Health promotion for improved refugee and migrant health


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Health promotion for improved refugee and migrant health
Technical guidance
This project is funded by the European Commission.

The Migration and Health programme
The Migration and Health programme, the first fully fledged programme on migration and health at the WHO Regional Office for Europe, was established to support Member States to strengthen the health sector’s capacity to provide evidenceinformed responses to the public health challenges of refugee and migrant health. The programme operates under the umbrella of the European health policy framework Health 2020, providing support to Member States under four pillars: technical assistance; health information, research and training; partnership building; and advocacy and communication. The programme promotes a collaborative intercountry approach to migrant health by facilitating cross-country policy dialogue and encouraging homogeneous health interventions along the migration routes to promote the health of refugees and migrants and protect public health in the host community.

Health promotion for improved refugee and migrant health
Technical guidance
This project is funded by the European Commission.

Abstract This technical guidance outlines current best practices, evidence and knowledge to inform policy and programme development in the area of health promotion for refugees and migrants. It highlights key principles, summarizes priority actions and challenges, maps available resources and tools and provides policy considerations and practical recommendations to improve health promotion activities for refugees and migrants in the WHO European Region. The target audience is not just those within the health or immigration sectors but also all those with a central role in policy-making at local, national and regional levels, and across all sectors of governance. Clinicians, fieldworkers and other practitioners are invited to draw upon this technical guidance; however, it is not intended to be at a level that would inform their daily work.
Keywords HEALTH PROMOTION, TRANSIENTS AND MIGRANTS, REFUGEES, SOCIAL DETERMINANTS OF HEALTH, EUROPE
Suggested citation Health promotion for improved refugee and migrant health. Copenhagen: WHO Regional Office for Europe; 2018 (Technical guidance on refugee and migrant health).
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ISBN 978 92 890 5380 8
© World Health Organization 2018
All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full.
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All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization.
This publication was produced with the financial assistance of the European Union. The views expressed herein can in no way be taken to reflect the official opinion of the European Union.
Cover © Ali Saltan

Contents
Acknowledgements.......................................................................................iv Abbreviations.................................................................................................v Summary.......................................................................................................vi Introduction....................................................................................................1
The Ottawa Charter for Health Promotion......................................................................1 Objectives.......................................................................................................................... 3 Methodology..................................................................................................................... 3 Overview.........................................................................................................4 Evidence.........................................................................................................5 Social determinants of health linked with migration....................................................5 Evidence on health promotion initiatives.......................................................................5 Areas for intervention.....................................................................................8 Create healthy public policies.........................................................................................8 Create supportive environments...................................................................................11 Strengthen community actions.....................................................................................14 Develop personal skills..................................................................................................17 Reorient health services................................................................................................19 Policy considerations...................................................................................22 Priority areas to support policy-making.......................................................................22 References...................................................................................................27 Annex 1. Resources and tools to support policy considerations for health promotion.....................................................................................................34
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Acknowledgements
The technical guidance series on the health of refugees and migrants in the WHO European Region was produced as part of the WHO Knowledge Hub initiative on Health and Migration under the aegis of the WHO Regional Office for Europe and the European Commission collaboration Migration and Health Knowledge Management (MiHKMa) project.
We would like to thank the MiHKMa project team led by Santino Severoni, who coordinates and leads the Migration and Health programme within the Division of Policy and Governance for Health and Well-being of the WHO Regional Office for Europe, directed by Piroska Östlin.
Kari Pahlman (Uppsala University) is the author of the Technical Guidance on Health Promotion for Improved Refugee and Migrant Health under the guidance of Santino Severoni (Coordinator Migration and Health programme, WHO Regional Office for Europe).
Guidance and consultation was provided by the Knowledge Management Committee: Ibrahim Abubakar (University College London), Richard Alderslade (WHO Temporary Advisor), Guiseppe Annunziata (WHO), Roberto Bertollini (Ministry of Health, Qatar), Raj Bophal (University of Edinburgh), Jaime Calderon (International Organization for Migration), Nils Fietje (WHO), Heiko Hering (Office of the United Nations High Commissioner for Refugees), Anders Hjern (University of Stockholm), Tamar Khomasuridze (United Nations Population Fund), Monika Kosinska (WHO), Allan Krasnik (European Public Health Association), Bernadette Kumar (University of Oslo), Rosemary Kumwenda (United Nations Development Programme), Anne MacFarlane (University of Limerick), Isabel de la Mata (European Commission), Åsa Nihlén (WHO), Svetlana Stefanet (United Nations Children’s Fund), Felicity Thomas (University of Exeter) and Jacqueline Weekers (International Organization for Migration).
The Expert Working Group for Mental Health of Migrants and Refugees also contributed technical advice and expertise. We thank Susanna Albertini (FVA New Media Research), Caroline Costongs (EuroHealthNet), Saoirse Gabhain (NUI Galway), Rogelio López-Vélez (Salud Entre Culturas) and Erio Ziglio (Health University of Applied Sciences Tyrol). We would like to thank Bente Mikkelsen, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-Course of the WHO Regional Office for Europe and her team for their contribution.
Acknowledgements are owed to the project manager, Jozef Bartovic, for his work in the successful coordination and execution of the technical guidance series. Our gratitude also goes to Hedvig Berry Wibskov, Palmira Immordino, Simona Melki, Kari Pahlman and Soorej Jose Puthoopparambil for their support with the project.
Finally, the WHO Regional Office for Europe wishes to thank the Consumer, Health, Agriculture and Food Executive Agency (Chafea) of the European Commission Directorate-General for Health and Food Safety (DG SANTE) for its financial support of the project, in particular Isabel de la Mata (European Commission) and Paola D’Acapito (Chafea) for their contribution and support in overseeing the project.
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Abbreviations

