Month: August 2018

The 15th Conference of the Italian Society for Migration Medicine took place in Catania from April 18th to April 22th. The title was “Dynamics of health and migration: between continuity and new needs”. The conference program was rich in contents and stimuli, and was a multidisciplinary and multiprofessional platform to exchange practices, ideas and field experiences. It was an opportunity for health workers, researchers and academics, operators and educators working with immigrants, activists, volunteers and common citizens, to come together, reflect and learn about “the health of immigrants” and engage in its promotion and  protection.

The title of the conference encouraged to move beyond the “emergency approach”, which often leads to consider simply the emergency dimension of migration, while forgetting the 5 millions of immigrants that have been living and working for years in our country. It is necessary, on the contrary, to understand the “new needs” and move away from a debate centred on the emergency, as a starting point and an opportunity to rethink the organization of the whole health systems and models of care, towards a new definition of the concept of health, centred on PHC, on health promotion and on territorial and community dimensions, with attention to migration as well as to marginality and inequality.

Together with some residents in public health from different Italian universities, we created a working group on migration medicine to address the gaps we perceived in our knowledge on the subject. The group was established as a subgroup of the Inequality Working group of the Italian Hygiene Society Committee of Residents, in collaboration with the Regional Immigration and Health Groups (GrIS) of the Italian Society for Migration Medicine (SIMM). We share the belief that, as future public health professionals, we cannot afford to lack the competences which are necessary to face and interpret this phenomenon, which is central in the current Italian and global debate.

Asylum seekers are refugees who have left their country of origin and have applied for asylum. Italy recognizes and guarantees international protection and healthcare coverage for asylum seekers. The process to apply for and be granted a residence permit may require months, and in both phases they could potentially find themselves without healthcare coverage. Each region has its autonomy in the application of national protocols. This regional autonomy is associated with different waiting times for the acceptance and formalization of the request for international protection, and this leads to discrepancy and discretion in healthcare access for asylum seekers between their arrival and the formalization of the asylum application.

We are realizing a study that we presented at SIMM conference. We wanted to describe the policies (law, regulations…) of the different Italian regions and the gaps between policy and practice, and to map the different practices, in order to highlight similarities and differences. Our goal is to investigate any inequalities between protocols and daily practices, and to deepen our understanding of the issues related to the assistance paths activated immediately after the arrival of the asylum seekers. Preliminary results show differences among regions and single Local Health Units (LHUs) as well as fragmentation of the pathways of care following the first contact with the health system.

It would certainly be useful and interesting to extend the study outside of Italy, to the European context, thus including other countries. Migration must necessarily be read as a complex, interconnected and global issue, and consequently also the analysis of policies and practices can not be limited to a small geographical area.

In this, the quality and strength of the work, as well as the potential transformative power, would be positively affected by the possibility of creating a European network of resident students, who deal with the issue of migration medicine to compare approaches and identify new ways to interpret the complex reality we are trying to describe.

Through the history of Public Health, we have a duty to try to change the world for the better, because anything is possible if someone dreams about it.

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References

Società Italiana di Medicina delle Migrazioni – https://www.simmweb.it/

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Chiara Milani
Public Health Resident
University of Firenze

Multidisciplinary work is part of everyday life of any resident; living among Medical Doctors in training for Public Health could isolate us from the different perspectives that exist out there. One of the efforts of Euronet is to connect the residents of the member countries, but also to build bridges between other groups, teams and associations related to Public Health. One example is the Global Health Next Generation Network (GHNGN), which in a short time has created a network of working groups, some with common objectives with Euronet, such as empowering young professionals in trainee with practical tools.

“As the voice of the next generation of Global Health professionals, GHNGN focuses on bringing people together and foster discussion around Global Health through formal (conferences) and informal events (global health hangouts) as well as mentorship opportunities (Global Health Mentorships and Peer to Peer sessions).”

The network was created in Barcelona, with students of the Master of Global Health at the University of Barcelona, with the aim of having a platform so that young professionals from different cultures and backgrounds can network and exchange Global Health expertise and skills; to promote trans-disciplinary teamwork, to help each other out in the transition from academic to professional careers in global health, to initiate and foster dialogue on Global Health education and to support engagement of young professionals in Global Health initiatives and projects worldwide. Currently, there are approximately 30 people in the team, working from 15 different countries.

There have been some attempts to bridge in the last years. But it was this 2018 winter, when members of Euronet and GHNGN gathered in Barcelona and pushed forward on partnering. Some ideas flew on our first exchange of emails like ‘Social media visibility’, ‘Inviting speakers from Euronet for the Global Health Forum‘, ‘nominating a Global Health Ambassador’, ‘Writing a blog/career story about people on each organization’, ‘Exchange of expertise’, ‘Internships´, etc.

The official presentation of the GHNGN to Euronet members was made in March, at the meeting of Nancy. In the assembly there was general approval to draft an agreement for the next meeting. This beautiful story has the next date next July in Valencia, where some members of the GHNGN will visit us to make a formal presentation of their network, pitch some ideas and party with us at our meeting organize by Euronet Spain.

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References

Twitter: twitter.com/globalhealthngn
Facebook: www.facebook.com/GHstudentnetwork/
Website: http://ghnetwork.org/

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Efrain Pantoja
MRPH at Hospital Clinic de Barcelona and ‘Mr Pantoja’ at EURONET

Elena Marban
Pre doctoral fellow at ISGLOBAL and GHNGN board member

Nowadays, we still deal with the ethical side of every public health program or initiative using concepts or ideas based on Kantianism or even Utilitarism. We overlight and quote Rose’s paradox(1), as if the population and the individual interests were the only ones that mattered on the difficult path of deciding whether a public health measure, law or policy must be implemented or not. We sometimes strive to achieve a middle point between the population’s best interest and the individual freedom. None of this is unfamiliar, however, the importance of public health as a tool to ensure the compliance of human rights is still rarely discussed.

