At the end of 2016, there were approximately 36.7 million people living with HIV worldwide with 1.6 million people being newly infected. In the same year, 1 million people died from HIV-related causes globally. The vast prevalence of HIV calls for an urgent need to develop and implement prevention programs aimed at reducing risk behaviors. Bronfenbrenner’s socio-ecological model provides an organizing framework to discuss HIV prevention interventions implemented at the individual, relational, community, and societal level. Historically, many interventions in the field of public health have targeted the individual level. Individual-level interventions promote behavior change by enhancing HIV knowledge, attitudes, and beliefs and by motivating the adoption of preventative behaviors. Relational-level interventions focus on behavior change by using peers, partners, or family members to encourage HIV-preventative practices. At the community-level, prevention interventions aim to reduce HIV vulnerability by changing HIV-risk behaviors within schools, workplaces, or neighborhoods. Lastly, societal interventions attempt to change policies and laws to enable HIV-preventative practices.
While previous interventions implemented in each of these domains have proven to be effective, a multipronged approach to HIV prevention is needed such that it tackles the complex interplay between the individual and their social and physical environment. Ideally, a multipronged intervention strategy would consist of interventions at different levels that complement each other to synergistically reinforce risk reduction while simultaneously creating an environment that promotes behavior change. Multilevel interventions provide a promising avenue for researchers and program developers to consider all levels of influences on an individual’s behavior and design a comprehensive HIV risk-reduction program.
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HIV Ed: A Global Perspective
Ralph J. DiClemente and Nihari Patel
Article
Homelessness and Vaccination Strategies: Problems and Potential Solutions to Vaccinate Vulnerable Populations
Elena Mitevska, Priyanka Gill, and Monty Ghosh
People experiencing homelessness (PEH) are at a higher risk of vaccine-preventable illnesses. They have higher rates of chronic illnesses that predispose them to communicable diseases, and this is compounded by poor access to sanitation. While vaccination is especially important in PEH, they tend to have lower rates of vaccine uptake compared to the general population. Factors impacting this discrepancy include difficulty accessing vaccines and public health programs, lack of access to primary care services, and distrust of the health care system. Despite this, there is evidence to suggest that many PEH are accepting of vaccinations and are willing to get vaccinated provided the right approach and interactions. Understanding client-specific barriers along with education and counseling are key to improving vaccine uptake in PEH, and programs targeted specifically at PEH can improve vaccine uptake and ultimately the health of PEH.
Article
Impacts of Climate Change on Workers’ Health and Safety
Barry S. Levy and Cora Roelofs
Climate change has increased the risk to workers’ health and safety. Workers, especially those who work outdoors or in hot indoor environments, are at increased risk of heat stress and other heat-related disorders, occupational injuries, and reduced productivity at work. A variety of approaches have been developed to measure and assess workers’ occupational heat exposure and the risk of heat-related disorders. In addition, increased ambient temperature may increase workers’ exposure to hazardous chemicals and the adverse effects of chemicals on their health. Global warming will influence the distribution of weeds, insect pests, and pathogens, and will introduce new pests, all of which could change the types and amounts of pesticides used, thereby affecting the health of agricultural workers and others. Increased ambient temperatures may contribute to chronic kidney disease of unknown etiology among workers. Global warming is increasing ground-level ozone concentrations with adverse effects on outdoor workers and others. Extreme weather events related to climate change pose injury risks to rescue and recovery workers. Reducing the risks of work-related illnesses and injuries from climate change requires a three-pronged approach: (1) mitigating the production of greenhouse gases, the primary cause of climate change; (2) implementing adaptation measures to address the overall consequences of climate change; and (3) implementing improved measures for occupational health and safety.
