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Article ; Online: Local political climate and spill-over effects on refugee and migrant health

Kayvan Bozorgmehr / Louise Biddle / Simon Kühne

BMJ Global Health, Vol 8, Iss

a conceptual framework and call to advance the evidence

2023 Volume 3

Abstract: The health of refugees and migrants is determined by a wide range of factors. Among these, the local political climate in the postmigration phase is an important determinant which operates at interpersonal and institutional levels. We present a ... ...

Abstract	The health of refugees and migrants is determined by a wide range of factors. Among these, the local political climate in the postmigration phase is an important determinant which operates at interpersonal and institutional levels. We present a conceptual framework to advance theory, measurement and empirical evidence related to the small-area factors which shape and determine the local political climate, as these may translate into variations in health outcomes among refugees, migrants and other marginalised population groups. Using the example of Germany, we present evidence of small-area variation in factors defining political climates, and present and discuss potential pathways from local political climates to health outcomes. We show that anti-immigrant and antirefugee violence is a Europe-wide phenomenon and elaborate how resilience of individuals, communities, and the health system may function as moderator of the effects of the local political climate on health outcomes. Building on a pragmatic review of international evidence on spill-over effects identified in other racialised groups, we present a conceptual framework which incorporates direct effects as well as ‘spill-over’ effects on mental health with the aim to spark further academic discussion and guide empirical analysis on the topic. After presenting and discussing methodological challenges, we call for collective efforts to build coalitions between social sciences, conflict and violence studies, political science, data science, social psychologists and epidemiology to advance theory, measurement, and analysis of health effects of local political climates.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	360
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Between Care and Coercion

Eilin Rast / Clara Perplies / Louise Biddle / Kayvan Bozorgmehr

International Journal of Public Health, Vol

Asylum Seekers’ Experiences With COVID-19 Containment and Mitigation Measures in German Reception Centres

2023 Volume 68

Abstract: Objectives: COVID-19 containment and mitigation measures have been criticised for amplifying pre-existing individual and structural vulnerabilities among asylum seekers. We qualitatively explored their experiences with and attitudes towards pandemic ... ...

Abstract	Objectives: COVID-19 containment and mitigation measures have been criticised for amplifying pre-existing individual and structural vulnerabilities among asylum seekers. We qualitatively explored their experiences with and attitudes towards pandemic measures to inform people-centred responses in future health emergencies.Methods: We interviewed eleven asylum seekers in a German reception centre (July-December 2020). The semi-structured interviews were recorded, transcribed, and analysed thematically with an inductive-deductive approach.Results: Quarantine was experienced as burdensome by participants. Shortcomings in social support, everyday necessities, information, hygiene, and daily activities exacerbated the strains of quarantine. Interviewees held different opinions about the usefulness and appropriateness of the various containment and mitigation measures. These opinions differed by individual risk perception and the measures’ comprehensibility and compatibility with personal needs. Power asymmetries related to the asylum system furthermore impacted on preventive behaviour.Conclusion: Quarantine can amplify mental health burdens and power asymmetries and can therefore constitute a considerable stressor for asylum seekers. Provision of diversity-sensitive information, daily necessities, and accessible psychosocial support is required to counteract adverse psychosocial impacts of pandemic measures and safeguard wellbeing in this population.
Keywords	mental health ; qualitative research ; COVID-19 ; quarantine ; refugees ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mandatory, voluntary, repetitive, or one-off post-migration follow-up for tuberculosis prevention and control

Katharina Wahedi / Dominik Zenner / Sergio Flores / Kayvan Bozorgmehr

PLoS Medicine, Vol 20, Iss 1, p e

A systematic review.

2023 Volume 1004030

Abstract: Background Post-migration follow-up of migrants identified to be at-risk of developing tuberculosis during the initial screening is effective, but programmes vary across countries. We aimed to review main strategies applied to design follow-up programmes ...

