January 2019
Welcome
Welcome to our first e-bulletin of 2019 which this month focuses on Migrant Health. International Migrants Day was held on the 18 December 2018 with the theme being Migration with Dignity. In 2018, close to 3,400 migrants and refugees lost their lives worldwide. Migration is the great issue of our era, and a force for dignity because it allows people to choose to save themselves, letting them choose participation over isolation. (United Nations, 2019) However the increase in population movement also has public health implications and migrant health needs to be taken in to consideration when planning health services. We have a busy year ahead of us and are already well ahead in our preparations for the first few events of the year. Our first seminar of 2019 entitled ‘A recipe for life’ Nutrition in Early Years takes place on 6 February 2019 at Cardiff Metropolitan University and is now fully booked. The ‘Futures Conference’ will take place at the All Nations Centre in Cardiff on the 26 March 2019 and the Annual Research in Wales Showcase Event will be held at Hadyn Ellis Building on 13 March 2019. We are always looking for information and events which we can include in the e-bulletin as well as on the website so please get in touch with us at publichealth.network@wales.nhs.uk Contact us You can contact Public Health Network Cymru in a variety of ways Email us publichealth.network@wales.nhs.uk Call us 02920 104450 Write to us Public Health Network Cymru, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ Social media twitter @PHNetworkCymru facebook Publichealthnetworkcymru
Spotlight on... Migrant Health More people are on the move now than ever before. There are an estimated 1 billion migrants in the world today of whom 258 million are international migrants and 763 million internal migrants – one in seven of the world’s population. 65 million of the world’s internal and international migrants are forcibly displaced today. This rapid increase of population movement has important public health implications, and therefore requires an adequate response from the health sector. (World Health Orgaization, 2019)
WHO launches technical guidance series on the health of refugees and migrants To mark International Migrants Day on the 18 December 2018 WHO launched a technical guidance series on the health of refugees and migrants. Produced in collaboration with the European Commission, each publication addresses a specific aspect of the health of refugees and migrants by providing tools, case studies and evidence to inform practices and policies to improve their health. Five publications are currently available: Health of refugee and migrant children When considering health and health-care interventions for migrant children, areas that need specific attention include their diverse backgrounds, whether they are unaccompanied and separated from family, whether they have been trafficked, and whether they have been left behind. This technical guidance presents policy considerations for promoting refugee and migrant children’s health and well-being, and particularly their mental health. It includes an intersectoral approach that targets risk factors at the individual, family and community levels. It emphasizes the important role of national/local governments in fostering or hindering equitable living conditions for refugee and migrant children in the areas of housing, health-care services and education. Health promotion for improved refugee and migrant health This technical guidance outlines current best practices, evidence and knowledge to inform policy and programme development in the area of health promotion for refugees and migrants in the WHO European Region. It highlights key principles, summarizes priority actions and challenges, maps available resources and tools, and provides policy considerations and practical recommendations to improve health promotion activities. Health of older refugees and migrants Population ageing caused by consistently low birth rates and increased life expectancy is a major current trend across Europe. This technical guidance aims to inform the development of policies and practices related to improving the health of older refugees and migrants. Both ageing and migration are in themselves complex, multidimensional processes shaped by a range of factors over the life-course of the individual. Responding to the needs of older refugees and migrants, therefore, must be integrated into all dimensions of policies and practices related to ageing. Improving the health care of pregnant refugee and migrant women and newborn children Being a migrant can be considered a risk factor for poorer maternal and newborn health outcomes. This technical guidance identifies problems and entry points for interventions for maternal and newborn health among refugees and migrants in the Region.
It outlines policy considerations for 4 main areas affecting refugee and migrant maternal and newborn health: • individual health status; • accessibility of health care; • quality of care; and • health-care policy and financing systems. Mental health promotion and mental health care in refugees and migrants The complexity and stress of migration are related to events before departure, during travel and transit, and after arrival. Consequently, refugees and migrants can suffer from mental disorders, although prevalence is highly variable across studies and population groups. This technical guidance reviews the prevalence of some disorders such as post-traumatic stress disorder and depressive and anxiety disorders. Based on the best available evidence regarding risk factors and areas for intervention, it identifies 8 priority action areas for consideration by policy-makers regarding the mental health of refugees and migrants.