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Improving Post-Acute Care Quality for Older Adults in the U.S.: Nursing Homes and Beyond
Caroline P. Thirukumaran and Brian E. McGarry
Medical and surgical post-acute care (PAC) encompasses the rehabilitative and palliative health services that individuals typically receive following a stay in an acute care hospital and is a critical source of post-hospitalization care for Medicare-insured patients undergoing surgeries such as hip and knee replacements, or with medical conditions such as septicemia or severe sepsis. PAC, commonly delivered through skilled nursing facilities (SNFs), has long been prone to quality issues, and national policies are routinely reformed to improve their quality. Yet reform initiatives are often hampered by challenges related to the measurement of quality and the way in which PAC, especially in SNFs, is financed. Moreover, the lack of clear guidelines about the optimal PAC setting (e.g., institution vs. home) and the clinical and social characteristics of patients that may benefit from a particular setting has resulted in PAC being a source of wasteful spending. These challenges have been heightened by extensive payment reforms following the passage of the Patient Protection and Affordable Care Act and the COVID-19 pandemic. These changes have the potential to upend the status quo of the PAC business model, with wide-ranging potential implications for older adults’ access to high-quality rehabilitative care. The determination of value in PAC settings has commonly used Medicare claims and assessment data; focused on metrics such as readmissions, length of stay, spending, and transition to the community; and relied on reporting through the Care Compare website. The advances in PAC-focused reforms and the growing emphasis on care coordination have motivated promising initiatives such as standardization of metrics across PAC settings; the use of accountable care organizations and episode-based bundled payments for PAC reimbursement; the use of telehealth; and other innovations that are positioned to encourage the delivery of high-quality rehabilitative care.
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Indigenous Health Policy
Ian Anderson and Kate Silburn
The United Nations estimates that there are more than 476 million Indigenous peoples across the globe, which is almost 7% of the world’s population. Although Indigenous peoples are defined in a variety of political and cultural ways, there is increasing recognition of the seven defining criteria for indigeneity as set out by UN Permanent Forum on Indigenous Issues. Globally, Indigenous peoples tend to do less well than benchmark populations in health and social outcomes—although the degree of difference varies markedly between countries.
Of the vast range of different in-country policy and service responses that address these inequalities, the collection of accurate and relevant data on Indigenous peoples is key to monitoring their health outcomes.
Health and data researchers and policymakers have advocated for stronger Indigenous governance of both the data and health system responses. To achieve this, they have increasingly engaged a variety of global governances systems. Principally, but not exclusively, this advocacy has targeted UN mechanisms such as the Permanent Forum on Indigenous Issues and the Human Rights Council Expert Mechanism on the Rights of Indigenous Peoples.
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Inequalities and Inequities in the Health of People With Intellectual Disabilities
Eric Emerson
Children and adults with intellectual disabilities have poorer health and are more likely to die sooner than their non–intellectually disabled peers. There is growing evidence that some of these inequalities in health are avoidable, unjust, and unfair, given that they are driven by the higher rates of exposure of people with intellectual disabilities to well-established social determinants of poor health. People with intellectual disabilities are more likely than their peers to: live in poverty, not be employed (or if employed to work under precarious conditions), be exposed to discrimination and violence, face significant barriers in accessing effective health care, and be less resilient when exposed to adversities. In other words, they are examples of health inequities that arise from “the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health. These include early years’ experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health” (World Health Organization).
Future research needs to address three key issues. First, most of the existing evidence is based on the experiences of people with intellectual disabilities in the world’s high-income countries. In contrast, the vast majority of the world’s population live in middle- and low-income countries. The limited evidence available suggests that children with intellectual disabilities growing up in middle- and low-income countries are much more likely than their peers to be growing up in poverty and to be exposed to specific social determinants of poorer health associated with poverty such as undernutrition, poor sanitation, low levels of parental stimulation, violent parental discipline, and hazardous forms of child labor. Second, little research has focused on health inequalities and inequities among two important groups of people with intellectual disabilities: people with intellectual disabilities from minority ethnic communities and people with mild intellectual disabilities. Third, very little research has attempted to test the proposition that people with intellectual disabilities may be more or less resilient than their peers when exposed to social determinants of health.