“In the absence of action, human rights are mere words on paper”(2). This, is one of the most important critics to the human rights approach (the most common approach related to human development). It states that human rights must be associated to measures that assure to genuinely safeguard human development. Nevertheless, political agendas and public health policies around the globe do not actively direct their efforts to assure human development or human rights on the grounds that if freedom is guaranteed, human rights will be guaranteed.

No more than a year ago I met an amazingly intelligent, successful, and wonderful woman that explained to me that the human rights approach is not all. That public health is not only screening, mental health, surveillance, health promotion or Antonovsky’s view for health and illness. She explained that a theoretical negative freedom does not safeguard anything; that social justice could give more answers than questions, problems or debates. She recommended me a book in order for me to get the bigger picture, to be able to see with other eyes the ethical (or unethical) part of public health, to think public health. I’ve been reading and re-reading it ever since.

The capabilities approach (2,3) offers a list of indicators of human development. We could consider 10 central capabilities that may ensure human development (but there are other perspectives of the capabilities approach(3)). Central capabilities, or capabilities in general, are meant to be understood as a common doctrine to be considered in every policy, and more specifically in every public health policy.

Lots of public health programs focus on the power of informing the population, promoting health by every kind of activity imaginable or limiting access implicitly or explicitly to products understood as harmful. Some would define this road as a form of “desired welfarism” and not as a path to achieve human health or human development. Every piece of information, every activity, is full of ethical principles that could affect people’s preferences – and these people’s preferences affect the population’s health results. The Kantian’s idea of community of equals, the Adam Smith’s theory of the impartial spectator or even the Hampton assumption of how preferences should be examined, do not reflect that people’s preferences do not consider social justice. It is not possible to identify the preferences that are the result of unfair and hierarchical circumstances without an independent ethics theory that thinks carefully about social justice.

However, it is not my role to explain to you the theory, the book, or someone’s opinion. My goal is to make us all think and re-think, read and re-read, have another view for every initiative, program or plan. Let’s envision every project with another approach. Let’s try to make something meaningful.

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References

1. Rose G. The strategy of preventive medicine. The strategy of preventive medicine. University Press; 1992.
2. Nussbaum MC. Creating capabilities: the human development approach. Harvard University Press. 2011. 256 p.
3. Sen A. Development as freedom. Oxford New. 2001. 366 p.

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Laura de la Torre Pérez
Public Health Resident
Servei de Medicina Preventiva i Epidemiologia – Hospital Clínic de Barcelona

Climate change is not a new issue in global agenda, as well as environmental adverse effects on health. Climate consequences are not limited to low and middle-income countries, and Europe will not be spared in such global threat. It is expected that climate change will cause over 250000 additional deaths per year between 2030 and 2050. (1) Globally it is urgent to include a new ecological public health attitude, in which sustainability becomes part of daily practice. (2) Quality evidence is required to mitigate through inclusive strategies undeniable climate outcomes. One health through a cohesive concept, addresses environment and human health sinergically with animal welfare and veterinary medicine. By moderating consequences through multiple tactics, it is possible to achieve objectives in their whole dimension. (3)

Besides total environmental related deaths have been constant, in the last decades a shift from infectious diseases to non-communicable diseases was seen both in environmental fraction and burden, translating years of development in water safety and sanitation in low and middle-income countries. By estimating burden of disease that can be attributable to environmental risks, we can predict how measures can have impact on safeguarding people’s health – population attributable fraction. The acknowledgment of which factors can be amendable is crucial to support evidence in order to locate resources in actions that have a quantifiable benefit. (4) (5)

To monitor these changes, a surveillance system that include both ecological and human health impacts is essential. It is not possible to address these issues without giving health systems an essential role on moderating climate impact on populations’ health and societies. By decreasing their not minor footprint, the sector can be an example that transformations are accessible to all, even in segments as complex as health systems. Second and more appealing to managers and business associates is that these changes can have a serious impact on systems budgets and expenses.

Remarkably, health sector can improve public health and reduce costs simultaneously. (6)

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References

1. Hales, S, et al. Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva : World Health Organization, 2014. ISBN 978 92 4 150769 1.
2. Brousselle, Astrid e Butzbach, Camille. Redesigning public health for planetary health. The Lancet Planetary Health. May 2018, Vols. 2, Issue 5 , e188 – e189.
3. One Health Initiative. One Health Initiative. About One Health. [Online] [Citação: 3 de May de 2018.] http://www.onehealthinitiative.com/about.php.
4. Prüss-Ustün, A, et al. Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. s.l. : World Health Organization, 2016.
5. World Health Organization. Preventing noncommunicable diseases (NCDs) by reducing environmental risk factors. Geneva : s.n., 2017 (WHO/FWC/EPE/17.1). Licence: CC BY-NC-SA 3.0 IGO.
6. WHO’s Department of Public Health and Environment and Health Care Without Harm. Healthy Hospitals – Healthy Planet – Healthy People | Addressing climate change in health care settings – discussion draft . s.l. : World Health Organization, 2008.

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Mariana Perez Duque
Public Health Resident
Public Health Unit ACeS Porto Ocidental, ARS Norte, Portugal