Fleischman Yonina, Willen Sarah S, Davidovitch Nadav, Mor Zohar
Public Health Services, Ministry of Health, Jerusalem, Israel.
Department of Anthropology, University of Connecticut, USA.
Soc Sci Med. 2015 Dec;147:89-97. doi: 10.1016/j.socscimed.2015.10.046. Epub 2015 Oct 21.
More than 150,000 irregular migrants reside in Israel, yet data regarding their utilization of and perceived barriers to health care services are limited. Drawing on semi-structured interviews conducted with 35 irregular migrant adults between January and September 2012, this article analyzes the role of migration as a social determinant of health for irregular migrants, and especially asylum seekers. We analyze two kinds of barriers faced by migrants when they attempt to access health care services: barriers resulting directly from their migration status, and barriers that are common among low-income communities but exacerbated by this status. Migration-related barriers included a lack of clear or consistent legislation; the threat of deportation; the inability to obtain work permits and resulting poverty and harsh living and working conditions; and discrimination. Barriers exacerbated by migrant status included prohibitive cost; poor and confusing organization of services; language barriers; perceived low quality of care; and social isolation. These findings support recent arguments that migrant status itself constitutes a social determinant of health that can intersect with other determinants to adversely affect health care access and health outcomes. Findings suggest that any meaningful effort to improve migrants' health will depend on the willingness of clinicians, public health officials, and policymakers to address the complex array of upstream political and socio-economic factors that affect migrants' health rather than focusing on narrower questions of access to health care.
超过15万非法移民居住在以色列，但关于他们对医疗服务的利用情况以及所感知到的医疗服务障碍的数据却很有限。本文基于2012年1月至9月间对35名成年非法移民进行的半结构化访谈，分析了移民作为非法移民（尤其是寻求庇护者）健康的社会决定因素所起的作用。我们分析了移民在试图获得医疗服务时面临的两种障碍：直接源于其移民身份的障碍，以及在低收入社区普遍存在但因这种身份而加剧的障碍。与移民相关的障碍包括缺乏明确或一致的立法；被驱逐的威胁；无法获得工作许可以及由此导致的贫困、恶劣的生活和工作条件；以及歧视。因移民身份而加剧的障碍包括费用过高；服务组织差且令人困惑；语言障碍；所感知到的低护理质量；以及社会孤立。这些发现支持了最近的观点，即移民身份本身构成了健康的社会决定因素，它可能与其他决定因素相互交织，对获得医疗服务和健康结果产生不利影响。研究结果表明，任何改善移民健康的有意义努力都将取决于临床医生、公共卫生官员和政策制定者是否愿意解决影响移民健康的一系列复杂的上游政治和社会经济因素，而不是只关注获得医疗服务这一较狭隘的问题。
