Policy Brief: Towards Realising Health Rights among Undocumented People in Dutch Cities : Lessons from participatory research (original) (raw)
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Seeking health below the radar: Undocumented People's access to healthcare in two Dutch cities
Social Science & Medicine
This study sought answers to a puzzling paradox. Generally, formal legal health care rights for undocumented people in The Netherlands are relatively good, with some exceptions (like dentistry and mental health). Despite this, many undocumented people were found only to access health care services in the case of an emergency, and sometimes not even then. Why were undocumented people not fully making use of their legal rights to access health care? Was it due to discrimination? A lack of information? Or some other deterrents? This article presents findings from a project entitled: "Count Us In": Towards Realising Health Rights among Undocumented People in Two Dutch Global Cities", funded by the Rotterdam Global Health Initiative (RGHI). Using the Participatory Ethnographic Evaluation and Research (PEER) methodology, research was conducted in The Hague and Rotterdam between 2012 and 2015. The study found that those in work or socially embedded in support networks or NGOs, were more likely to claim their health rights in practice. Rejected asylum seekers, more isolated on the whole, tended to access health care only in extreme situations or emergencies. Both groups reported self-medication, which was found to be quite common. We also found that undocumented people exclude themselves from health care services, for fear of being detected, detained and even deported. We conclude with some modest suggests to ensure that the basic health rights of undocumented people are better protected in these and other Dutch cities in future. Seeking Health Below the Radar: Undocumented People's access to healthcare in Two Dutch Cities "The biggest wish is to get a residence permit. All misery comes from the lack thereof" (interview Bernard (not real name) asylum-seeker from Guinea) (D46). 1 "My medicines are my wife" (D01). 2
Laws, 2016
The present study analyzes the preventive health care provisions for nationals and undocumented migrants in Germany, the Netherlands and Spain in light of four indicators derived from the United Nations Committee on Economic, Social and Cultural Rights’ General Comment 14 (GC 14). These indicators are (i) immunization; (ii) education and information; (iii) regular screening programs; and (iv) the promotion of the underlying determinants of health. It aims to answer the question of what preventive health care services for undocumented migrants are provided for in Germany, the Netherlands and Spain and how this should be evaluated from a human rights perspective. The study reveals that the access to preventive health care for undocumented migrants is largely insufficient in all three countries but most extensive in the Netherlands and least extensive in Germany. The paper concludes that a human rights-based approach to health law and policy can help to refine and concretize the individual rights and state obligations for the preventive health care of undocumented migrants. While the human rights framework is still insufficiently clear in some respects, the research concedes the added value of a rights-based approach as an evaluation tool, advocacy framework and moral principle to keep in mind when adopting or evaluating state policies in the health sector.
Health and human rights, 2012
Undocumented migrants' access to health care varies across Europe, and entitlements on national levels are often at odds with the rights stated in international human rights law. The aim of this study is to address undocumented migrants' access to health care in Denmark, Sweden, and the Netherlands from a human rights perspective. Based on desk research in October 2011, we identified national laws, policies, peer-reviewed studies, and grey literature concerning undocumented migrants' access to health care in the three involved countries. Through treaties and related explanatory documents from the United Nations and the Council of Europe, we identified relevant international laws concerning the right to health and the rights of different groups of undocumented migrants. A synopsis of these laws is included in the analysis of the three countries. Undocumented migrants in Denmark have the right to emergency care, while additional care is restricted and may be subject to pay...
Journal of Health Politics, Policy and Law, 2012
The presence of undocumented migrants is increasing in many Western countries despite wide-ranging attempts by governments to increase border security. Measures taken to control the influx of immigrants include policies that restrict access to publicly funded health care for undocumented migrants. These restrictions to health care access are controversial, and evidence suggests they do not always have the intended effect. This study provides a comparative analysis of institutional, actor-related, and contextual factors that have influenced health care policy development on undocumented migrants in England and the Netherlands. For undocumented migrants, England restricts its access to care at the point of service, while the Netherlands restricts through the payment system for services. The study includes an analysis of policy papers and semistructured, in-depth interviews with various actors in both countries. Findings confirm the influence of such contextual factors as immigration considerations and cost concerns on health care policy making in this area. However, these factors cannot explain the differences between the two countries. Previously enacted policies, especially the organization of the health care system, affected the kind of restrictions for undocumented migrants. Concerns about the side effects of generous treatment of undocumented migrants on other groups played a substantial role in formulating restrictive policies in both countries. Evidently, policy development and implementation is critically affected by institutional rules, which govern the degree of influence that doctors and professional medical associations have on the policy process.
Health of migrants and migrant health policy, The Netherlands as an example
Social Science & Medicine, 1995
In The Netherlands, as in many other countries, many studies have addressed the health situation of migrant groups. After a discussion on methodological pitfalls in migrant studies, the article reviews the most important results. The data show that there are differences in the health status and mortality patterns between migrant groups and the indigenous population. Most, but not all, of the differences are in disfavour of ethnic groups. Possible determinants of these differences are evident in socio/cultural, genetic and socioeconomic factors. A model is presented that demonstrates the relation between these factors and health and disease.lmplications for research and for health policy are discussed.