While much remains to be learned about the inequalities and inequities faced by people with intellectual disabilities, the existing knowledge is sufficient to guide and drive changes in policy and practice that could reduce the health inequities faced by people with intellectual disabilities. These include: improving the visibility of people with intellectual disabilities in local, national, and international health surveillance systems; making “reasonable accommodations” to the operation of health care systems (e.g., introducing annual health checks into primary care services, making “easy read” materials available, employing intellectual disabilities liaison nurses in acute hospitals) to ensure that people with intellectual disabilities are not exposed to systemic discrimination; and ensuring that people with intellectual disabilities (along with all other people with disabilities) are included in and benefit equally from local and national strategies to reduce population levels of exposure to well-established social determinants of poor health.
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Infectious Diseases Among Migrant Populations
Silvia Declich, Maria Grazia Dente, Christina Greenaway, and Francesco Castelli
Increasing human mobility, of which migration is a component, is a key driver of microorganism circulation. Migration is a minor component of all human mobility, with most movement due to international tourism, travel for work, business, or study, and military operations abroad. Migration flows from southern low-income countries to the industrialized north have steadily increased as a consequences of a complex array of distal and proximal factors such as economic inequality, climate change, political turbulence, war and persecution, and family reunification. This has raised concerns about the potential transmission and reintroduction of microorganisms and infectious diseases into high-income host countries from migrants with asymptomatic infections such as tuberculosis, HIV, viral hepatitis, malaria, Chagas disease, and arboviral infections. These factors contribute to the mounting hostile attitude sometimes observed in receiving countries and deserve careful scientific assessment to inform policies and interventions.
The available evidence does not support the hypothesis that migrants constitute a relevant infectious public health risk for the local population, although careful epidemiological surveillance is mandatory, especially where competent vectors for specific infection are present in the destination area, where certain diseases may potentially be introduced or reintroduced.
The greatest risk of infectious diseases is to the migrants themselves due to increased risk of exposure within their own communities and from the burden of undetected and untreated infections caused by marginalization and poor living conditions. The health conditions vary at the different stages of settlement and interventions need to be tailored accordingly. In the early arrival phase the main health concerns are psychological, traumatic, and chronic conditions. Crowded unhygienic living conditions often experienced by migrants in reception camps coupled with low vaccination rate may facilitate the transmission of respiratory or gastrointestinal infections or vaccine-preventable diseases. After resettlement, undetected infections and the lack of access to health care due to social marginalization may lead to the reactivation or progression of infections such as tuberculosis, viral hepatitis, HIV, and chronic helminthiasis. These outcomes could be prevented through screening and treatment and would benefit both migrants and the host populations. Pretravel interventions that increase the awareness of the possible infectious risks in their countries of origin are critical to decrease travel-related infection among visiting friends and relatives, especially those traveling with children. Migrant-friendly health systems that ensure prompt access to diagnosis and treatment, regardless of legal status, are the best interventions to limit the burden and transmission of infections in this population.
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The Intersection of Disability With Substance Use and Addiction
Sharon Reif, Margaret T. Lee, and Emily Ledingham
As many as one in four adults have a disability and up to one in 12 have addiction to alcohol or drugs yet little is known about their intersection or more broadly about substance use among people with disabilities. The complex interplay of social, economic, and health factors associated with disability are also risk factors for substance use, unhealthy use, and addiction. Disability stigma and stereotypes are common around substance use by disabled people and their ability to engage in treatment and recovery. Many people with disabilities abstain from alcohol and drug use yet rates of addiction are higher across most disabilities than among the nondisabled, with the notable exception of alcohol. Despite this, disabled people are less likely to enter addiction treatment than nondisabled people. Stigma and other barriers to treatment are common for all people with substance use problems and more so for people with disabilities. Attitudes, discriminatory policies or practices, communications, and physical constraints reflect ableism and affect the ability of people with disabilities to enter addiction treatment. Once treatment is initiated, success can be maximized by meeting specific disability-related needs. For people with physical and sensory disabilities, if physical accessibility and communications accommodations are met, success in addiction treatment presumably should parallel that of people without these disabilities. For people with intellectual, developmental, and cognitive disabilities, success may require additional adaptations. Promising approaches exist but cross-systems training and collaboration is essential. By reducing ableism, misbeliefs, and stigma and offering flexible treatment approaches along with the required accommodations, people with disabilities who also have addiction should be supported in reducing unhealthy substance use and in their paths to recovery.
