should build on trust about vaccination in general to tackle undocumented migrants’ hesitancy for COVID-19 vaccination with a specific attention to men, younger migrants and those at low clinical risk of severe infection."

Alex Brown (Lancet)

Alex  Brown leads the recently formed Global Collective for Indigenous Adolescent Health and Evidence-Based Action. In this Lancet Commentary, he calls for a focus on Indigenous adolescents and youth across the world, particularly given that a third of global Indigenous communities are aged 10–24 years. The Collective will identify, develop and share solutions and strategies to overcome the inequities that exist for Indigenous young people. He highlights  their capacity to contribute to meaningful policy dialogue when given the opportunity. The Collective aims to publish the new knowledge generated by its work  in a two part Series on Indigenous adolescent health in The Lancet.

Charles Agyemang, Anke Richters, Shahab Jolani, Stevie Hendriks, Saurabh Zalpuri, Evan Yu, Bart Pijls, Maria Prins, Karien Stronks, Maurice P Zeegers. BMJ Global Health

This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes. The risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic.

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International Organisation for Migration

Sweetmavourneen Pernitez-Agan  and four colleagues

This review identified 276 publications about migration health and COVID-19 published between 1 January and 20 May 2020. More than half were by authors from China or the US.  They were mainly about disease epidemiology and mathematical modelling, public health interventions and clinical management.   There were few  studies involving specific migrant populations  and these were limited to international students, migrant workers, immigrants, migrants, refugees, and asylum seekers.

This publications portal is a repository of all IOM migration health publications from 2006 to present where IOM was a primary contributor. Among over 800 publications are peer-reviewed scientific papers, technical reports, training guides/manuals, policy briefs/discussion papers, factsheets, newsletters, research reviews, conference and poster presentations. These are categorised by topic, author, country/region covered as well as by year, language, and type of publication.

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World Health Organisation

On 18 March 2022, following a meeting in Istanbul encompassing 122 countries in three WHO regions, and in the light of the unfolding crisis in Ukraine, the WHO have announced a 5+5 framework for action, with five priorities based on five key lessons learned from recent years. 

The goal of this project was  to develop guidelines to facilitate policymaking and targeted interventions aimed at helping refugees and migrants during the pandemic and its aftermath. Systematic evidence reviews of English language documents were undertaken  using stringent screening criteria and quality assessment methods. These focused on three areas: border policies; migration policies for foreigners already within the territory of States; and public health policies on access to health care for refugees and migrants. From the resultant evidence, recommendations were formulated, giving explicit consideration of benefits and harms; feasibility and resource use; equity and non-discrimination; human rights and socio-cultural acceptability.  Examples include:

- Prioritise entry requirements over border closure to carry out medical screening on the basis of a careful and evidence-informed risk assessment

- Release migrants from detention centres and implement non-custodial, community-based alternatives to immigration detention with proper safeguards

- Provide equal access to health care for all refugees and migrants, regardless of status, nationality, gender or ethnicity

For this online survey, the WHO recruited about 30,000 refugees and other migrants living in 170 countries.  The aim was to learn more about the experiences and coping strategies of refugees and other migrants during the pandemic in the light of anecdotal evidence of discrimination, stigmatisation, and the lockdown of refugee and migrant populations.  On a scale of 1-10, the average overall impact of the pandemic on participants varied from 7.0 to 7.85 across the six WHO regions.  This seems high but no control group data were available. Higher scores were reported by participants whose housing or resident status was precarious.  Migrants with limited or no schooling or undocumented migrants reported the least use of healthcare.   Lack of finances (35%) or fear of deportation (22%) were given as the main reasons for not seeking healthcare.  

  • WHO Europe - Collection and integration of data on refugee and migrant health in the WHO European Region - Policy Brief and Technical Guidance (December 2020)

Multi-author team led by Soorej Jose Puthoopparambil, WHO Regional Office for Europe

Reliable, consistent and good-quality data are essential to address health inequality among refugees and migrants and ensure their equitable health status in a population. Many Member States lack the routine systems to collect the necessary data. Key issues include: health data are available but cannot be disaggregated by migratory status; migratory status data exist but are not linked with health data; and the currently available migration health data are not representative of all migrant populations. Challenges include: the heterogeneity of migrants, with varying terminology for what constitutes a migrant; lack of trust in the authorities and health institutions that collect data; and language barriers and difficulty accessing migrant subgroups. The policy brief outlines all the elements needed to overcome the current shortcomings and summarises the policy requirements at national and regional levels. These are described in more detail in the technical guidance.

Other International Organisations

Lilla Farkas for the European Commission.

This is an analysis and comparative review of equality data collection practices in the European Union. It demonstrates the shortcomings of such data collection at the national level, including the stigmatising effect of the use of migrant categories, as well as their inability to capture the population whose situation they seek to measure.  

This index is a useful tool to evaluate and compare what governments are doing to promote the integration of migrants in all the 52 countries currently analysed.  A large number of recently updated reports were published in 2020.