Sanctuary In Wales It will not have escaped your attention that the world is currently experiencing the largest flows of forced migration since the Second World War – what you might know as the ‘refugee crisis’. In the Human Rights Day edition of the PHNC e-bulletin we looked at the right to asylum. In Wales, there is a long history of welcoming those seeking sanctuary. The total number of refugees in Wales is not known, but some 893 Syrian refugees have been resettled here since 2015, as well as a likely larger number of refugees granted leave to remain through the asylum process . However, we know that people seeking sanctuary face numerous challenges even when they have found the relative safety of the UK. Mental and physical health issues, financial difficulties, language barriers and perceived or actual discrimination can hinder their integration journey, delaying their ability to start rebuilding their lives. For people to truly find sanctuary in Wales, organisations and individuals in every sector need to play their part in addressing these challenges and reducing the barriers to integration. In doing so, they will be contributing to Wales’ ambition to become the world’s first Nation of Sanctuary. There is an opportunity here in Wales to be at the forefront of policy in this area. Like the Scottish Government, the Welsh Government aims to support people seeking sanctuary from their arrival, rather than depending on the Home Office’s decision on their asylum claim. Welsh Government policy is that integration begins on day one. At Public Health Wales, we are responding to this call for people and organisations to work together to support the integration, health and well-being needs of people seeking sanctuary in Wales. We are ambitious and aim to become a recognised ‘Organisation of Sanctuary’, aligned to the City of Sanctuary movement, to ensure welcome and inclusion for all, particularly those seeking safety from violence and persecution. We will provide opportunities for all of our staff to learn about the circumstances of people seeking sanctuary in the UK through training and research. Teams will be encouraged to use that learning to embed welcoming and inclusive practices in their day-to-day roles. We hope to be recognised with the Sanctuary Award, and aim to share our efforts both internally and externally to encourage other public sector and health bodies to join the movement as well. We are currently co-designing an e-learning module about asylum seekers and refugees linked to our equality and human rights mandatory training. NHS Wales staff can contribute to the co-design of this training resource by completing the short survey here: https://www.surveymonkey.co.uk/r/Z8852MJ In addition, we are running two workshops with people seeking sanctuary and health professionals, on 14th February and 14th March. To find out more or to register your interest in attending, please contact Rebecca Scott on rebecca.scott2@wales.nhs.uk.
Joint Action on Health Equity Europe Public Health Wales is proud to be working on the Joint Action on Health Equity Europe (JAHEE) initiative with the Welsh Government who are the UK Designated Authority for this Action. The overall objective of the JAHEE is: to improve the health and well-being of the EU citizens and; to achieve greater equity in health outcomes across all groups in society by a solid focus on the socio-economic determinants of health as well as on lifestyle related health inequalities throughout the life-course. Migrant health is currently an area of deep inequity, both due to the impact of migration on health, particularly in the longer term, and due to migrants often being negatively impacted by the social determinants of health. They are more likely to be in insecure employment, for example. Ill health and lack of access to health services can be an ongoing obstacle to integration and participation in society, further embedding health inequities in a vicious cycle. The World Health Organization “recognizes the urgent need for the health sector to address more effectively the impact of migration and displacement on health” . This is in the context of the Sustainable Development Agenda, of which ‘leaving no-one behind’ is a central principle . Migrant Health is naturally one of the work packages of the JAHEE programme. This work package is led by Norway and includes more than 10 countries including Greece, Italy, Sweden, Germany and Spain. The overall objective of the work package on migrant health is to bridge the policy implementation gaps of integration of migrants in the short, medium and long term, with emphasis on children and youth. Being a migrant does not necessarily make an individual person ‘vulnerable’. However, there are a large number of migrants in Wales who require additional care and support to enable them to stabilise and flourish as healthy, active members of society. Recognising the enormous diversity among migrants, some of whom have strong resilience, makes it possible to focus on the migrants who are most ‘left behind’ and most in need of supportive policies. In addition, whole communities benefit from effective policies on integration and health and well-being for excluded groups. The Wales (UK) JAHEE programme work package lead for Migrant Health is Dr Gill Richardson, Policy, Research and International Development, Public Health Wales. Catherine Weatherup from the same Directorate is work package lead for Health and Equity in All Policies – Governance.
