Migration and dermatology: an issue of planetary importance

Migration and dermatology: an issue of planetary importance Relatively little attention has been paid by the International Community to the most vulnerable population groups in the context of migration. Yet the magnitude of migration, both forced and voluntary, regular and irregular, suggests that unless attention is paid to these groups, there is a risk that in many settings, individuals and groups will remain socially excluded and unable to benefit from the health care that is due to them as human beings and is required to maintain public health and social cohesion in an increasingly mobile world. According to the World Health Organization (WHO), more people are on the move now than ever before. There are an estimated 1 billion migrants in the world today of whom 250 million are international migrants and 763 million internal migrants – one in seven of the world's population. About 65 million of the world's internal and international migrants are asylum seekers and refugees today. Recent events in North Africa and the Middle East triggered a dramatic increase in migration, in Europe, which highlights the need to engage in a cross‐national political dialogue on migration. Overall, migration has led to an increase in the Region's population by 5 million since 2005 and accounts for nearly 70% of the population growth between 2005 and 2010. Today, 73 million migrants are estimated to be living in the European Region, accounting for nearly 8% of the total population. Women represent 52% of migrants. This rapid increase in population movement has important public health implications, and therefore requires an adequate response from the health sector, especially in dermatological care, as recently reported in this journal. The right of everyone to enjoy the highest attainable standard of physical and mental health is established in the WHO Constitution of 1948.The experience of San Gallicano Dermatological Institute in Rome, founded by the Pope Benedictus XIII in the Holy Year 1725, with migrants coming from Africa to Lampedusa is very interesting. Since 1985, San Gallicano Dermatological Institute has been the only Italian public referral point not only for assistance and treatment but also for medical–epidemiological, social and anthropologic research concerning the immigrant, nomadic and homeless population. The collated experience has led to much valued documentation regarding how best skin care can be delivered. Italy has a huge influx of migrants from EU states and from developing countries. These mobile populations obtain free access to services and essential drugs by registering their name, date of birth and nationality, and receiving a number and fiscal code. They are then given medical advice and examination from several specialties, and in the case of dermatology, the necessary microbiological, mycological, histopathological, X‐ray and electron microscopy investigations are provided for free.The ability of healthcare system to deal with linguistic and cultural diversity in equitable and effective ways is no longer a marginal issue. When dealing with immigrant patients’ health, it reveals crucial to bear in mind their attitude towards illness, pain, suffering and fear of death, which is different from our own. All populations have a culturally specific perception of symptoms. It is fundamental to take into account the fact that often immigrants use somatic metaphors as a shortcut for expressing emotions and feelings, which they would not otherwise be able to communicate. Very often, they complain of cenestopathic symptoms (headaches, digestive troubles, vague and generalized pain, itching, a burning sensation when urinating, worries about their physical health), in the absence of objective evidence on examination. Illness, too, like culture, is perceived differently by the different individuals experiencing it. As reminded by the WHO, failure to deal with the whole person in their specific familial and community contexts misses out important aspects of health. Transcultural mediators’ tasks include facilitating relations between local and foreign citizens to promote reciprocal knowledge and comprehension between subjects of different cultural backgrounds. The main skills of transcultural mediators are communicative competence, empathy, active listening and good knowledge of both the hosting country and country of origin (culture, laws, traditions, etc).Paradoxically, the phenomenon of immigration can contribute to creating a new model of health and to prioritizing persons’ well‐being over profit.Conflict of interestNone declared.ReferencesFuller LC, Hay R, Morrone A et al. Guidelines on the role of skin care in the management of mobile population. Int J Dermatol 2013; 52: 200–208.WHO. Seventieth World Health assembly. Provisional agenda item 13.7, A70/24, 17 May 2017, Geneva.Ring J. Dermatology at the forefront – also with regard to actual politics. J Eur Acad Dermatol Venereol 2016; 30: 567–568.Morrone A. Lampedusa, Gateway to Europe. A Dream to Survive. Edizioni MAGI, Roma, 2009. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the European Academy of Dermatology & Venereology Wiley