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Intervention Approaches for Osteoarthritis
Susan Hughes, Cheryl Der Ananian, and Andrew DeMott
Osteoarthritis (OA) currently affects 32.5 million people in the United States at a cost of $136.8 billion. The available literature on the epidemiology of OA shows that the number of people affected will increase exponentially by the year 2040, affecting 78.4 million people. There is an abundance of evidence that self-management and physical activity (PA) approaches improve multiple outcomes for individuals with arthritis. However, these programs are not widely accessible to the population that can benefit from them across the United States. Two national organizations—the arthritis program of the Centers for Disease Control and Prevention (CDC) and the Administration on Community Living (ACL)—have established similar, but distinct, criteria for the review of evidence-based programs and seek to promote their dissemination. The CDC arthritis program has reviewed the evidence bases of arthritis-appropriate, evidence-based intervention programs and classified them as self-management or PA approaches. These “recognized” programs are recommended for national dissemination by the CDC. The ACL has also recognized several of the same programs by using its own criteria and classified them as Self-Management or Falls Prevention approaches. The different review criteria used by these two national public organizations present significant challenges for investigators who design interventions. The situation is further compounded by an investment in funding that hugely supports the discovery of interventions as opposed to the dissemination of interventions that have demonstrated efficacy. The National Public Health Agenda for Osteoarthritis: 2020 Update presents a blueprint that includes nine strategies for improving public health outcomes among persons with OA. These recommendations should be considered by interventionists in the future when developing programs. Other areas that can substantially benefit from further research include weight management and weight loss, injury prevention, technology-based interventions, addressing comorbid conditions, and understanding program mechanisms of action. Finally, underscoring all of these approaches and common to them is the need to enroll underserved populations to improve health equity. Underserved populations disproportionately include African Americans, Hispanics, persons with low socioeconomic status, and persons who live in rural areas of the United States. Policy recommendations to render future approaches to improving health outcomes for persons with OA are (a) to increase funding for the dissemination of programs that demonstrated efficacy and effectiveness, (b) to increase the transparency of the review and funding processes across public agencies, and (c) to nurture, broker, and provide sustainable funding streams to maintain evidence-based programming for all persons with OA across the United States.
Article
Investing in Community Organizations That Serve Marginalized Populations
Margarita Alegria, Lauren Cohen, Ziqiang Lin, Michelle Cheng, and Sheri Lapatin Markle
Minoritized racial and ethnic groups experience mental health issues yet persistently encounter systemic barriers to accessing mental health care. Disparities in mental health services are linked to structural racism, discrimination, and stigma. Social determinants of health also impact the risk of experiencing mental health issues and contribute to mental healthcare access. Community-based organizations (CBOs) can serve as vital linkages for delivering much-needed support across many domains (e.g., physical and mental health, housing, food, recreation, etc.) and provide opportunities for fostering connections with members of underserved communities. There is untapped potential in leveraging the skills and expertise offered by CBOs and their staff. Designing programs and interventions that incorporate the goals and ideals of the community served may facilitate sustainability and contribute to a reconceptualization of care delivery based on equity. Ensuring that community-informed initiatives are set up for success will require advocacy for multisector collaboration and innovative approaches and policies that facilitate community collaborations to improve mental health and well-being for communities of color to flourish.
Article
Latino Health
Ana Abraído-Lanza, Lillian Amanda Ruiz, and Sonia Mendoza-Grey
Latinos are the fastest-growing population in the United States and comprise nearly 20% of the population with approximately 63 million residing in the United States in 2021. The Latino population in the United States is a diverse community with approximately one-third of Latinos living in the United States being foreign born and representing every country in Latin America. Given the high proportion of recent immigrants to the United States within the group, the Latino community has unique social and policy needs that impact health and access to medical care. Latino immigrant country of origin, political trajectories, and nativity status are particularly relevant in regard to disease prevalence, treatment, and prevention. Although being foreign-born is a protective factor for some forms of cancers and cardiovascular disease among Latinos, for example, recent immigrant Latinos are susceptible to acute mental health distress and lack of access to medical care. Despite the observation that Latinos as a whole persistently exhibit longer life expectancies relative to non-Latino whites at the face of high comorbidity rates, the recent COVID-19 pandemic has impacted this health advantage for several age groups within the community. As one of the fastest-growing populations in the United States, Latino youth health is important to address, especially with prevention measures for metabolic disease, and the impact of poverty on family access to healthcare. Understanding the nuanced and varying social and political determinants of health for Latinos, as well as differences within subgroups, sheds light on the effects of environment, behavior, and the impact of access to health on morbidity and mortality.
