Suchergebnisse

Neu angekommene Geflüchtete haben in Deutschland eingeschränkten Zugang zur Gesundheitsversorgung. Viele medizinische Leistungen müssen individuell bei der jeweils zuständigen Behörde beantragt werden. Im Rahmen der gesetzlichen Vorgaben werden darüber Ermessensentscheidungen getroffen. Wir werfen in diesem Beitrag die Frage auf, ob soziale Kategorisierungsprozesse Einfluss auf diese Entscheidungen und damit auf den Umfang der Gesundheitsversorgung nehmen. Insbesondere wollen wir Erwägungen zur ›Bleibeperspektive‹ im Kontext von Verteilungsentscheidungen im Gesundheitssektor kritisch diskutieren. Zudem stellen wir Vorüberlegungen dazu an, wie der Hypothese der ›Bleibeperspektive‹ als möglicherweise neuer sozialer Determinante der Gesundheit wissenschaftlich weiter nachgegangen werden kann.

Comparative health economic evaluation is based on premise of being able to compare the worth of a year of life lived in full quality across different patients, population groups, settings and interventions. Given the rising numbers of forcibly displaced people, the nexus of economics, migration and health has emerged as a central theme in recent conceptual and empirical approaches. However, some of the assumptions made in conventional economic approaches do not hold true in the decision-making context of migration and the health of forcibly displaced populations. Using the experience of conducting and disseminating economic analyses to support decision-making on health screening policies for refugees in Germany, we show that in particular the assumptions of individual utility with no positive externalities, equity-blind utilitarian ethical stances and stable budgets are challenged. The further development of methods to address these challenges are required to support decision-makers in this contentious and politically fraught context and continue to make choices and decisions transparent.

Der subjektive Sozialstatus (SSS) ist mit physischer und psychischer Gesundheit assoziiert. In dieser qualitativen Interviewstudie wurde exploriert, welche Faktoren den SSS asylsuchender Menschen bedingen. Der Rechtsstatus war ein zentraler Faktor für den niedrigen SSS der Befragten. Zugleich akzentuiert Flucht die Dynamik und Pluralität des Konstrukts, das abhängig von Referenzrahmen und Indikatoren ist. Für die Befragten waren unterschiedliche Faktoren für ihre gesellschaftliche Position ausschlaggebend, darunter konventionelle sozioökonomische Faktoren (Geld, Bildung und Beruf) wie auch Selbstverwirklichung, Zufriedenheit oder Moral. Die Bedeutung von Geld, Bildung oder Beruf wurde durch Erfahrungen einiger Befragter im Asylsystem und Herkunftsland aber auch eingeschränkt oder negiert. Die Implikationen für die Operationalisierung des SSS bedürfen weiterer Diskussion.

The German government's response to the COVID-19 pandemic has been predominantly considered wellfounded. Still, the practice of mass quarantine in reception centres and asylum camps has been criticised for its discrimination of refugees and asylum seekers. Building on the concept of othering, this article argues that processes of othering are structurally anchored in German asylum regulations and they have further pervaded public health measures against COVID-19. The practice of mass quarantine made the negative consequences of exclusionary othering for public health particularly noticeable. In the light of recent data indicating this measure to be epidemiologically, legally and ethically insufficient, we apply the concept of othering to public health and discuss (1) exclusionary, (2) inclusionary and (3) diversity-sensitive approaches to public health. We finally conclude that a shift of perspective from exclusion to inclusion, from subordination to empowerment and from silencing to participation is urgently required.

