Tuesday 10 March 2015

Migration, social disadvantage & health

It's not often you go to a conference which opens with one of the keynotes literally juggling, but Associate Professor Kevin Pottie, from the University of Ottawa, did just that at the recent Migration, Social Disadvantage & Health conference in Melbourne.

He only just succeeded in keeping three balls in the air, which aptly demonstrated the difficulties of ensuring health equity for migrants. The balls represented political will, support and education for health practitioners, and the policy & social determinants of health. It was an excellent start to a conference in which a wide range of engaging presentations and discussions provided ample evidence for the challenges of keeping all of these factors in balance and working together to produce better health outcomes for migrants in Australia and internationally.

This was primarily an academic conference, with research being presented on a wide range of health issues, from ageing to obesity, and robust debate on research and policy priorities for migrant, refugee and asylum seeker health.

While AFAO has been working in the migration law reform space for several years now, the conference provided a valuable opportunity for our staff to learn more about the broader context of migrant health, including insights into the experience of refugees prior to migration, debates about terminology and research frameworks, the meanings of health literacy, myths around migrants and health, evidence-based and client-centred approaches to health promotion and service provision, and the public health rationale for the health screening of migrants. A recurring theme throughout the conference was that of people with higher health needs having less access to healthcare, which was often related to inconsistent or inadequate funding.

HIV and sexual health 

HIV and sexual health issues were well represented at the conference, with presentations from Australia and overseas examining the experience of HIV-positive migrants and refugees, and providing examples of outreach STI and BBV prevention and peer education programs. As well as a whole breakout session devoted to HIV issues, there several other relevant presentations and posters throughout the conference.

AFAO's Michael Frommer.
AFAO Policy Analyst Michael Frommer gave a presentation on AFAO's immigration law reform advocacy and I spoke about our African project work, in the context of an increase in HIV diagnoses in Australia among people born in high prevalence regions.

Sue Porter, from Hunter New England Local Health District, presented a poster on compassionate access to antiretroviral treatment for people living in that region who are not eligible for Medicare.  The poster focussed on the disconnect between the 7th National Strategy and the lack of a national policy on the availability of HIV care to people not eligible for Medicare.

Sue also gave an oral presentation on a culturally appropriate STI/BBV screening program conducted among Asian sex workers in collaboration with ACON and SWOP, among other partners. The program, which also developed gonorrhoea and chlamydia fact sheets in translation for the workers, resulted in a decrease in STI diagnoses (although numbers were small to begin with) and better engagement with sexual health services for the sex workers.

Graham Brown from The Australian Research Centre for Sex, Health and Society (ARCSHS) gave a presentation on the HIV and Mobility Roadmap for Action, which was developed during 2014 to identify strategies for reducing the impact of HIV on mobile and migrant populations.

Maureen Plain, from the CALD HIV Unit at the Alfred Hospital in Melbourne, presented her qualitative research on the experience of clients of the unit. She found that stigma continues to be a significant issue for these clients, more than half of whom did not engage with their own community for fear of people finding out their HIV status. Those who did interact with their community kept their HIV a secret, sometimes telling people they had another condition. Fear of disclosure and gossip also affected the use of interpreters. However, Maureen noted that the clients, many of whom had experienced trauma and conflict and were refugees and asylum seekers, displayed considerable resilience, and as their health improved, so did their emotional wellbeing.

Carol El-Hayek presented an evaluation of a community-led STI/BBV peer education program conducted by the Multicultural Health and Support Service (MHSS) with the Karen and Liberian communities in Melbourne. She said that the way the program had been structured, with a rigorous recruitment process and strong community ownership of the program (including development of their own resources) pointed to a lot of potential for sustainability, which can be one of the stumbling blocks for ongoing health promotion work in culturally and linguistically diverse communities.

International HIV research and programs

There were also several interesting international presentations on HIV programs and research in other countries. Student Cat Street presented on challenges to care and support  for female migrant workers living with HIV in Bangladesh; Aurelie Ponthieu (of Médecins Sans Frontières) described an effective mobile clinic for HIV screening and treatment among migrant labourers in South Africa; and Dr Lois Orton described the results of research into quality of life issues for migrants living with HIV in the UK.

Her findings showed striking similarities to those identified among some migrant populations in Australia: stigma, fear of disclosure, uncertainty about their future, ineligibility for work, financial hardship, and difficulty accessing treatment. Dr Orton reiterated a message that was common throughout the conference; that social exclusion leads to health inequality and poor health outcomes.

LGBTI issues

The experiences of LGBTI people from migrant and refugee communities were conspicuously absent at the conference, with only one speaker raising LGBTI issues on a plenary panel on gender. Dr Maria Pallotta Chiarolli, who is on the Executive Committee of the Australian GLBTIQ Multicultural Council (AGMC), spoke about the crucial importance of recognising the 'multiple lifeworlds' and 'multiple marginalities' experienced by LGBTI people of multicultural backgrounds. She noted the assumptions made about peoples' sexuality and the silencing of LGBTI people because of the gender roles they have to perform in public.

Aside from this gap, which could perhaps be addressed at future conferences by inviting greater participation from community-based organisations, the conference had a strong focus on human rights. A number of presenters gave evidence for the negative impact of marginalisation, racism and discrimination on health, and two sessions in particular looked at racism and social attitudes towards migrants, refugees and asylum seekers.

Racism and intolerance

Professor Andrew Markus reported on the latest findings from the Scanlon Foundation's national survey - the Mapping Social Cohesion Report  and Vic Health's 'Victorians' attitudes to race and cultural diversity' survey. He concluded that while Australians' attitudes to migration and multiculturalism are generally positive, there is still evidence of a recent rise in intolerance, especially of Muslims. He suggested that social acceptance of diversity needs to be managed, for example through more use of imagery that shows people working together for common goals. Professor Markus has written about the report findings for The Conversation.

Professor Kevin Dunn reported on the results of the Cyber Racism survey conducted by the Challenging Racism Project based at University of Western Sydney. The survey found that both witnessing and being targeted by racism online could result in physical and emotional distress, which he argued provided a 'public health rationale' for addressing cyber racism.

The Melbourne Declaration

These themes of racism and discrimination, social inclusion and exclusion, effective research, and the benefits of adequate funding and culturally appropriate service provision were captured in an advocacy document: The Melbourne Declaration on Building Integration and Reducing Migration Related Health Inequity, which conference delegates were invited to sign and organisations represented at the conference have been asked to endorse.You can read and sign here.

The Declaration will be tabled in Federal Parliament by Senator Richard di Natale, who gave a keynote on the final day of the conference, in which he argued that Australia has a responsibility to provide care for asylum seekers and refugees.

Some of the conference presentations will be available online. For more information, contact the Conference Secretariat

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