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Managing Pain Within Vulnerable Populations of Seniors With Chronic Care Issues
Patricia Schofield
The Western world is facing a crisis. The population is aging dramatically, and soon there will be twice as many older adults as younger counterparts. Clearly, there is a high incidence of pain in the older population, and with this comes a significant burden, including falls, frailty, depression, anxiety, sleep disturbance, reduced mobility, and impaired cognitive function. Unfortunately, chronic pain in the older population is often neglected and poorly managed for many reasons, including the expectation that pain is part of the aging process and therefore to be expected; poor assessment practices, hampered by communication problems; limited time for a comprehensive assessment to be carried out; fear of prescribing and administering drugs; and beliefs held by the older person themselves that they should expect to be in pain and therefore do not report it. All of these issues can be addressed with appropriate education and training to enable staff to appropriately apply evidence-based guidelines and effectively manage pain.
Article
Managing the Paradox of Conflictual Policy and Strategy Regarding Health of Irregular Migrants: Perspective From Europe and Africa
Ursula Trummer, Michela Martini, and Sabelo Mbokazi
Irregular migrants belong to the most vulnerable migrant groups. Health threats associated with an irregular status are high, and access to health services is severely restricted globally. Concerning migration aspects, a common public narrative for Europe and Africa is that Africa is sending thousands of migrants to embark on an irregular life-threatening journey of migration to Europe every year. Although this is a well documented reality, it is by far not the most important migration pattern in terms of numbers and health threats when looking at Africa. It can be argued that, on the contrary, Africa is mainly characterized by south-to-south migration both for economic and humanitarian reasons, with African nation-states like Uganda being among the top three nations worldwide hosting refugees. In addition, main migration routes from Africa do not target Europe but rather other regions like the Gulf countries.
Existing dialogue between Europe and Africa has great potential to fast track and develop joint policies and strategies for meaningful, affordable legal migration patterns and access to the human right to health for irregular migrants. First, a change of the rhetoric around irregular migration from Africa mainly directed toward Europe is needed. Second, existing policies and strategies regarding the health of irregular migrants need to be examined and evaluated. Within all the huge differences concerning public health systems and capacities in Europe and Africa, a common strategy to discourage irregular migration seems to be restricting the access of irregular migrants to their human right to health through national regulations. This has paradoxically created a simultaneous inclusion on grounds of human rights regulations and exclusion on grounds of national restrictions, with “functional ignorance” (health care organizations and personnel ignore the lack of residence permits and its legal implications) and “structural compensation” (facilities run by nongovernmental organizations take over public health responsibilities and health care provision) as key features. Such strategies put a lot of strain on health care providers and irregular migrants and should not be considered as a sustainable solution.
Instead, action should be taken to overcome the paradox of contradictory migration and health policies by means of firewalls and structural mechanisms. An important step in this direction can be to rethink cooperation between Europe and Africa in this domain, starting with the development of a joint evidence base relevant for Europe and Africa in an interdisciplinary approach and with European and African scholars that can support proactive policy and strategy development to safeguard the human right to health for irregular migrants together with good migration governance.
Article
Maternal Health and Well-Being
Samuel Akombeng Ojong, Bridgette Wamakima, Cheryl A. Moyer, and Marleen Temmerman
Maternal health and well-being refers to the physical, psychological, and emotional well-being of women during pregnancy, childbirth, and the postnatal period, as well as the absence of any morbidities or death either due to pregnancy or its management.