Background: Universities, public institutions, and the transfer of knowledge to the private sector play a major role in the development of medical technologies. The decisions of universities and public institutions regarding the transfer of knowledge impact the accessibility of the final product, making it easier or more difficult for consumers to access these products. In the case of medical research, these products are pharmaceuticals, diagnostics, or medical procedures. The ethical dimension of access to these potentially lifesaving products is apparent and distinguishes the transfer of medical knowledge from the transfer of knowledge in other areas. While the general field of technology transfer from academic and public to private actors is attracting an increasing amount of scholarly attention, the specifications of knowledge transfer in the medical field are not as well explored. This review seeks to provide a systematic overview and analysis of the qualitative literature on the characteristics and determinants of knowledge transfer in medical research and development. Methods: The review systematically searches the literature for qualitative studies that focus on knowledge transfer characteristics and determinants at medical academic and public research institutions. It aims at identifying and analyzing the literature on the content and context of knowledge transfer policies, decision-making processes, and actors at academic and public institutions. The search strategy includes the databases PubMed, Web of Science, ProQuest, and DiVa. These databases will be searched based on pre-specified search terms. The studies selected for inclusion in the review will be critically assessed for their quality utilizing the Qualitative Research Checklist developed by the Clinical Appraisal Skills Programme. Data extraction and synthesis will be based on the meta-ethnographic approach. Discussion: This review seeks to further the understanding of the kinds of transfer pathways that exist in medical knowledge transfer as well as what factors lead to the adoption of one pathway over another. The aim is to provide evidence for political and academic actors designing policies for the translation of medical knowledge and public-private cooperation. Systematic review registration: PROSPERO CRD42015014241

Chapter 1: Health Policy and Systems Responses to Forced Migration: An Introduction -- Chapter 2: The Political Economy of Health and Forced Migration in Europe -- Chapter 3: Innovative Humanitarian Health Financing for Refugees -- Chapter 4: Health Care Financing Arrangements and Service Provision for Syrian Refugees in Lebanon -- Chapter 5: Health Financing for Asylum Seekers in Europe: Three Scenarios towards Responsive Financing Systems -- Chapter 6: Understanding the Resilience of Health Systems -- Chapter 7: Health Security in the Context of Forced Migration -- Chapter 8: Security Over Health: The Effect of Security Policies on Migrant Mental Health in the United Kingdom -- Chapter 9: Evidence on Health Records for Migrants and Refugees: Findings from a Systematic Review -- Chapter 10: Assessing the Health of Persons Experiencing Forced Migration: Current Practices for Health Service Organisations -- Chapter 11: Discrimination as a Health Systems Response to Forced Migration -- Chapter 12: Health Systems Responsiveness to the Mental Health Needs of Forcibly Displaced Persons -- Chapter 13: Global Social Governance and Health Protection for Forced Migrants.

Abstract Background In Germany, educational deficits or potential benefits involved in global health education have not been analysed till now. Objective We assess the importance medical students place on learning about social determinants of health (SDH) and assess their knowledge of global health topics in relation to (i) mobility patterns, their education in (ii) tropical medicine or (iii) global health. Methods Cross-sectional study among medical students from all 36 medical schools in Germany using a web-based, semi-structured questionnaire. Participants were recruited via mailing-lists of students' unions, all medical students registered in 2007 were eligible to participate in the study. We captured international mobility patterns, exposure to global health learning opportunities and attitudes to learning about SDH. Both an objective and subjective knowledge assessment were performed. Results 1126 online-replies were received and analysed. International health electives in developing countries correlated significantly with a higher importance placed on all provided SDH (p ≤ 0.006). Participation in tropical medicine (p < 0.03) and global health courses (p < 0.02) were significantly associated with a higher rating of 'culture, language and religion' and the 'economic system'. Global health trainings correlated with significantly higher ratings of the 'educational system' (p = 0.007) and the 'health system structure' (p = 0.007), while the item 'politics' was marginally significant (p = 0.053). In the knowledge assessment students achieved an average score of 3.6 (SD 1.5; Mdn 4.0), 75% achieved a score of 4.0 or less (Q 25 = 3.0; Q 75 = 4.0) from a maximum achievable score of 8.0. A better performance was associated with international health electives (p = 0.032), participation in tropical medicine (p = 0.038) and global health (p = 0.258) courses. Conclusion The importance medical students in our sample placed on learning about SDH strongly interacts with students' mobility, and participation in tropical medicine and global health courses. The knowledge assessment revealed deficits and outlined needs to further analyse education gaps in global health. Developing concerted educational interventions aimed at fostering students' engagement with SDH could make full use of synergy effects inherent in student mobility, tropical medicine and global health education.