Case study: EU-settlement scheme What is your name and where do you work? My name is Anna and I work for the International Health Team of Public Health Wales. What is your place of birth? I was born in Germany. When did you come to Wales and why? I had lived and studied in England before coming to Wales for the first time in 2015. I did an internship at Public Health Wales for a couple of months before starting my Masters programme in the Netherlands. After finishing my degree I came back to Wales at the end of 2016 and have been working and living here since. What is the EU Settlement Scheme and how did you find out about it? The EU Settlement Scheme is aimed at EU citizens to continue living and working and accessing public services in the UK after 30 June 2021. I have taken part in the Home Office pilot of the EU Settlement Scheme which has taken place from November 2018. The pilot is testing the Settlement Scheme and is aimed at EU citizens working in the health and social care sector in the UK. The Settlement Scheme will officially open in March 2019. Our Business Operations Manager as well as my line manager made me aware of the pilot. What was the process of applying for the Scheme? Applying for the Scheme involves different steps, including scanning relevant documents with the EU exit document check app followed by an additional online application at the Home Office website. Verification of identity, criminality check and residence verification are required as well as a payment of an application fee (this may vary for different users). When do you hope to hear if you have been successful? I hope to hear back from the Home Office at the end of March 2019, once the official EU settlement scheme has been launched. https://www.gov.uk/settled-status-eu-citizens-families https://www.gov.uk/government/collections/eu-settlement-scheme-pilot-applicant-information
Good practices in Migration and Health; Primary HealthCare, Malta The following article has been sent in by Marika Podda Connor who is a member of Public Health Network Cymru and lives and works in Malta. The article highlights some of the work going on in Malta in relation to migrant health. Malta is a Mediterranean European island which is known for its history, sunny weather and beautiful sea. However over the last decade it has struggled to rescue and accommodate over 20 thousand migrants who arrive by boat from sub-Saharan Africa and more recently from Syria, Libya, Bangladesh and Iraq. Very often migrants are not aware of how, when and where to seek health care services and health is not always their primary concern. The Primary HealthCare which is an entity within the Ministry of Health in Malta set up the Migrant Health Liaison Office to: 1. Address issues of appropriate accessibility to health care services 2. Training for health professionals and students of Health Sciences on topics related to migration and health such as Cultural Competence Identifying victims of trafficking in a clinical setting, Preventing, Protecting and Supporting Victims of Female Genital Mutilation and Working with Cultural Mediators. 3. Health education sessions to the migrant population are also organised both at the receptions centres and within the community. 4. Training and support for cultural mediators The Migrant Health Liaison Office has also developed a training programme for ‘Cultural Mediators in Health Care’ and to date has trained 15 groups of migrants who applied to attend. In a nutshell the role of a cultural mediator involves assisting migrant patients and health professionals in overcoming linguistic barriers and cultural mismatches. Cultural mediators working within Primary HealthCare in Malta are usually members of the migrant community who would be holders of the certificate of the training programme delivered by Primary HealthCare and who are usually well integrated within the Maltese society. Within their role they provide a positive outcome to patients who otherwise would not be able to communicate with health professionals. Similarly Health professionals working with cultural mediators learn about cultural behaviours in health and how to negotiate a care plan with a patient coming from a different background. EU projects that the Migrant Health Liaison Office (amongst which are: Marenostrum, EQUIHealth, COST Actions, CARE, MIG_H Project and TRAIN4M&H) has been involved in have offered health professionals, social workers and law enforcement offices the opportunity to attend various training seminars on Communicable Diseases, Mental Health, and Cultural Competence. Primary HealthCare has been considered an example of good practice amongst other European states and has managed to sensitize professionals working with migrants on a daily basis. Marika Podda Connor MSc Trancultural Health, BSc, Diploma Gender and Development, RN Transcultural Practice Nurse Primary Health Care, Malta Email: marika.poddaconnor@gov.mt Webpage URL: https://deputyprimeminister.gov.mt/en/phc/mhlo/Pages/mhlo.aspx
The Importance of Play in Situations of Crisis We are all too aware that there are huge number of children affected by conflict, displacement and the necessity to build new lives in new places. In emergency and crisis programmes, such as those supporting migrant children, play is often given lower priority than provision of food, shelter and medicines. The United Nations Committee on the Rights of the Child has expressed a deep concern regarding the low priority that playing is given in such situations and in support programmes. In its General Comment no. 17 on article 31 (which includes the right to play), it notes: ‘Children have a spontaneous urge to play and participate in recreational activities and will seek out opportunities to do so in the most unfavourable environments. However, certain conditions need to be assured, in accordance with children’s evolving capacities, if they are to realise their rights under article 31 to the optimum extent.’ It stressed that in these situations, playing: • • • •
‘has a significant therapeutic and rehabilitative role in helping children recover a sense of normality and joy after their experience of loss, dislocation and trauma helps refugee children and children who have experienced bereavement, violence, abuse or exploitation, to overcome emotional pain and regain control over their lives can restore a sense of identity, help them make meaning of what has happened to them, and enable them experience fun and enjoyment offers children an opportunity to engage in a shared experience, to re-build a sense of personal value and self-worth, to explore their own creativity and to achieve a sense of connectedness and belonging’.