HIA HiAP SDG

health impact assessment health in all policies Sustainable Development Goal

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Summary
As for all people, refugees and migrants have the fundamental right to enjoy the highest attainable standard of health. Health, however, is influenced not only by biological factors, individual behaviours or even access to health services but also by many other overlapping and intersecting social, political and economic factors; these are known as the social determinants of health. Importantly, the processes of migration and displacement are also social determinants of health and can pose significant risks and increased vulnerability for poor health outcomes. Not only do many refugees and migrants originate from countries affected by poverty and conflict, poor or disrupted health systems and high burdens of disease, the conditions surrounding their migration may exacerbate health inequalities and expose them to greater health risks. These include conditions experienced in transit and destination countries, such as lack of clean water and adequate nutrition; the legal status of the individual and the policies that grant or deny access to services; and their living and working conditions. Social and cultural barriers to integration, low socioeconomic status, acculturation stress, exclusion and discrimination are additional factors that impact the health of refugees and migrants.
Addressing the impacts of migration and displacement on each person’s health and advocating for the diverse and unique needs of refugees and migrants are imperative. Health promotion is a key mechanism through which to act. Health promotion is the process of enabling people to gain more control over, and improve, their own health and well-being, and that of their families and communities. Through a health promotion lens, health is seen not merely as the absence of illness or disease but rather as a means for everyday life in which people realize aspirations, satisfy needs and adapt and cope with their personal environment in order to achieve physical, social and mental wellbeing. The Ottawa Charter for Health Promotion was established in 1986 and provides the grounding framework for research, policy and practice on health promotion. It emphasizes how broader socioecological factors, and indeed the social determinants of health, impact health outcomes and even influence health-related behaviours. The Ottawa Charter outlines five key priority areas: building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills and reorienting health services. It is important however, that these domains for action are approached collectively in a structured and systematic manner, as health promotion will not have as great an impact if it is conducted by isolated sectors (socalled silo action).
The approach of the Ottawa Charter can form the basis to guide the development of effective interventions for refugees and migrants in the WHO European Region. Policy considerations for decision-makers include to:
„„ adopt a health in all policies (HiAP) approach to ensure policies within all sectors of government, not just the health care sector, promote the health of refugees and migrants;
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„„ improve social services and the quality of the physical and social environments in which refugees and migrants live;
„„ prioritize community-centred approaches that mobilize the resources and assets within refugee and migrant communities and build local capacities;
„„ invest in language support and health literacy initiatives to develop personal skills in the host country; and
„„ promote cultural- and diversity-sensitive approaches to health care and build a culturally competent health workforce that is responsive to the unique needs of refugee and migrant populations.
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© Ali Saltan

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Health promotion for improved refugee and migrant health