Abstract	Background Post-migration follow-up of migrants identified to be at-risk of developing tuberculosis during the initial screening is effective, but programmes vary across countries. We aimed to review main strategies applied to design follow-up programmes and analyse the effect of key programme characteristics on reported coverage (i.e., proportion of migrants screened among those eligible for screening) or yields (i.e., proportion of active tuberculosis among those identified as eligible for follow-up screening). Methods and findings We performed a systematic review and meta-analysis of studies reporting yields of follow-up screening programmes. Studies were included if they reported the rate of tuberculosis disease detected in international migrants through active case finding strategies and applied a post-migration follow-up (defined as one or more additional rounds of screening after finalising the initial round). For this, we retrieved all studies identified by Chan and colleagues for their systematic review (in their search until January 12, 2017) and included those reporting from active follow-up programmes. We then updated the search (from January 12, 2017 to September 30, 2022) using Medline and Embase via Ovid. Data were extracted on reported coverage, yields, and key programme characteristics, including eligible population, mode of screening, time intervals for screening, programme providers, and legal frameworks. Differences in follow-up programmes were tabulated and synthesised narratively. Meta-analyses in random effect models and exploratory analysis of subgroups showed high heterogeneity (I2 statistic > 95.0%). We hence refrained from pooling, and estimated yields and coverage with corresponding 95% confidence intervals (CIs), stratified by country, legal character (mandatory versus voluntary screening), and follow-up scheme (one-off versus repetitive screening) using forest plots for comparison and synthesis. Of 1,170 articles, 24 reports on screening programmes from 7 countries were included, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mandatory, voluntary, repetitive, or one-off post-migration follow-up for tuberculosis prevention and control

Katharina Wahedi / Dominik Zenner / Sergio Flores / Kayvan Bozorgmehr

PLoS Medicine, Vol 20, Iss

A systematic review

2023 Volume 1

Abstract	Background Post-migration follow-up of migrants identified to be at-risk of developing tuberculosis during the initial screening is effective, but programmes vary across countries. We aimed to review main strategies applied to design follow-up programmes and analyse the effect of key programme characteristics on reported coverage (i.e., proportion of migrants screened among those eligible for screening) or yields (i.e., proportion of active tuberculosis among those identified as eligible for follow-up screening). Methods and findings We performed a systematic review and meta-analysis of studies reporting yields of follow-up screening programmes. Studies were included if they reported the rate of tuberculosis disease detected in international migrants through active case finding strategies and applied a post-migration follow-up (defined as one or more additional rounds of screening after finalising the initial round). For this, we retrieved all studies identified by Chan and colleagues for their systematic review (in their search until January 12, 2017) and included those reporting from active follow-up programmes. We then updated the search (from January 12, 2017 to September 30, 2022) using Medline and Embase via Ovid. Data were extracted on reported coverage, yields, and key programme characteristics, including eligible population, mode of screening, time intervals for screening, programme providers, and legal frameworks. Differences in follow-up programmes were tabulated and synthesised narratively. Meta-analyses in random effect models and exploratory analysis of subgroups showed high heterogeneity (I2 statistic > 95.0%). We hence refrained from pooling, and estimated yields and coverage with corresponding 95% confidence intervals (CIs), stratified by country, legal character (mandatory versus voluntary screening), and follow-up scheme (one-off versus repetitive screening) using forest plots for comparison and synthesis. Of 1,170 articles, 24 reports on screening programmes from 7 countries were included, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees

Amir Mohsenpour / Louise Biddle / Kayvan Bozorgmehr

PLOS Global Public Health, Vol 3, Iss 12, p e

A cross-sectional, population-based, multi-level analysis in a German federal state.

2023 Volume 0001755

Abstract: Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random ... ...

Abstract	Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Changing the Discourse in Ambitions Towards Universal Health Coverage

Sarah J. Simpson / Victoria Saint / Kayvan Bozorgmehr

International Journal of Health Policy and Management, Vol 11, Iss 6, Pp 851-

Lessons From Australian Primary Healthcare; Comment on “Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”

2022 Volume 854

Abstract: While Australia’s health system has reached universal health coverage (UHC), recent scholarship points to its strengths and identifies ways it could be more effective and equitable, especially for tackling non-communicable diseases (NCDs). Building on ... ...