Opportunities for playing have a significant role in helping children recover a sense of normality and joy after their experience of loss, dislocation and trauma. Having welcoming places, enough time and the company of others to play with every day, is of great consequence to all children and as adults we can foster environments that support this. Any interventions made should acknowledge play’s characteristics and allow sufficient flexibility, unpredictability and security for children to play freely. Regular, protected time and space for play supports children’s mental health and this is crucial when the world around them is in turmoil. Through play children experience a range of emotions and can learn how to manage them. Socialising with their friends on their own terms gives children opportunities to build their own resilience, to have fun and to relax. Fantasy and role-play allow for imagination and creativity, but can also be a way of children making sense of and ‘working through’ difficult and distressing aspects of their lives. Through play children participate in rituals and customs that support a feeling of belonging and being included, while older children may benefit from a feeling of nurturing younger ones. Quality play environments are more than simply physical spaces. They are social places where children negotiate space, relationships and resources and they can provide opportunities to experience a wide range of feelings. To children themselves, playing is one of the most important aspects of their lives– they value time, freedom and quality places to play. If we can find ways of ensuring that all children have periods of security and support to play even in the most difficult circumstances, the experience will be a resource they can draw upon for the rest of their lives.
Conscious that there is a general lack of understanding of the importance of play to children in such circumstances, the International Play Association (IPA) has published a toolkit – Access to Play for Children in Situations of Crisis – which has been written by Play Wales’ Marianne Mannello and Martin King-Sheard. The toolkit has been produced to support people and agencies working in crisis situations including those supporting the integration of displaced children, so that they are better able to understand and support children’s everyday play. It provides: clear and concise information to individuals and organisations, and practical, step-by-step tools and templates. A review of the toolkit notes that ‘a practical tool kit such as this is much needed in order to apply knowledge and research and realize the results of our shared goal: every child’s right to play’. The toolkit can be found via the Play Wales website: www.playwales.org.uk/eng/news/792-access-to-play-for-children-in-situations-of-crisis-toolkit-
Welcome to our new PHNC Podcast Page of the Ebulletin. Here you can listen to the the previously released Podcasts. Currently we have several podcasts in the pipeline on topics such as Health and Housing, Health Impact Assessments, Workplace Health and Cardiovascular Disease. This months Podcast is on Migrant Health and has been recorded with Rebecca Scott, Senior Project Manager for Vulnerable Groups within the International Development team in Public Health Wales. If you are interested in recording a podcast with us in the future, please contact us via email: publichealth.network@wales.nhs.uk
NEW: Public Health Network Cymru Podcast Migrant Health
Community Care for Older People who are Neurodiverse
Dementia Friendly Toilets (World Toilet Day Podcast)
Love Activity, Hate Exercise
Predictors of Dementia
Learning Disability in Hospitals
Sexual Health
Alcohol and Older People
Healthy Ageing
Gambling
Drugs and Alcohol
Trans Health
Sun Safety
Welcome Press Play, here you can get the latest PHNC videos from youtube! Every month we will add new videos as they get uploaded. We have a number of events planned over the next few months so keep your eyes peeled for the latest streams on our twitter feed or come back and visit Press Play after the event!
