scholarly journals The Violence of Uncertainty: empirical evidence on how asylum waiting time undermines refugees’ health

2021 ◽  
Author(s):  
Jenny Phillimore ◽  
Sin Yi Cheung

Grace and colleagues (2018) introduced the idea of violent uncertainty making claims about the deleterious impacts of insecure immigration status on the health of migrants. Policies of uncertainty are said to directly and indirectly create harm by impacting on individual’s health via detention and public degradation and undermining healthcare services. We offer original empirical evidence indicating an association with uncertainty, in the form of asylum waiting times, on refugees’ self-reported health. We devise four hypotheses that: long waiting time for asylum decisions increases likelihood of self-reported health problems and the effect persists overtime, that female refugees report higher levels of health problems and religion moderates the association between health and uncertainty. We use data from the UK longitudinal Survey of New Refugees wherein all new refugees were sent a baseline survey immediately after receiving refugee status and then follow-up surveys 21 months later. The findings show longer asylum waiting time is associated with poor health. Female refugees were more likely to report poor emotional and physical health. The negative effect of asylum waiting time on emotional health persists 21 months post settlement with hypotheses about the ameliorating effect of religion only partially supported. Our findings supports existing theory and findings from qualitative studies about the deleterious effects of using policies of waiting-related uncertainty for managing migration. Given the wide use of such policies in the Global North, our work is suggestive of likely generalisability. Thus, countries with large refugee populations might want to consider our findings when developing asylum policy which minimises impact on refugee health.

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Bertoncello ◽  
M Fonzo ◽  
S Zanovello ◽  
S Ferretti ◽  
R Brunetta ◽  
...  

Abstract In recent years, Italy has been facing an increase in migration flows. Migrants are vulnerable: understanding underlying conditions is essential to provide suitable assistance. We investigated health conditions of AS arrived in 2014-2016 and living in hosting centres in northeast Italy. AS filled in a multi-language questionnaire. Demographic characteristics, self-reported health status and travel conditions were recorded. Logistic regression (adjusting for age, sea/land arrival, marital status, education level), χ2 and Fisher’s test were used (significance at .05). 216 AS were included, of which 98% males and 91% aged 15-34; 72% arrived by sea, of which 96% from West Africa (WA), while 94% of land arrivals were from the Indian Subcontinent (IS). 62% experienced health problems after arrival. This condition was significantly associated with sea arrival (aOR 2.9), married status (aOR 3.1) and higher education levels. Most problems involved GI tract (13%), teeth (17%) and skin (25%), being AS from WA (31%) more affected than IS (10%). STDs and alcohol were considered as health threats by more than 30% of AS, while smoking, diet and drugs were ignored; 27% and 23% declared to smoke and consume alcohol, respectively, with no substantial change compared with pre-arrival habits. 88% considered their current health good/satisfactory. While anxiety seemed to affect 10% of AS, 30% reported symptoms of depression, especially those arrived by sea (aOR 3.1) and with higher education. However, physical (94%) and mental (88%) health was considered improved/stable after arrival. Perceived health is overall good. However, AS by sea, with higher education or experiencing family breakdown suffer more from both physical and mental issues, especially depression. Long waiting times to grant refugee status and partial fulfilment of life expectations may worsen health conditions. Customised solutions in hosting centres may be encouraged, considering travel conditions and cultural background. Key messages Migrants’ health in hosting centres is good; AS by sea, married and with higher education are more at risk, especially as regards mental health; depression warning signs must not go unnoticed. AS in hosting centres represent a heterogeneous population: they may benefit from a more tailored assistance, considering differences in travel conditions, cultural background and life expectations.


2020 ◽  
pp. 095148482092830
Author(s):  
Stefano Landi ◽  
Enrico Ivaldi ◽  
Angela Testi

Inequalities in effective access to healthcare are present among countries and within the same country. Despite in Italy exist the principle of equity in access to health system, there are evidence of different access rates in the form of unequal waiting time within the country. Waiting times are an instruments to ration healthcare services dealing with resource scarsity. Theoretically, it is a fair tool because waiting times should depend only on health needs and not on the ability to pay. However, a growing literature has pointed out that belonging to a particular socioeconomic status leads to waiting times inequalities for healthcare services. Many countries have socioeconomic disparities among regions, and healthcare organizations need to take into account these differences. The increasing power of Regional Health Authorities in decentralized health systems, as in the case of Italy, has generated different organizational ways to provide health care, possibly leading to different access rates in the form of unequal waiting time within the country. This paper aims to understand if the administrative area (Regional Health Authorities) in charge of health services affects waiting times lowering or strengthening health care access inequalities. Using a series of logistic regression models, this work suggests the presence of two vectors: socioeconomic inequalities and regional inequalities. Health organizations need to implement different kinds of answers for each vectors of inequalities.