Abstract	While Australia’s health system has reached universal health coverage (UHC), recent scholarship points to its strengths and identifies ways it could be more effective and equitable, especially for tackling non-communicable diseases (NCDs). Building on the Australian experience, we add to these perspectives and present pertinent lessons for the quest towards UHC, and for policy-makers globally with regard to NCDs. Potential lessons include: the need for (i) vigilance – UHC requires ongoing monitoring and evaluation of not only financial risk protection but non-financial barriers and impacts such as forgone care; (ii) investment and action now on structural determinants of NCDs and related inequalities to avoid potentially higher (fiscal, social and health) costs in the longer term; and (iii) the opportunity for policy-makers globally and nationally to revisit their ambitions for UHC to include population health policies/programs beyond essential health services that are required for healthier, more equitable and thriving societies.
Keywords	australia ; equity ; non-communicable diseases ; financial risk protection ; universal health coverage ; structural determinants ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Resilience of Health Systems

Kayvan Bozorgmehr / Andreas Zick / Tobias Hecker

International Journal of Health Policy and Management, Vol 11, Iss 9, Pp 1956-

Understanding Uncertainty Uses, Intersecting Crises and Cross-level Interactions; Comment on “Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada”

2022 Volume 1959

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has created opportunities to study resilience in multiple, interrelated societal systems while considering the institutional, community and individual level. We aim to discuss critical, yet ... ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic has created opportunities to study resilience in multiple, interrelated societal systems while considering the institutional, community and individual level. We aim to discuss critical, yet underrepresented, issues in resilience discourses which are fundamental to advance theories, concepts and measurement of health system resilience. These relate to a better understanding of (i) how government’s handle and use uncertainties to facilitate or impede change, including the role of negotiation and conflicts, (ii) the intersections of health with multiple, co-occurring crises (systemic intersections), and (iii) cross-level interactions, ie, the interrelation between individual-level resilience, the collective resilience of groups and communities, and the resilience of a system as a whole (and vice versa). Analyses of these aspects can help to “contextualize” our understanding of resilience in complex adaptive systems. However, conceptual clarity is needed whether resilience is considered an underlying feature, outcome, or intermediate determinant of a (health) system’s performance.
Keywords	resilience ; uncertainty ; governance ; multi-scale dynamics ; conflict ; health system ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-09-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inequalities in health system responsiveness among asylum seekers and refugees

Louise Biddle / Judith Wenner / Kayvan Bozorgmehr

PLOS Global Public Health, Vol 2, Iss 9, p e

A population-based, cross-sectional study in Germany.

2022 Volume 0000984

Abstract: Global migration has sparked renewed interest in Universal Health Coverage in high-income countries. However, quality of care has received little attention. This study uses the concept of responsiveness to study quality of care for asylum seekers and ... ...

Abstract	Global migration has sparked renewed interest in Universal Health Coverage in high-income countries. However, quality of care has received little attention. This study uses the concept of responsiveness to study quality of care for asylum seekers and refugees (ASR) in Germany and identify inequalities among this group. We report results from a population-based, cross-sectional health monitoring survey in Germany's third-largest federal state using random sampling methods. Established instruments were used to measure responsiveness, health status and socio-demographic factors. Data were weighted and adjusted logistic regression models applied to identify inequalities related to health status, structural and socio-demographic factors. N = 344 survey participants were included in the analysis (response rate 39.2%). Combined responsiveness was 77% (95%CI: 68%; 83%) but varied between domains. Responsiveness was poor for individuals with symptoms of anxiety (OR 0.35, 95%CI 0.13,0.99), longstanding illness (OR:0.42, 95%CI:0.17,1.06) and diminished health-related quality of life (OR:0.24, 95%CI:0.06,0.95). Individuals from Southern Asia (OR: 0.24, 95%CI: 0.07,0.86) and young participants (OR:0.31, 95%CI:0.12,0.82) also reported less responsive care. Unique patterns of explanatory factors were identified within each responsiveness domain. We found important differences in responsiveness related to health, socio-demographic and structural factors, both in combined responsiveness and in individual domains. Inequalities related to health status factors are particularly concerning given the potential implications for equity of access. Future research should explore responsiveness for different sectors, include individuals who have not utilised healthcare and allow for the adjustment of differential expectations of care between population groups.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health Status and Access to Healthcare for Uninsured Migrants in Germany

Lukas Kratzsch / Kayvan Bozorgmehr / Joachim Szecsenyi / Stefan Nöst

International Journal of Environmental Research and Public Health, Vol 19, Iss 6613, p

A Qualitative Study on the Involvement of Public Authorities in Nine Cities

2022 Volume 6613

Abstract: Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. ... ...

