Health and Citizenship: Empowering minorities through health education
Author(s):
José Manuel Peixoto Caldas (presenting / submitting) Lígia Moreira Almeida (presenting)
Conference:
ECER 2012
Format:
Paper

Session Information

08 SES 14, Learning for Change: Health, ESD and Citizenship

Parallel Paper Session

Time:
2012-09-21
15:30-17:00
Room:
FFL - Aula 11
Chair:
Per Sund

Contribution

One of the most noble challenges affected by migration relates to the provision of universal and equitable health care, central accessibility and quality of services, regardless of gender, ethnicity or country of origin - health as a universal right. Health and accessibility to health care are keystones for social inclusion of immigrants, consisting one of the primary routes of access to citizenship and civil rights.

Portugal has shown strong commitment on improving the migrants’ integration through a series of inclusive policies, favoring legalization and family reunification, presenting a framework of free access to health care. Nevertheless there are undeniable weaknesses in investigating these areas, as development of national research, comparative health indicators and strategies for concerted action in this area are needed.

The most recent waves of immigration unanimously show the feminization of migration and increasing participation of migrant women in European demography. However, scientific evidence shows that immigrant populations have a higher risk of contracting diseases, such as cardiovascular disease, showing higher rates of diabetes prevalence and mortality associated to cancer, compared with native populations; migrants are also at higher risk of contracting infectious diseases such as tuberculosis, HIV / AIDS and hepatitis. They also exhibit a greater risk of suffering from mental illness, including depression, schizophrenia and post traumatic stress, as a result of specific psychosocial determinants. These factors induce and cause an ascending vulnerability during pregnancy (psychopathological complications after delivery - postpartum blues, psychosis and depression - exacerbated by stressors associated with the migration process), so maternal and child health care should be handled with particular attention.

European lines of research indicate that the morbidity associated with pregnancy, as well as some sexual and reproductive complications tend to be higher among immigrants. There is also evidence that the outcomes of pregnancy tend to be impoverished (losses shown in general state of health, with significant weight to public health), particularly the greater incidence of preterm and low birth weight babies. This population also has the worst health indicators associated with higher maternal, neonatal and infant mortality, spontaneous abortion, increased incidence of postpartum depression, negligible gynecological follow-up and poor prenatal education.

It can be pointed out that a key aspect of integration and acceptance lies, above all, on supplying accessibility to make informed decisions (that implies the availability of multilingual information in different contexts, and ideally providing multicultural mediators, trained to be sensitive and attentive to diversity and cultural specificity), to allow constructed knowledge of legislation and civil rights, and especially access to education as the core of developing a full autonomy.

Method

We are following a mixed methodology for collecting and analyzing data (quantitative and qualitative interface). This is assumed as a major asset, and will be based in exploration and confirmation of key health indicators, considering subjective meanings that determine decision and behavioral change, fundamental in Health (e.g. adherence to therapy, health protective behaviors). Nevertheless it’s intended to assess whether the qualitative data collected (interviews) converge with numerical indicators (gathered through a case-control study) using triangulation techniques. A comprehensive interpretation of the resulting information will be made (content analysis of information emerged), and confronted with quantitative data contiguously collected and statistically analyzed (maternal health outcomes). Interviews will be used (organized according to strict inclusion criteria, through nationalities) in order to collect sensitive information from the perspective of immigrant mothers, which determine demand, access and effective use of available services. Through qualitative strategies, we aim to make a survey of perceived needs and cultural challenges that potentially influence their subjective perceptions, affecting demand and adherence to treatment and achieving behavior health advice. Therefore, our research is leading to grounded specific needs for intervention and health education in different areas, supporting necessary resource optimizations without neglecting human rights.

Expected Outcomes

From law to practice, there are a number of gaps that contribute to systematically worsen health and integration indicators of immigrants. Privileged information was collected through semi-structured interviews with members of the Civic Associations (population and association leaders) in the city of Porto. Very different perspectives have been obtained. Ongoing research can already point out that most complaints concern aspects not covered by legislation, which facilitate the interpretability of the law and its usurpation by those who receive immigrants. On the other hand, the growing bureaucracy from the Portuguese government institutions that are available to supervise and regulate the entry and integration of immigrants in the country has been extremely damaging, increasing difficulties and vulnerabilities arising from the migration process. Immigrants often face difficulties in early integration (due to intrinsic and external barriers), but over time and between generations, the integration process is usually successful. The main mechanisms identified as facilitators of this process were the acquisition of citizenship / nationality (length of stay in Portugal), and gradual adoption of the language, culture and customs of the host society, enabling the development of an active and increasingly adapted social participation.

References

Bunevicius, R., Kusminskas, L., Bunevicius, A., Nadisauskiene, R., Jureniene, K., & Pop, V. (2009). Psychosocial risk factors for depression during pregnancy. Acta Obstetricia et Gynecologica, 88, 599-605. Carballo, M. (2009a). Non-communicable Diseases. In A. Fernandes & J. Miguel (Eds.), Health and Migration in the European Union: Better Health for All in an Inclusive Society (pp. 73-82). Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge. Carballo, M. (2009b). Communicable Diseases. In A. Fernandes & J. Miguel (Eds.), Health and Migration in the European Union: Better Health for All in an Inclusive Society (pp. 53-70). Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge. Creswell, J. (2003). Research Design: qualitative, quantitative and mixed methodes approaches (Second Edition ed.). California: SAGE Publications. Dias, S., A. Gama, & Rocha, C. (2010). Immigrant women's perceptions and experiences of health care services: insights from a focus group study. . Journal of Public Health, 18, 489-496. Dias, S., Gama, A., Cortes, M., & Sousa, B. (2011). Healthcare-seeking patterns among immigrants in Portugal. Health and Social Care in the Community, 19(5), 514-521. Fernandes, A., & Miguel, J. (2009). Health and Migration in the European Union: Better Health for All in an Inclusive Society. Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge. Ingleby, D., Chimienti, M., Hatziprokopiou, P., & Freitas, C. (2005). The role of health in integration. In M. Fonseca & J. Malheiros (Eds.), Social integration and mobility: education, housing and health (pp. 88-119). Lisbon: Centro de Estudos Geográficos. Padilla, B., Portugal, R., Ingleby, D., Freitas, C., & Lebas, J. (2009). Health and migration in the European Union: Good Practices. In A. F. J. P. Miguel (Ed.), Health and Migration in the European Union: Better Health for All in an Inclusive Society. Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge.

Author Information

José Manuel Peixoto Caldas (presenting / submitting)
CIIE-FPCE Oporto University
Education
Oporto
CIIE-FPCE Oporto University, Portugal

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