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      Middle Eastern Conflicts: Implications for Refugee Health in the European Union and Middle Eastern Host Countries

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          Abstract

          Until very recently, health care in conflict settings was based on a model developed in the second half of the twentieth century. Things have changed, and present civil wars, such as those that are currently taking place in the Middle East, do not address the complexity of the ongoing armed conflicts in countries such as Syria, Iraq, and Afghanistan. These conflicts have caused a significant increase in the number of refugees in the region, as well as in Europe. Hundreds of thousands of refugees succeed in settling in mid- and north-European countries, and their health issues are becoming of great importance. Refugees in Europe in the twenty-first century do not suffer so much from infectious diseases but more from noninfectious chronic diseases such as diabetes, cardiac disease, and cancer. These facts profoundly alter the demographics and disease burden of hostility-derived migrants. Thus, host European countries face situations they have never faced before. Hence, new approaches and strategies are urgently needed to cope with this new situation. The efforts to absorb refugees of different traditions and cultural backgrounds often cause increasing ethnic and religious tensions, which frequently escort the emergence of social violence. To date, little attention has been paid to the overall load of distress being experienced, especially among the first-generation refugees. The current ongoing hostilities in the Middle East induce a long-term health impact on people expelled from their homes, communities, traditions, and cultural environment. The realization of collective suffering forces communities and governmental health agencies to develop new programs that include social determinants to overcome the severe cultural gaps of the newcomers in their new European host countries.

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          Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities.

          This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.
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            Cancer disparities by race/ethnicity and socioeconomic status.

            This article highlights disparities in cancer incidence, mortality, and survival in relation to race/ethnicity, and census data on poverty in the county or census tract of residence. The incidence and survival data derive from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; mortality data are from the National Center for Health Statistics (NCHS); data on the prevalence of major cancer risk factors and cancer screening are from the National Health Interview Survey (NHIS) conducted by NCHS. For all cancer sites combined, residents of poorer counties (those with greater than or equal to 20% of the population below the poverty line) have 13% higher death rates from cancer in men and 3% higher rates in women compared with more affluent counties (less than 10% below the poverty line). Differences in cancer survival account for part of this disparity. Among both men and women, five-year survival for all cancers combined is 10 percentage points lower among persons who live in poorer than in more affluent census tracts. Even when census tract poverty rate is accounted for, however, African American, American Indian/Alaskan Native, and Asian/Pacific Islander men and African American and American Indian/Alaskan Native women have lower five-year survival than non-Hispanic Whites. More detailed analyses of selected cancers show large variations in cancer survival by race and ethnicity. Opportunities to reduce cancer disparities exist in prevention (reductions in tobacco use, physical inactivity, and obesity), early detection (mammography, colorectal screening, Pap tests), treatment, and palliative care.
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              Paediatric cancer in low-income and middle-income countries.

              Patterns of cancer incidence across the world have undergone substantial changes as a result of industrialisation and economic development. However, the economies of most countries remain at an early or intermediate stage of development-these stages are characterised by poverty, too few health-care providers, weak health systems, and poor access to education, modern technology, and health care because of scattered rural populations. Low-income and middle-income countries also have younger populations and therefore a larger proportion of children with cancer than high-income countries. Most of these children die from the disease. Chronic infections, which remain the most common causes of disease-related death in all except high-income countries, can also be major risk factors for childhood cancer in poorer regions. We discuss childhood cancer in relation to global development and propose strategies that could result in improved survival. Education of the public, more and better-trained health professionals, strengthened cancer services, locally relevant research, regional hospital networks, international collaboration, and health insurance are all essential components of an enhanced model of care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                J Glob Oncol
                J Glob Oncol
                jgo
                jgo
                JGO
                Journal of global oncology
                American Society of Clinical Oncology
                2378-9506
                December 2016
                15 June 2016
                : 2
                : 6
                : 422-430
                Affiliations
                [1] Michael Silbermann, Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; Lea Baider, Assuta Medical Center, Tel Aviv, Israel; Michel Daher, University of Balamand, Saint George Hospital, Beirut, Lebanon; Rejin Kebudi, Oncology Institute, Istanbul, Turkey; Omar Nimri, Ministry of Health, Amman, Jordan; and Mazin Al-Jadiry, Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq.
                Author notes
                Corresponding author: Michael Silbermann, 15 Kiryat Sefer St, Haifa 3467630, Israel; e-mail: cancer@ 123456mecc-research.com .

                M.S., M.D., R.K., and L.B. contributed equally to this work.

                Article
                005173
                10.1200/JGO.2016.005173
                5493250
                28717729
                c29ac15c-f611-498a-88c8-016ca3f4d936
                © 2016 by American Society of Clinical Oncology

                Licensed under the Creative Commons Attribution 4.0 License: http://creativecommons.org/licenses/by/4.0/.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 9
                Categories
                Policy Analysis
                Ethics
                Special Article

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