Abstract	Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of public authorities’ role in the parallel health care system and their view of the health situation of UM. We conducted qualitative semi-structured interviews with 12 experts recruited by purposive sampling from local public health authorities (LPHAs), state-level public health authorities (SPHAs), and social services offices (SSO) in nine cities, recorded, transcribed, and subjected the data to qualitative content analysis. LPHAs are more often directly involved in providing medical services, while SSOs and SPHAs function as gatekeepers for access to social benefits, including health insurance, and in grant-funded projects. NGOs keep substituting for the lack of access to regular health care from public institutions, but even in settings with extended services, public authorities and NGOs have not been able to provide sufficient care through the parallel health care system: Experts report gaps in the provision of health care with respect to the depth and height of coverage, due to the fragmentation of services and (ostensible) resource scarcity. Our study highlights the necessity for universal access to regular health care to overcome the fragmentation of services and improve access to needed health care for UM in Germany.
Keywords	health services accessibility ; health inequality ; public authorities ; transients and migrants ; uninsured migrants ; irregular migrants ; Medicine ; R
Subject code	360 ; 306
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inequalities in access to healthcare by local policy model among newly arrived refugees

Judith Wenner / Louise Biddle / Nora Gottlieb / Kayvan Bozorgmehr

International Journal for Equity in Health, Vol 21, Iss 1, Pp 1-

evidence from population-based studies in two German states

2022 Volume 12

Abstract: Abstract Background Access to healthcare is restricted for newly arriving asylum seekers and refugees (ASR) in many receiving countries, which may lead to inequalities in health. In Germany, regular access and full entitlement to healthcare (equivalent ... ...

Abstract	Abstract Background Access to healthcare is restricted for newly arriving asylum seekers and refugees (ASR) in many receiving countries, which may lead to inequalities in health. In Germany, regular access and full entitlement to healthcare (equivalent to statutory health insurance, SHI) is only granted after a waiting time of 18 months. During this time of restricted entitlements, local authorities implement different access models to regulate asylum seekers’ access to healthcare: the electronic health card (EHC) or the healthcare voucher (HV). This paper examines inequalities in access to healthcare by comparing healthcare utilization by ASR under the terms of different local models (i.e., regular access equivalent to SHI, EHC, and HV). Methods We used data from three population-based, cross-sectional surveys among newly arrived ASR (N=863) and analyzed six outcome measures: specialist and general practitioner (GP) utilization, unmet needs for specialist and GP services, emergency department use and avoidable hospitalization. Using logistic regression, we calculated odds ratios (OR) and 95% confidence intervals for all outcome measures, while considering need by adjusting for socio-demographic characteristics and health-related covariates. Results Compared to ASR with regular access, ASR under the HV model showed lower needs-adjusted odds of specialist utilization (OR=0.41 [0.24-0.66]) while ASR under the EHC model did not differ from ASR with regular access in any of the outcomes. The comparison between EHC and HV model showed higher odds for specialist utilization under the EHC model as compared to the HV model (OR=2.39 [1.03-5.52]). GP and emergency department utilization, unmet needs and avoidable hospitalization did not show significant differences in any of the fully adjusted models. Conclusion ASR using the HV are disadvantaged in their access to healthcare compared to ASR having either an EHC or regular access. Given equal need, they use specialist services less. The identified inequalities constitute ...
Keywords	Access to healthcare ; Health inequalities ; Refugees ; Asylum seekers ; Healthcare utilization ; Unmet needs ; Public aspects of medicine ; RA1-1270
Subject code	306
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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