Author(s):  
Jose Antonio Vazquez-Ibarra ◽  
Rodolfo Rafael Medina-Ramirez ◽  
Irma Jimenez-Saucedo

Public healthcare services face a growing demand and Emergency department is the main entrance to these services. Waiting times at Emergency departments are increasing at risky levels, causing that people die in wait rooms due to a lack of staff to serve timely every patient. Present chapter describes one research project conducted in a mexican public hospital which was in the process of adopting a triage systems in order to reach the goal of a maximum wait time in department. Design of experiments is the tool proposed to analyze waiting time factors and define the best levels to reduce the response variable value.


Author(s):  
Jose Antonio Vazquez-Ibarra ◽  
Rodolfo Rafael Medina-Ramirez ◽  
Irma Jimenez-Saucedo

Public healthcare services face a growing demand and Emergency department is the main entrance to these services. Waiting times at Emergency departments are increasing at risky levels, causing that people die in wait rooms due to a lack of staff to serve timely every patient. Present chapter describes one research project conducted in a mexican public hospital which was in the process of adopting a triage systems in order to reach the goal of a maximum wait time in department. Design of experiments is the tool proposed to analyze waiting time factors and define the best levels to reduce the response variable value.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Normaizira Hamidi ◽  
Yeung R’ong Tan ◽  
Suhana Jawahir ◽  
Ee Hong Tan

Abstract Background Community pharmacies provide alternatives for medication procurement and other basic and minor health-related services in addition to mainstream hospitals and primary healthcare services. This study aimed to determine the characteristics of community pharmacy users and associated factors for community pharmacy utilisation in Malaysia. Methods Secondary data analysis was performed using data from the National Health and Morbidity Survey 2019, a nationwide cross-sectional household survey that used a two-stage stratified random sampling design. Adults aged 18 years and over were included in the analysis. Respondents who reported visiting the community pharmacy for health purposes two weeks prior to the study were considered as users. Complex sample descriptive statistics were used to describe the respondents’ characteristics. Logistic regression analyses were employed to determine factors associated with community pharmacy utilisation. Results Of the 11,155 respondents interviewed, 10.3 % reported community pharmacy utilisation for health purposes. Females (OR = 1.41, 95 % CI = 1.14, 1.73), those with tertiary education (OR = 2.03, 95 % CI = 1.26, 3.29), urban dwellers (OR = 1.42, 95 % CI = 1.13, 1.79), and those with self-reported health problems (OR = 7.62, 95 % CI = 6.05, 9.59) were more likely to utilise the community pharmacy. Conclusions Demographic and socioeconomic factors were important determinants of community pharmacy utilisation in Malaysia with sex, age, education level, locality, and self-reported health problems as the associated factors. These findings serve as evidence for policy interventions, crucial for improvements in accessibility to healthcare services.


1990 ◽  
Vol 67 (7) ◽  
pp. 960 ◽  
Author(s):  
DONNA M. DAVILLA

Author(s):  
A. K. Warps ◽  
◽  
M. P. M. de Neree tot Babberich ◽  
E. Dekker ◽  
M. W. J. M. Wouters ◽  
...  

Abstract Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.


Sensors ◽  
2021 ◽  
Vol 21 (8) ◽  
pp. 2845
Author(s):  
Fahd Alhaidari ◽  
Abdullah Almuhaideb ◽  
Shikah Alsunaidi ◽  
Nehad Ibrahim ◽  
Nida Aslam ◽  
...  

With population growth and aging, the emergence of new diseases and immunodeficiency, the demand for emergency departments (EDs) increases, making overcrowding in these departments a global problem. Due to the disease severity and transmission rate of COVID-19, it is necessary to provide an accurate and automated triage system to classify and isolate the suspected cases. Different triage methods for COVID-19 patients have been proposed as disease symptoms vary by country. Still, several problems with triage systems remain unresolved, most notably overcrowding in EDs, lengthy waiting times and difficulty adjusting static triage systems when the nature and symptoms of a disease changes. In this paper, we conduct a comprehensive review of general ED triage systems as well as COVID-19 triage systems. We identified important parameters that we recommend considering when designing an e-Triage (electronic triage) system for EDs, namely waiting time, simplicity, reliability, validity, scalability, and adaptability. Moreover, the study proposes a scoring-based e-Triage system for COVID-19 along with several recommended solutions to enhance the overall outcome of e-Triage systems during the outbreak. The recommended solutions aim to reduce overcrowding and overheads in EDs by remotely assessing patients’ conditions and identifying their severity levels.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hayat ◽  
E Kinene ◽  
S Molloy

Abstract Introduction Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised. Method To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken. Results 84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress. Conclusions A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.


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