Aldo Rosano - Access to Primary Care and Preventative Health Services of Migrants

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Preventive health services (PHS) form part of primary healthcare with the aim of screening for and preventing disease. PHS have a key role in preventing chronic disease, reducing related morbidity and mortality. Preventive healthcare interventions act at different stages of life and may intervene before the occurrence of any disease (primary prevention), or at an early stage of the disease (secondary prevention). Primary prevention includes interventions that aim at preventing the appearance of a disease and include strategies to quit tobacco use, vaccinations/immunization against infectious diseases and health promotion towards healthy lifestyles, including diet and physical activity. Secondary prevention includes activities such as population-based screening programmes for early detection of diseases or provision of chemo-prophylactic agents to control risk factors.

One important piece of preventive strategies relies on health promotion. Health promotion is the process of enabling people to increase control over, and to improve, their health. Health promotion concerns in general diet, physical activity, sexual and reproductive health and healthy lifestyles (WHO 1986).

Migrants show significant differences in lifestyle, health beliefs and risk factors as compared to the native population (Loue and Sajatovic 2012). This could have a significant impact on migrants access to health systems and participation in prevention programs. On the other hand, barriers to access to preventive health services can be higher than to other health services. Even in countries with widely accessible healthcare systems, migrants access to preventive health services may be difficult (Mladovsky 2007). Moreover, health promotion programs should be culturally sensitive and adequately targeted in order to reach migrant population and ethnic minorities (Liu 2012).

Nowadays health inequalities are undoubtedly a public health and policy concern. Health care systems are also measured taking into account how equitable they are. The fight against social exclusion could be, in this perspective, a mean of achieving better health care systems. Nevertheless, access to preventive health services is inequitable. Equity refers to the extent to which access is determined by 'medical need' as proxied by health status as opposed to socio-economic factors such ethnicity, income and insurance status (Uiters 2009). Gender, socio-economic position and immigrant status have always been the factors analysed to monitor a possible variation in health care access/utilization. There is evidence, although not always coherent, that access to health care services and preventive health services varies between immigrant and native population.

International conventions, such as the International Convenant on Economic, Social and Cultural Rights or the International Convention on the Elimination of All Forms of Racial Discrimination or the Council of Europe Convention on Human Rights and Biomedicine, should ensure equitable access to health care of appropriate quality without any discrimination based on nationality or legal status. Among European countries full access to health care is guaranteed only for migrants in a legal status, with some discrepancies. For undocumented migrants and asylum seekers the situation may vary considerably according to national legislation, as the competence to act in the field of public health is still primarily a national matter (Pace 2011; MIPEX 2017). Major access barriers reported in the literature are lack of awareness of legal entitlements, fear of being reported to authorities, financial obstacles, cultural and language barriers, complexity of actual needs and health problems of the migrant population.

Social determinants may increase the risk of poor health status or poor access to health care services of migrants as the results of a combination of poor social policies and ethnic discrimination.