Despite making a comparatively late appearance on the international global policy agenda, maternal health and well-being has progressively become a global health policy priority following Deborah Maine’s revolutionary article on maternal mortality. Consequently, key international policy events from Alma Ata to the International Conference on Population and Development events, through the Millennium Development Goals to the Sustainable Development Goals (SDGs) in the last decade have consecrated women’s inalienable right to safe and respectful health services. Also, the growing focus on rights-based care against the backdrop of the need to ensure equity in all communities worldwide has led to an evolution in policy focus, calling on health systems to not only protect women and girls from preventable deaths but to also empower them to thrive, all while recognizing their unique role is ensuring the positive transformation of the communities in which they live.
This increasing policy attention has contributed to a disproportionate yet marked reduction in global maternal mortality and morbidity statistics over the last 30 years. However, if the world is to achieve its 2030 SDGs women’s health and gender equality agendas, it is important to recognize that the broad concept of women’s health cannot be limited to the rather narrow window of pregnancy, childbirth, and the postpartum period. While there are huge gaps in all resource-type settings in promoting and protecting women’s agency and autonomy, the fact remains that in addition to ensuring the availability of and access to high-quality maternal health services, women’s health outcomes are inextricably linked to their decision-making power on key issues such as when to become sexually active, the use of contraception, whether or not they want to achieve pregnancy and childbirth, and access to safe abortion care services. Additionally, the growing burden of noncommunicable diseases and the increasing occurrence of worldwide pandemics are providing novel challenges to the health and well-being of the world’s most vulnerable women and girls, thus creating the need to ensure resilient health systems that are considerate of the rights and wishes of the world’s women and girls.
Article
Menopause
Funmilola M. OlaOlorun and Wen Shen
Menopause is the natural senescence of ovarian hormonal production, and it eventually occurs in every woman. The age at which menopause occurs varies between cultures and ethnicities. Menopause can also be the result of medical or surgical interventions, in which case it can occur at a much younger age. Primary symptoms, as well as attitudes toward menopause, also vary between cultures. Presently, the gold standard for treatment of menopause symptoms is hormone therapy; however, many other options have also been shown to be efficacious, and active research is ongoing to develop better and safer treatments.
In a high-resource setting, the sequelae/physiologic changes associated with menopause can impact a woman’s physical and mental health for the rest of her life. In addition to “hot flashes,” other less well-known conditions include heart disease, osteoporosis, metabolic syndrome, depression, and cognitive decline. In the United States, cardiac disease is the leading cause of mortality in women over the age of 65. The growing understanding of the physiology of menopause is beginning to inform strategies either to prevent or to attenuate these common health conditions. As the baby boomers age, the distribution of age cohorts will increase the burden of disease toward post-reproductive women. In addition to providing appropriate medical care, public health efforts must focus on this population due to the financial impact of this age cohort of women.
Article
Menstrual Health
Erin C. Hunter, Adesola O. Olumide, and Marni Sommer
Menstruation refers to the periodic flow of blood from the uterus exiting the body through the vagina. Menarche (the first menstruation) signals the onset of reproductive maturity in females and is a result of the shedding of the wall of the uterus that occurs when there is no implantation of a fertilized ovum. The menstrual cycle commences on the first day of menstrual blood flow until the day before the next menstrual blood flow, and the cycle lasts an average of 28 days.
Menstrual health refers to the state of complete physical, mental, and social well-being related to the menstrual cycle and is integral to both human rights to dignity and reproductive health as well as achieving multiple Sustainable Development Goals. The concept of menstrual health as a holistic framework encompasses the factors that contribute to the menstrual experiences of girls, women, and all people who menstruate—as well as the broader impacts of those menstrual experiences on well-being.