Migration and dermatology: an issue of planetary importance

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Copyright © 2018 European Academy of Dermatology and Venereology
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0926-9959
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Abstract

Relatively little attention has been paid by the International Community to the most vulnerable population groups in the context of migration. Yet the magnitude of migration, both forced and voluntary, regular and irregular, suggests that unless attention is paid to these groups, there is a risk that in many settings, individuals and groups will remain socially excluded and unable to benefit from the health care that is due to them as human beings and is required to maintain public health and social cohesion in an increasingly mobile world. According to the World Health Organization (WHO), more people are on the move now than ever before. There are an estimated 1 billion migrants in the world today of whom 250 million are international migrants and 763 million internal migrants – one in seven of the world's population. About 65 million of the world's internal and international migrants are asylum seekers and refugees today. Recent events in North Africa and the Middle East triggered a dramatic increase in migration, in Europe, which highlights the need to engage in a cross‐national political dialogue on migration. Overall, migration has led to an increase in the Region's population by 5 million since 2005 and accounts for nearly 70% of the population growth between 2005 and 2010. Today, 73 million migrants are estimated to be living in the European Region, accounting for nearly 8% of the total population. Women represent 52% of migrants. This rapid increase in population movement has important public health implications, and therefore requires an adequate response from the health sector, especially in dermatological care, as recently reported in this journal. The right of everyone to enjoy the highest attainable standard of physical and mental health is established in the WHO Constitution of 1948.The experience of San Gallicano Dermatological Institute in Rome, founded by the Pope Benedictus XIII in the Holy Year 1725, with migrants coming from Africa to Lampedusa is very interesting. Since 1985, San Gallicano Dermatological Institute has been the only Italian public referral point not only for assistance and treatment but also for medical–epidemiological, social and anthropologic research concerning the immigrant, nomadic and homeless population. The collated experience has led to much valued documentation regarding how best skin care can be delivered. Italy has a huge influx of migrants from EU states and from developing countries. These mobile populations obtain free access to services and essential drugs by registering their name, date of birth and nationality, and receiving a number and fiscal code. They are then given medical advice and examination from several specialties, and in the case of dermatology, the necessary microbiological, mycological, histopathological, X‐ray and electron microscopy investigations are provided for free.The ability of healthcare system to deal with linguistic and cultural diversity in equitable and effective ways is no longer a marginal issue. When dealing with immigrant patients’ health, it reveals crucial to bear in mind their attitude towards illness, pain, suffering and fear of death, which is different from our own. All populations have a culturally specific perception of symptoms. It is fundamental to take into account the fact that often immigrants use somatic metaphors as a shortcut for expressing emotions and feelings, which they would not otherwise be able to communicate. Very often, they complain of cenestopathic symptoms (headaches, digestive troubles, vague and generalized pain, itching, a burning sensation when urinating, worries about their physical health), in the absence of objective evidence on examination. Illness, too, like culture, is perceived differently by the different individuals experiencing it. As reminded by the WHO, failure to deal with the whole person in their specific familial and community contexts misses out important aspects of health. Transcultural mediators’ tasks include facilitating relations between local and foreign citizens to promote reciprocal knowledge and comprehension between subjects of different cultural backgrounds. The main skills of transcultural mediators are communicative competence, empathy, active listening and good knowledge of both the hosting country and country of origin (culture, laws, traditions, etc).Paradoxically, the phenomenon of immigration can contribute to creating a new model of health and to prioritizing persons’ well‐being over profit.Conflict of interestNone declared.ReferencesFuller LC, Hay R, Morrone A et al. Guidelines on the role of skin care in the management of mobile population. Int J Dermatol 2013; 52: 200–208.WHO. Seventieth World Health assembly. Provisional agenda item 13.7, A70/24, 17 May 2017, Geneva.Ring J. Dermatology at the forefront – also with regard to actual politics. J Eur Acad Dermatol Venereol 2016; 30: 567–568.Morrone A. Lampedusa, Gateway to Europe. A Dream to Survive. Edizioni MAGI, Roma, 2009.

Journal

Journal of the European Academy of Dermatology & VenereologyWiley

Published: Jan 1, 2018

References

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