Background: The provision of high-quality medical care to asylum seekers represents a key challenge in many countries of the European Union. Especially continuity of care has been difficult to achieve as the migrant trajectory moves asylum seekers across and within European countries. Patient-held personal health records (PHR) have been proposed to facilitate the transfer of medical history between health sectors and providers, but so far there is no data to support its use in the migrant setting. The present paper addresses this knowledge gap by exploring the experiences and practices of healthcare providers in reception centers for asylum seekers using a patient-held PHR as well as the perceived associated benefits and shortcomings. Methods: Early evaluation by means of a multi-sited qualitative study in six asylum seeker reception centers in five cities in the German state of Baden-Wuerttemberg, conducted between November 2016 and January 2017. The PHR evaluated in this study was implemented in five of these reception centers between February and October 2016; the remaining one only receiving patients with the PHR through transfer from the other facilities. 17 interviews were conducted with physicians and nurses working at these reception centers exploring their experiences, routines, and perspectives regarding the patient-held PHR. The interviews were recorded, transcribed and analyzed following the approach of thematic analysis. Results: Healthcare providers recognise the potential of a patient-held PHR to improve access to medical history. They use the PHR to document their medical consultations and to collect other medical reports. However, physician adherence to the patient-held PHR was described as unsatisfactory, in particular among external doctors, thus limiting its immediate benefit. Reasons given for this low adherence included lack of information before implementation, demanding working conditions with little support, low perceived benefits depending on the degree of fragmentation of settings, parallel existence of other documentation platforms and strained patient relationships. Conclusion: A patient-held PHR could improve the availability of health-related information in reception centers if a context-sensitive implementation process achieves high adherence to the PHR among physicians as well as high patient compliance and includes guidelines regarding its adequate integration into local routines.

Objective: Caring for refugee patients places special demands on health professionals. To date, medical students in Germany have rarely been systematically prepared for these challenges. This article reports on the development, conceptualisation, implementation, evaluation, and relevance of a multidisciplinary elective for medical students in the clinical study phase. Methodology: The course content was developed based on a needs-assessment among medical students and in cooperation with medical colleagues working in the field of refugee care. The course consisted of a seminar with medical, legal, administrative and socio-cultural learning content as well as a field placement in the medical outpatient clinic of the local reception centre for asylum seekers, which was accompanied by a systematic reflection process. The evaluation concept contained qualitative and quantitative elements. Results: 123 students completed the elective over six semesters (summer 2016 through to winter 2018). It was continuously evaluated and further developed. The students reported learning progress mainly in the following areas: Legal foundations of the asylum procedure and health care entitlements for asylum seekers; multi-perspectivity through multidisciplinarity as well as professional, ethical, interpersonal, and political insights gained through the practical experience. Summary: To prepare students for the complex challenges to be faced in medical care for refugees, a structured, multidisciplinary teaching programme, which combines theory, practice and reflection helps to foster insights into the many facets of this field of activity. The questions students brought to the seminar, the course contents and evaluation results are intended to inspire the design and implementation of similar courses at other universities.

Background: Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). We aim to advance current health monitoring approaches and obtain reliable estimates on health status and access to essential healthcare services among ASR in Germany's third largest federal state, Baden-Württemberg. Methods: We conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR and their children in collective accommodation centres in 44 districts. Questionnaire items capturing health status, access to care, and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1938 accommodation centres with 70,634 ASR was employed to draw a balanced sample of 65 centres with a net sample of 1% of the state's ASR population. Multilingual field teams recruited eligible participants using a "door-to-door" approach. Parents completed an additional questionnaire on behalf of their children. Results: The final sample comprised 58 centres with 1843 ASR. Of the total sample expected eligible (N = 987), 41.7% (n = 412) participated in the survey. Overall, 157 households had children and received a children's questionnaire; 61% (n = 95) of these were returned. Age, sex, and nationality of the included sample were comparable to the total population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), depression (46%), and anxiety (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation compared to older and female ASR. Conclusions: Our health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed in order to sustain this approach as a health planning tool.

