Themed Paper – Short CommunicationOvercoming the barriers migrants face in accessing health care
Introduction
How can we overcome the barriers migrants face in accessing health services? This was the subject of a workshop held at the First World Congress on Migration, Ethnicity, Race, and Health in Edinburgh in May 2018, where practitioners and researchers with both practical and theoretical knowledge outlined their experiences. In this short communication, we describe the issues discussed at the workshop, beginning with the often overlooked area of structural competence in migrant health and then examining two contemporary examples of the issues facing civil society organizations supporting migrants in need of health care. The first, from the United Kingdom (UK), examines ways of overcoming barriers to accessing care. The second, from Greece, addresses the related, and complex, issue of cultural competence.
Section snippets
Structural competency for migrant health
The training of health professionals has, traditionally, focused on the immediate causes of disease, such as exposure to microorganisms, trauma, or certain risk factors such as tobacco. The skills acquired in diagnosis and treatment are clearly important, but, on their own, they are inadequate to address the powerful societal, political, and economic structures that influence health. For this, health professionals need a different set of skills, which have been termed, collectively, ‘structural
Access to health care in England
One of the examples alluded to above is the agreement, in January 2017, between the National Health Service (NHS) in England and immigration authorities. Despite the obvious risk of deterring those whose immigration status is uncertain from obtaining healthcare, it allowed the immigration authorities to access non-clinical patient information. One non-governmental organization (NGO), Doctors of the World (DOTW) UK, part of the Médecins du Monde international network, launched an ultimately
Cultural competence
An example from Greece explored the related issue of cultural competence, initially defined as ‘a set of congruent behaviors, attitudes, and policies that comes together in a system, agency, or among professionals and that enables them to work effectively in cross-cultural situations’.8 It was adapted in the health sector as ‘the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to meet patients' social, cultural, and
Discussion
The workshop documented how migrants face many diverse barriers in accessing health care. It provided a forum for sharing potential solutions, while raising awareness of issues which are often neglected, such as cultural and structural competency, which can equip health professionals to address some of the underlying determinants of the health of those they are caring for. There are also some specific lessons. The experience of DOTW in the UK shows that civil society organizations can
Acknowledgements
The authors would like to thank Joshua Neff and the Structural Competency Working Group for sharing the slide used in Figure 1 (see www.structcomp.org, c.f. Neff et al., 20172).
Ethical approval
None sought.
Funding
Open Society Foundations funded the workshop and speakers.
Competing interests
LH worked as Doctors of the World UK health advisor at the time of the workshop and writing of the piece.
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