Climate change aggravating migration and health issues in the African context: The views and direct experiences of a community of interest in the field.

Climate change is an increasingly important theme in Africa, where a large majority of its people depend on livestock and agricultural activities for livelihood. Concurrently, the topic of health of migrants and people on the move is rapidly raising both in the health debate and migration governance agenda in the Region. The link with climate change from the perspective of health and migration experts needs to be systematically addressed. Objectives: The article aims to contribute to the discourse on the interrelation of climate change, migration, and health by providing contributions of experts in the field of health and migration directly working with migrant and refugee communities in Africa. Methods: A webinar was conducted to collect and discuss first-hand experience with 25 participants from a postgraduate online course on health and migration funded by the Austrian Government and implemented in a co-operation of the Center for Health and Migration, Austria, with Makerere University, Uganda, the International Organization for Migration - UN Migration, and Lancet-Migration. As a result from the discussions, two cases from Sudan and Zimbabwe were selected to be further analysed with desk research to illustrate and underpin the points made. Results: All webinar participants reported to encounter climate change effects on health and migration in their professional practice. In their experience, climate change aggravates issues of health and migration by fueling forced migration and displacement, increasing health care needs, and deteriorating access to health care. Specific health challenges were identified for mental health problems caused by effects of climate change-induced migration, which remain widely undiagnosed and untreated, and the special affectedness of women and girls, with their mental, sexual and reproductive health severely deteriorated in insecure environments. The case studies from Sudan and Zimbabwe underline these observations. Conclusions: The interplay of effects of climate change, (internal) migration, and health is reported by a community of experts in the field of health and migration who are residing in Africa and working with migrant communities. Webinars prove to be an easy to implement tool to collect first hand evidence from practice experts, to foster exchange of experiences, and to get people engaged in further collaboration and discussion.

How Structural Compensation Facilitates Health Care for the Homeless. A Comparative View on Four European Union Member States.

There is robust evidence that homelessness and the associated life conditions of a homeless person may cause and exacerbate a wide range of health problems, while healthcare for the homeless is simultaneously limited in accessibility, availability, and appropriateness. This article investigates legal frameworks of health care provision, existing knowledge on numbers of homeless to be considered, and current means of health care provision for four EU countries with different economic and public health background: Austria, Greece, Poland, and Romania. National experts investigated the respective regulations and practices in place with desk research. The results show differences in national frameworks of inclusion into health care provision and knowledge on the number of people experiencing homelessness, but high similarity when it comes to main actors of actual health care provision for homeless populations. In all included countries, despite their differences in economic investments and universality of access to public health systems, it is mainly NGOs providing health care to those experiencing homelessness. This phenomenon fits into conceptual frameworks developed around service provision for vulnerable population groups, wherein it has been described as "structural compensation," meaning that NGOs compensate a structural inappropriateness that can be observed within public health systems.

Economic arguments in migrant health policymaking: proposing a research agenda.

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.

'Falling off the radar' of public health: The case of uninsured Chinese patients in Vienna, Austria.

In public health policy debates, the 2015-2016 refugee crisis made visible that even in European welfare states with (close to) universal health coverage there are specific vulnerable groups with highly limited access to health care. Among them is a population of so-called 'undocumented' or 'irregular' migrants who have no regular status of residence and falls off the radar of publicly funded health care services and thus from the public health surveillance systems. The aim of our study is to provide the first-of-its-kind evidence on the characteristics, health problems and health care needs of one such vulnerable group in Austria - Chinese migrants residing in Vienna without a regular status. Medical records of 74 uninsured assumingly undocumented Chinese patients were analysed. The data was provided by a Non-governmental organisation (NGO) which delivers primary care to uninsured people in Vienna. The most frequently diagnosed health problems clustered around cardiovascular and metabolic-related diseases (hypertension and diabetics) and there was a high burden of multiple chorionic non-communicable diseases. Further efforts and resources are needed for collecting more data in a systematic way. A trusting relationship between science and practice and a cooperative relationship between and among the government agencies and NGOs are essential for evidence-based public health policy making.

Does physician-patient communication that aims at empowering patients improve clinical outcome? A case study.

OBJECTIVE: A case study at the department for heart surgery of an Austrian University Hospital in 2001, examined the outcome of improved communication aimed at empowering patients to be more effective co-producers of recuperation after surgery. METHODS: Evaluated were the effects of a training program for developing communication skills of health professionals (physicians, physiotherapists, and nurses) along with a reorganization of patient information schemes. The clinical outcomes after four types of surgery (bypass, stent, artificial valve insertion and combination of these) were observed in 100 patients without (control group) and 99 with the intervention administered (intervention group). Two objective and two subjective health outcome parameters were selected for analysis: care level adjusted length of stay in hospital, frequency of post-surgery complications, subjective health, subjective satisfaction with care received. Self-administered breathing exercises were measured as an intermediary outcome parameter. RESULTS: In the intervention group length of hospital stay was shorter (by 1 day), incidence of post-surgery tachyarrhythmia was reduced (by 15%), transfer to less intensive care levels was faster and patient ratings for communicative quality of care by doctors and nurses were improved. CONCLUSION: Professional communication aimed at empowering patients to act as co producers can indeed have an effect on clinical outcome. PRACTICE IMPLICATIONS: Staff training and reorganization of communication schemes can be an effective intervention in hospital care.