Recognising global health as a rapidly emerging policy field, the German federal government recently released a national concept note for global health politics (July 10, 2013). As the German government could have a significant impact on health globally by making a coherent, evidence-informed, and long-term commitment in this field, we offer an initial appraisal of the strengths, weaknesses, and opportunities for development recognised in this document. We conclude that the national concept is an important first step towards the implementation of a coherent global health policy. However, important gaps were identified in the areas of intellectual property rights and access to medicines. In addition, global health determinants such as trade, economic crises, and liberalisation as well as European Union issues such as the health of migrants, refugees, and asylum seekers are not adequately addressed. Furthermore, little information is provided about the establishment of instruments to ensure an effective inter-ministerial cooperation. Finally, because implementation aspects for the national concept are critical for the success of this initiative, we call upon the newly elected 2013 German government to formulate a global health strategy, which includes a concrete plan of action, a time scale, and measurable goals.

Abstract
In 2015, more than 1 million asylum seekers and refugees arrived in Europe. Information on how European countries addressed the prevention and control of infectious diseases among these populations during and after this period is limited. This study is based on 27 semi-structured interviews conducted with first-line staff and health officials in May–June 2016 in first-entry countries (Greece/Italy), transit countries (Croatia/Slovenia) and destination countries (Austria/Sweden). Characteristics of health-service provision for infectious diseases at each stage of reception, with a focus on tuberculosis, viral hepatitis, intestinal parasites and human immunodeficiency virus infections, were investigated. No major differences in the provision of services in accordance with migration status (asylum seekers vs refugees) were reported. At arrival, interventions were focused on addressing emerging health needs and no major barriers to accessing acute hospital care for infectious diseases were reported. There were shortcomings in interventions to tackle medium- to long-term needs with respect to infectious diseases, including screening for chronic treatable infections and adult vaccination. European evidence-based guidance highlighting the most relevant interventions for infectious diseases during the reception process is needed.

Welfare states around the world restrict access to public healthcare for some migrant groups. Formal restrictions on migrants' healthcare access are often justified with economic arguments; for example, as a means to prevent excess costs and safeguard scarce resources. However, existing studies on the economics of migrant health policies suggest that restrictive policies increase rather than decrease costs. This evidence has largely been ignored in migration debates. Amplifying the relationship between welfare state transformations and the production of inequalities, the Covid-19 pandemic may fuel exclusionary rhetoric and politics; or it may serve as an impetus to reconsider the costs that one group's exclusion from health can entail for all members of society. The public health community has a responsibility to promote evidence-informed health policies that are ethically and economically sound, and to counter anti-migrant and racial discrimination (whether overt or masked with economic reasoning). Toward this end, we propose a research agenda which includes 1) the generation of a comprehensive body of evidence on economic aspects of migrant health policies, 2) the clarification of the role of economic arguments in migration debates, 3) (self-)critical reflection on the ethics and politics of the production of economic evidence, 4) the introduction of evidence into migrant health policymaking processes, and 5) the endorsement of inter- and transdisciplinary approaches. With the Covid-19 pandemic and surrounding events rendering the suggested research agenda more topical than ever, we invite individuals and groups to join forces toward a (self-)critical examination of economic arguments in migration and health, and in public health generally.

Die kollektive Unterbringung von Asylsuchenden ist ein wichtiger Bestandteil der flüchtlingspolitischen Verwaltungspraxis in Deutschland. Bei aller Varianz der Art solcher Sammelunterkünfte sind damit stets auch prinzipielle Herausforderungen verbunden. Denn mit einem zentralen Raum zum Umgang mit Flucht und Ankunft werden zugleich Gefahren und Konflikte örtlich konzentriert. Parallel zur Entwicklung von Konzepten zur Bewältigung dieser Herausforderungen untersuchen die Beiträger*innen des Bandes die Lebensrealitäten in diesen Einrichtungen. Hierbei sind besonders Ansätze des kritischen Humanitarismus leitend, die die Handlungsfähigkeit unter den restriktiven Bedingungen kollektiver Unterbringung betonen