Old and Alone: Not an Isolated Incident
Sustainability Showcase 2018
Workplace Mental Health and Wellbeing
Sexual Health Conference 2018
Contribution of Allied Health Professionals to Public Health
Public Health Network Cymru Roadshow Video 2018
Check out the PHNC Sound and Vision Pages for more videos
The Grapevine True cost of gambling underestimated, say new publications The current focus on individual ‘problem gamblers’ fails to take into account the full health and social cost of gambling because it overlooks the wider impact on families, friends and communities, according to new work published today. The joint work by Bangor University, Public Health Wales, Heather Wardle Research and Swansea University also shows that problem gambling rates are highest in the most deprived communities of Wales. The work examines the challenges and opportunities for addressing gambling harms as a public health concern both at a UK level and within Wales. It highlights that children and young people, people with money worries and debts, people with mental health problems, people from minority ethnic groups, and people living in areas of deprivation are more vulnerable to gambling harms than others. https://www.publichealthnetwork.cymru/en/news/true-cost-of-gambling-underestimated-say-new-publications/
Talking to mothers about their adverse childhood experiences Findings from a new health visitors’ study in Anglesey. ACES Health Visiting ReportA new ground-breaking local initiative delivered in Anglesey by the Betsi Cadwaladr UHB, has seen health visitors routinely asking new mothers about the Adverse Childhood Experiences or ACEs they suffered as children. Adverse Childhood Experiences (ACEs) are traumatic events that affect children while growing up, such as suffering child maltreatment or living in a household affected by domestic violence, substance misuse or mental illness. The routine ACE enquiry aims to better prepare individuals for parenting through providing opportunities to discuss and reflect on what impacted mother’s own experiences of childhood. This is the first time such an approach has been piloted with health visitors in the UK. It represents a key first step towards understanding how to support mothers who have experienced ACEs in achieving positive health, wellbeing for themselves and better outcomes for them as parents. Whilst this is only an initial study, the findings from an independent evaluation by Public Health Wales are very promising. More than 8 in 10 mothers believed it important for health visitors to have this understanding of their ACEs and over 90% of mothers considered it acceptable to provide such information to a health visitor. For over 40% of mothers with ACEs, enquiry in health visiting was the first time in their lives they had been able to discuss these experiences with a professional. The evaluation also identified that ACE enquiry considerably improved the health visitors understanding of families, creating a greater openness and trust in their relationships with service users. The work in Anglesey builds on a larger programme of work led by Public Health Wales that aims to address early adversity in people’s lives in order to improve their health and wellbeing throughout their life course. Professor Bellis, Director of Policy and International Development at Public Health Wales said: “We are delighted to have been working with health visitors in Anglesey on this important piece of work. “All too often the harms that affect children in one generation are repeated in future generations within the same families. “Health visitors are in an ideal position to provide the types of support that can break such cycles. “Although this is just an initial study, the results already indicate that it is providing an opportunity for some woman to discuss problems in their own childhood for the first time and is seen as a useful development by both health visitors and new mothers. “We are now working with Welsh Government to develop this work in other parts of Wales to help ensure all children grow up in safe and nurturing environments that provide them with the best opportunities to reach their full potential.”
The Headlines New National Report examines how Brexit may affect health and well-being of people across Wales Eating more fibre linked to reduced risk of non-communicable diseases and death, review finds Health experts issue fresh offer of stop smoking support as lung cancer death rate increases Welsh Government pitch in with extra ÂŁ5m for sports facilities
10 year olds in the UK have consumed 18 years’ worth of sugar
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Whats on in...
February 1 Improving Health through Education and Research
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11
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Safer Internet Day
‘A Recipe for Life’ Nutrition in Early Years
Improving Disabled Children’s Services
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Motivational Interviewing
Motivational Interviewing
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The impact of health promotion and prevention in the context of HIV
Opportunities for Ultra Low Emission Transport & Local Mobility
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Children and Young People’s Mental Health
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Delivering on the Wellbeing of Future Generations Act
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Early Years Nutrition