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      Migrants’ and refugees’ health: towards an agenda of solutions

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          Abstract

          Despite the greatly increased numbers of migrants and refugees worldwide in recent years, insufficient attention has been paid to addressing their health needs. While a variety of international instruments assert the right to health, in practice, migrants and refugees—especially those awaiting clarification of their status, such as asylum seekers and those without documentation—often fall in cracks between service providers and humanitarian relief programmes at national and regional levels.

          This report provides a summary of the current state of knowledge regarding the health issues of migrants and refugees and of the extent to which they are being met. It highlights, through a series of case studies, the diverse approaches to policies, entitlements and services provided in different jurisdictions, ranging from regional (Europe) and country (Germany, Iran, Italy, Turkey, South Africa) levels to provinces and cities (Quebec/Montreal, Berlin). These provide evidence of successes and challenges and highlight areas requiring further effort, including in the domains of policy, service design and delivery, education and training, research and communication. They also underscore the challenges of highly neglected aspects such as mental health and the critical importance of developing cultural/transnational competence in the health professional individuals and institutions working with migrants and refugees.

          Results from discussions taking place in an M8 Alliance Expert Group Meeting (Rome, 23–24 June 2017) and from the literature are synthesised to develop an ‘agenda of solutions’. This agenda aims to provide a comprehensive framework, which bridges humanitarian, ethical and rights-based imperatives to provide a framework for action to tackle this crucial area.

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          Most cited references 48

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          An ethics framework for public health.

           Nancy Kass (2001)
          More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed. To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community.
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            Health system in Iran

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              Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

              In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021).
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                Author and article information

                Contributors
                s.matlin@imperial.ac.uk
                Journal
                Public Health Rev
                Public Health Rev
                Public Health Reviews
                BioMed Central (London )
                0301-0422
                2107-6952
                24 September 2018
                24 September 2018
                2018
                : 39
                Affiliations
                [1 ]ISNI 0000 0001 2113 8111, GRID grid.7445.2, Institute of Global Health Innovation, Imperial College London, ; London, UK
                [2 ]Centre Virchow-Villermé for Public Health Paris-Berlin, Paris Office, Paris, France
                [3 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Institute of Global Health, , University of Geneva, ; Geneva, Switzerland
                [4 ]GRID grid.7841.a, University of Sapienza, ; Rome, Italy
                Article
                104
                10.1186/s40985-018-0104-9
                6182765
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Meeting Report
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                © The Author(s) 2018

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