The menstrual cycle has historically been neglected in global health discussions. The inaccessibility and inadequacy of information, support, and resources necessary for experiencing optimal menstrual health can have consequences for the physical health, well-being, social participation, education, and economic opportunities of individuals who menstruate. Timely provision of accurate, age-appropriate information about the menstrual cycle and the practical aspects of experiencing menstrual periods is important for girls who will soon reach menarche—and also for the wider population to foster appropriate social support and inclusive environments that accommodate the needs of those who menstruate. Such needs include access to effective and affordable menstrual materials and appropriate sanitation facilities with waste disposal mechanisms, timely diagnosis and treatment for menstrual discomforts and disorders, and freedom from menstrual stigma. Promoting menstrual health thus requires comprehensive efforts to promote menstrual health education, address pervasive menstrual stigma, challenge social norms that perpetuate discrimination based on menstruation, and improve access to necessary resources for addressing menstrual needs.
Article
Mental Health of Migrant Children
Saida M. Abdi
The psychosocial well-being of migrant children has become an urgent issue facing many Western countries as the number of migrant children in the population increases rapidly and health-care systems struggle to support them. Often, these children arrive with extensive exposure to trauma and loss before facing additional stressors in the host country. Yet, these children do not access mental health support even when available due to multiple barriers. These barriers include cultural and linguistic barriers, the primacy of resettlement needs, and the stigma attached to mental health illness. In order to improve mental health services for migrant children, there is a need to move away from focusing on trauma and mental health symptoms and to look instead at migrant children’s well-being across multiple domains, including activities that can promote or diminish psychological well-being. Trauma Systems Therapy for Refugees (TST-R) is an example of an approach that has succeeded in overcoming these barriers by adopting a culturally relevant and comprehensive approach to mental health care.
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Mental Health of Refugees
Jutta Lindert
People who are forcibly displaced are forced to flee by serious threats to fundamental human rights, caused by factors such as persecution, armed conflict, and indiscriminate violence. Contemporary drivers of forced displacement are increasingly complex and interrelated. They include population growth, food insecurity, and water scarcity, at times compounded and multiplied by the effects of climate change. A refugee is someone who fled his or her home and country owing to “a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group, or political opinion,” according to the United Nations 1951 Refugee Convention. Internally displaced persons (IDPs) are people who have not crossed an international border but were forced to move to a different region than the one they call home within their own country. People who cannot return home without serious risk to their human rights have specific needs.
Forced displacement, both within a country and to other countries, is a major life event that abruptly changes environmental living conditions, such as social networks, language, and cultural environment of the displaced populations. The changes in environmental living conditions and disruptions in life challenge both the individual and the families of the displaced persons. Both types of forced displacement challenge adaptational mechanisms of individuals and families. Accordingly, the challenges can contribute to changes in mental health and mental disorders. However, estimates of mental health, mental disorders, and mental health determinants vary across and between forcibly displaced persons. This heterogeneity in estimates is associated with differences between refugee groups and with methodological difficulties in assessing refugees’ mental health. Instruments to assess mental health need to be culture-grounded and gender-sensitive to capture the scope and extent of refugees’ mental health and mental disorders. Based on reliable and valid instrument needs for assessing mental health and mental disorders, determinants can be identified and intervention can be developed and evaluated.
Article
Migrant Health in Refugee Camps: A Neglected Public Health Issue
Manuela Valenti
There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced.
Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration.
Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care.
Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health.
Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care.
Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.
Article
Migration and Obesity
Solveig A. Cunningham and Hadewijch Vandenheede
There are over 230 million international migrants worldwide, and this number continues to grow. Migrants tend to have limited access to and knowledge about resources and preventative care in their communities of reception, but nonetheless they are often in better health by many measures compared with native-born people in their communities of reception and with the people they left behind at their place of origin. With time since arrival, however, immigrants’ health advantages often dissipate and they experience increases in health problems, especially obesity and diabetes, which are chronic diseases that are increasingly prevalent in the overall population as well and are associated with multiple co-morbidities and limitations. It may be that immigrants have specific health endowments leading to these health patterns, or that the processes involved in migration, including exposure to new environments, behavioral change, and stress of migration may also affect risks of obesity and other chronic conditions. Understanding the health patterns of migrants can be useful in identifying their specific health needs, as well as contributing to our understanding of how specific environments, changes in environments, and individual health endowments interplay to shape the long-term health of populations.
