Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Glob Health. 2021 Dec;6(12). doi: 10.1136/bmjgh-2021-006828.
Globally, the burden of non-communicable diseases (NCDs) falls disproportionately on underserved populations. Migrants and refugees are particularly vulnerable due to economic instability and systemic poverty. Despite the myriad of health risks faced by migrants and refugees, access to appropriate healthcare is hindered by structural, cultural and socioeconomic barriers. We conducted a systematic review and meta-ethnography to obtain critical insight into how the interplay of social capital and structural factors (eg, state policies and socioeconomic disadvantage) influences the prevention and treatment of NCDs in migrant and refugee populations. We included 26 studies of 14 794 identified articles, which reported qualitative findings on the structure and functions of social capital in NCD prevention and management among migrants and refugees. We synthesised findings, using the process outlined by Noblit and Hare, which indicated that migrants and refugees experienced weakened social networks in postmigration settings. They faced multiple barriers in healthcare access and difficulty navigating healthcare systems perceived as complex. Family as the core of social capital appeared of mixed value in their NCD prevention and management, interacting with cultural dissonance and economic stress. Community organisations were integral in brokering healthcare access, especially for information diffusion and logistics. Healthcare providers, especially general practitioners, were important bridges providing service-user education and ensuring a full continuum of quality care. While social capital reduced immediate barriers in healthcare access for NCD prevention and management, it was insufficient to address structural barriers. System-level interventions appear necessary to achieve equitable healthcare access in host countries. PROSPERO registration number: CCRD42020167846.
在全球范围内,非传染性疾病(NCDs)的负担不成比例地落在服务不足的人群身上。移民和难民由于经济不稳定和制度性贫困,尤其容易受到伤害。尽管移民和难民面临着无数的健康风险,但由于结构性、文化和社会经济障碍,他们获得适当医疗保健的机会受到阻碍。我们进行了系统回顾和元民族志研究,以深入了解社会资本和结构因素(例如国家政策和社会经济劣势)的相互作用如何影响移民和难民人群中 NCD 的预防和治疗。我们纳入了 26 项研究,共涉及 14794 篇已确定的文章,这些研究报告了移民和难民中 NCD 预防和管理中社会资本的结构和功能的定性发现。我们使用 Noblit 和 Hare 概述的过程综合了研究结果,这表明移民和难民在移居后环境中经历了弱化的社交网络。他们在获得医疗保健方面面临多重障碍,并且难以驾驭被认为复杂的医疗保健系统。家庭作为社会资本的核心,在他们的 NCD 预防和管理中具有混合价值,与文化不和谐和经济压力相互作用。社区组织在获得医疗保健方面发挥了不可或缺的作用,特别是在信息传播和后勤方面。医疗保健提供者,特别是全科医生,是提供服务用户教育和确保提供全面优质护理的重要桥梁。虽然社会资本减少了 NCD 预防和管理中获得医疗保健的即时障碍,但不足以解决结构性障碍。似乎需要系统层面的干预措施,以在东道国实现公平获得医疗保健的机会。PROSPERO 注册号:CCRD42020167846。