Migration is central to the lives of a sizeable portion of today’s global population. In 2015, an estimated 244 million people were international migrants, whilst a further 740 million were estimated to migrate within their own country. Many millions more people, whilst not themselves moving, are directly affected by migration, both as social networks extend across national borders, and as labour markets and service provision become increasingly entangled within the wider global political economy.
Migration today is also very deeply politicised, and as the current era of economic austerity plays out, we have seen an amplified tendency for policy makers and certain sectors of the popular media to react against migrants who are considered ‘undeserving’, framing them as both a public health and a security ‘threat’ to be monitored, controlled and contained. Perhaps nowhere has this been more blatant in recent times than in the context of the current European migrant crisis, where increasingly right-leaning political rhetoric, protectionist policies and (in)action have combined with very real and, all too often, adverse consequences for the lives of those involved. Indeed, whilst most governments claim to recognise health as an essential human right, it is increasingly clear that their accountability in delivering on these commitments remains elusive and far too easily avoidable.
Under these circumstances, the duty of care for migrant health across Europe is falling increasingly to the discretion, initiative and goodwill of individual health care providers. And whilst there are many examples of sound and compassionate practice taking place, health care systems are rarely set up or resourced to respond adequately to the needs of people from diverse cultural and linguistic backgrounds, particularly at the scale currently required. Evidence abounds that migrants from all but the most elite groups experience challenges and vulnerabilities through disparities in health care access, and that even when they are able to receive healthcare, the specific needs they face may be poorly understood and inadequately responded to.
The provision of inter-culturally competent and diversity sensitive health care is therefore vital if basic human rights to healthcare are to be met. Importantly, this requires not only the engagement of individual healthcare practitioners, but a systemic and ‘whole organisation’ approach in which discussions around healthcare for all, and the training and interventions required to realise this are firmly embedded and supported within the policy, regulations, strategic plans and infrastructure of health care organisations and systems themselves.
We also know that these issues are not just about overcoming legal and language barriers – but about expanding our notions of what health and effective responses to ill health might look like. This requires health professionals to reflect on their own perspectives, and to recognise that all forms of knowledge, including scientific and medical practice, are inherently cultural. As research is now showing, being culturally aware in this way can enable health professionals to recognise their own preconceptions and biases and enable them to better realise, and respond positively to, the existence of other perspectives and understandings. This is important in helping avoid cultural stereotyping and in ensuring respectful relationships within healthcare consultations. It is also crucial in managing and responding effectively to the ‘everyday’ matters that are embedded within a patient’s identity and sense of self, for example, issues relating to diet and hygiene, as well as the more exceptional moments such as the breaking of bad news, and end of life decisions, that define health and wellbeing-related experiences and human dignity.
We are also increasingly learning that if people are not consulted and involved in the design of their own health services, then services will not be optimally accessible, relevant or inclusive. Ensuring that health professionals are able to listen to patients, and to learn about their beliefs and experiences relating to health and illness requires mechanisms to be in place for patients and community members to participate in dialogue and debate that helps to shape health care responses that reflect what they consider to be their needs, their concerns and their priorities. Participation in decision-making and practice not only helps build trusting relationships, but has also been linked to community empowerment and can enable communities to invest in, and ‘take ownership’ of, health processes and interventions.
Until the wider social, economic and structural disadvantages facing migrants are addressed, there is little doubt that intercultural competence and diversity sensitivity can remain only a partial solution to on-going health inequities. Despite this however, a number of examples of good practice in inter-culturally competent and diversity sensitive healthcare can be identified and built upon in ways that will have positive implications for the health and wellbeing of migrant groups. These include services that have prioritised provision of good quality interpreting and cultural mediation, training programmes for health professionals that involve a process of self-reflection in which embedded assumptions and ways of working can be challenged, and efforts to involve migrant groups within the decision making processes that affect their health and wellbeing.
This blog post was written by Dr Felicity Thomas