2 September 2014 - At the end of 2012, 6.6% of EU27 population was born outside the European Union. New and undocumented migrants are more likely to come from lower socio-economic backgrounds if not being pushed into poverty and social exclusion by the migration factor alone. The associated burden of disease, injuries and disability has been well documented and constitutes a firm evidence-base for action at international, European, national and local levels.
A private-public pilot project to improve health communication and literacy of minority and migrant mothers.
By Dorota Sienkiewicz, Health Equity and Policy Coherence Coordinator
In addition, the economic recession resulted in budgetary constraints for many EU Member States’ governments which turned to seeking savings in cuts to public services’ spending. Unfortunately, as the relevant data has started pouring recently, they have also adversely impacted health outcomes, health services’ utilisation and access of many individuals, particularly members of the most vulnerable groups, such as the migrants and Roma community.
Within the migrant and minority groups, mothers and mothers-to-be are even more vulnerable. Maternal mortality among black African women in the UK is up to seven times higher than it is among white women. Neonatal complications are significantly more common in the infants of immigrant mothers. Risks from adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin are greater than among the general population. Although not directly caused by the ethnic background itself, deleterious lifestyle factors (such as malnutrition, underweight and smoking), maternal age (early marriages and early childbearing) but also low health literacy and health services utilisation associated with poverty, deprivation and discrimination (high among the Roma population) negatively affect European Roma women’s antenatal health outcomes with high rates of low birth weight and preterm births , higher prevalence of cesarean sections, miscarriage, obstetric hemorrhage and infections linked to poor hygiene conditions.
Those do not spare their offspring - there is evidence of higher mortality rates among children of migrants and Roma women, which have been associated with low-quality housing, low education attainment and delays in seeking care. Caring for migrants’ health, especially the female and the child population, is a key factor in comprehensively addressing inequalities in health opportunities and outcomes.
Health literacy goes beyond the ability to read with comprehension written medical information or instructions. It has been defined as "the ability to make sound health decisions in the context of everyday life: at home, in the community, at the workplace, the health care system, the market place and the political arena." And as such therefore, its degree among the people living in Europe vary significantly. Recent research undertaken as part of the European Health Literacy Study (HLS-EU) has shown that limited health literacy is a challenge in several countries in Europe. On average, 47% of respondents have limited health literacy across eight countries. Migrants in particular experience a number of barriers when it comes to accessing good quality healthcare services in Europe, ranging from legal and administrative, financial, technical, geographical, cultural, and linguistic obstacles. Barriers such as language mean lower health literacy and an unnecessarily additional burden of disease. Lack of meaningful information about health issues or how to access preventive services also contribute to the deterioration in health status of the migrants over time. Health professionals, although already better equipped with communication skills than before, still lack essential competence and confidence in overcoming language and/or cultural barriers related to one’s health.
The European Public Health Alliance (EPHA) has entered into a project with MSD (Merck Sharp & Dohme Corp.) to collaborate on a practical solution to the challenge. Both organisations are fully committed to improving maternal and infant health and well-being - EPHA as part of its organisational mission and vision, and its core values of equity, sustainability and diversity and MSD through its MSD for Mothers programme and broader commitment to Corporate Social Responsibility to tackle the world’s biggest health challenges by discovering better ways to make a difference in everything the company does, thereby pursuing shared value creation.
EPHA and MSD have launched a process to develop, test and implement a mHealth-type interactive Health Literacy tool.
Both organisations believe that efforts benefiting women - particularly of the migrant and minority background - have great immediate as well as long-term potential to impact on families, communities and the society at large. Ultimately, increased health literacy and empowered individuals (whether as patients or still as healthy individuals) will improve diagnosis, access to prevention and treatment, and adherence to medication or other interventions. To us, the resilience-building potential and focus on preventive measures (including simple but known for their cost-effectiveness lifestyle interventions into fundamental determinants of health) are of particular importance.
As Naveen Rao, MD lead on Merck for Mothers stated “MSD for Mothers is an initiative focused on creating a world where no woman dies as a complication of pregnancy or childbirth. We want to make sure that all women give birth safely across Europe, regardless of their background or economic status. We are already working with partners in more than 30 developing nations and want to ensure that marginalized women from developed nations are not left out.”
To date, the partnership has managed to convene a selected group of European civil society stakeholders active in the field of health systems and services, healthcare professionals, vulnerable groups and health justice to come together to discuss the need behind such a project, its objectives, processes and expected outcomes/outputs. By creating a sense of ownership, shared responsibility and contributing to the innovation that responds to societal needs, the public health community - and health professionals in particular - can lend a vital voice to current EU political, research and economic discourse.
The partners are finalizing the development of the mobile application to support healthcare professionals seeing minority and migrant mothers. The tool is being designed to facilitate the discussion between the HCP and the mother, breaking down linguistic or cultural barriers. Ultimately, the app aims at enhancing the health literacy of these mothers around pregnancy and infancy health challenges. The app will be tested by a small group of healthcare professionals, before being rolled out.