Health care for undocumented migrants: European approaches
Issue brief (Commonwealth Fund), 2012
European countries have smaller shares of undocumented migrants than does the United States, but these individuals have substantial needs for medical care and present difficult policy challenges even in countries with universal health insurance systems. Recent European studies show that policies in most countries provide for no more than emergency services for undocumented migrants. Smaller numbers of countries provide more services or allow undocumented migrants who meet certain requirements access to the same range of services as nationals. These experiences show it is possible to improve access to care for undocumented migrants. Strategies vary along three dimensions: (1) focusing on segments of the population, like children or pregnant women; (2) focusing on types of services, like preventive services or treatment of infectious diseases; or (3) using specific funding policies, like allowing undocumented migrants to purchase insurance.
Public Health Reviews, 2016
Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM's health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs' entitlement and barriers to healthcare and related policies citing evidence from peer-reviewed and grey literature concerning people living in a country within the European Union without the legal right to be/remain in the destination country. A systematic review was performed using several databases and websites, and a total of 54 publications in English, with full text available, were taken into consideration. Between 2000 and 2015, Europe hosted the second largest number of international migrants (20 million, 1.3 million per year) after Asia. Even though there is limited evidence specifically focused on UMs' health, it is possible to state that infectious diseases, chronic illnesses, mental disorders, maternal-child conditions, dental issues, acute illnesses and injuries are the most common pathologies. In most cases across Europe, UMs have access only to emergency care. Even in countries where they are fully entitled to healthcare, formal and informal barriers hinder them from being or feeling entitled to this right. Socio-cultural barriers, such as language and communication problems, lack of formal and informal social and healthcare networks and lack of knowledge about the healthcare system and about informal networks of healthcare professionals are all common impediments. From the healthcare providers' perspective, there can be difficulties in providing appropriate care and in dealing with cultural and language barriers and false identification. Communication strategies play a central role in addressing the inequalities in access to healthcare services, and the definition and provision of specific training, focused on UMs' health needs, would be desirable. Improving access to healthcare for UMs is an urgent priority since the lack of access is proven to have serious consequences for UMs' health and wellbeing. Notwithstanding, few available examples of policies and best practices aimed at overcoming barriers in the delivery of healthcare to UMs are available.
Access to Health Care for Undocumented Migrants
Scientific Coordination and Editing: Ana Alexandre …, 2008
Among the respondents, a third of men (34%) and a quarter of women (23%) perceive their health as "bad" or "very bad". Most studies show a good general correlation between this indicator and objective (and/or medical) indicators of health. This is 3 times higher 6 than for the population of the 25 European Union countries. Among the youngest respondents (18-25 years), 27% of men and 12% of women already say that their health is "bad" or "very bad". 32% of people surveyed are affected by at least one chronic health problem. This is more common among men than women. These people often live in insecure accommodation (35%) and are relatively isolated (half of them feel lonely and 17% cannot count on anybody for emotional support). They need medical treatment: two thirds of respondents (65%) have at least one health problem for which treatment is considered by the doctors as preferable, necessary (29%) or indispensable (21%). 8% of those who are suffering from a condition for which treatment is considered indispensable are rough sleepers and 7% live in a shortterm or medium-term shelter. Many people also suffer from more than one health problem: 24% of people interviewed present with at least 2 health problems for which treatment is considered to be preferable. This high rate, in such a young population, is indicative of delayed access to healthcare. Thus, according to the doctors, 16% of the population present with a vital prognosis that is possibly, probably or certainly bad unless they receive treatment. Only 8% present with only one health problem for which treatment is judged to be optional. Contrary to the widespread pre-conception that foreigners would abuse European health systems, the impoverished survey population hardly seeks any care for minor health problems. Unsuitable and largely inadequate medical follow-up, irrespective of the severity of the health problem. Under half of pregnant women (48%) received antenatal monitoring during their pregnancy. Of the 1,371 health problems identified in the survey population, only a quarter (26%) were comprehensively treated or monitored. A quarter (27%) received partial treatment and nearly half (45%) were not being treated or followed-up at all on the day of the survey. Even when the health problems are serious, they receive very little treatment or follow-up: among the health problems for which treatment is judged by the doctors to be indispensable, less than half (43%) received comprehensive follow-up, one fifth were partially followed up or treated (21%) and a third (34%) did not receive any follow-up at all. When the treatment was "only" considered to be necessary, nearly half of the problems (44%) did not receive any followup either. Treatment of less serious health problems is also problematic: only 13% of less serious health problems-for which treatment is nonetheless preferable-received comprehensive medical follow-up. 6. It is important to bear in mind that the survey mostly took place in programmes of a medical organisation. * The "other" category includes Near and Middle East countries, the European Union and stateless persons. 33. Sub-Saharan African respondents were living as undocumented migrants for, on average, 3.1 years.